Total Hip Replacement

Question 1

Describe orthopaedic conditions

Answer 1

Orthopaedic conditions involve injury and disease to bones, joints and related structures

Question 2

What is the incidence and prevalence of orthopaedic conditions such as hip fractures?

Answer 2

• Older adult women sustain 80% of hip fractures
• Hip fractures contribute to long term functional impairment and increased nursing home admissions
• Primary cause of disability and mortality on older adults
• OT interventions increased a patients ability to perform ADLs

Question 3

What are the precautions for a total hip replacement?

Answer 3

Precautions can relate to weight bearing and also to ROM of the hip joint

• Reduce the amount of stress/pressure placed on the structures in the hip joint to allow healing and fusion.
  1. Avoid hip rotation (internal/external)
  2. Avoid hip flexion past 90 degrees – avoid bending or making the angle between the femur and the body less than 90 degree
  3. Avoid hip adduction, especially past the midline. (Do not cross your legs or ankles at any time – sitting, lying or standing)

Question 4

What is the diagnosis for a total hip replacement?

Answer 4

• Physician performs clinical evaluation to obtain information on signs and symptoms
• Refers patient to radiology to confirm and determine degree and classification of fracture
• Confirmed through x-ray or other studies

Question 5

What is the medical and surgical management for hip fractures?

Answer 5

• Internal fixation- securing the # site with pins, rods, plates and screws
• Replacement of part of the femur (hemiarthroplasty)
• Total hip replacement.

Question 6

What equipment can be used to assist the client with recovering from a total hip replacement?

Answer 6

• Shower chair/shower stool
• Toilet seat raiser
• Long handled reacher/pick up stick
• Long handled shoe horn
• Sock aid
• Bed blocks
• Bed stick/rail

Question 7

What are signs and symptoms for hip fractures?

Answer 7

• Experience severe pain in their hip or groin region, accompanied by bruising, swelling or stiffness around the area
• Presented with limited mobility immediately after the fall and find themselves unable to weight bear on their on the side of the injured hip
• Disparity between the length of the injured leg and the other

Question 8

How does a THR impact on OP?

Answer 8

ADL’s

• Washing and dressing lowering body will be difficult due to hip precautions. (Need for long-handled devices such as a pick up stick to assist with these tasks.)
• Toileting: unable to sit down on the toilet as it will be too low for hip precautions. Will need toilet seat raiser. Difficulty with wiping bottom without rotating hip. Will need to practise alternative technique or use bottom wiper device.
• Driving: unable to drive for at least 6 weeks after the operation due to hip precautions.
• Cooking: unable to reach down into low cupboards, or get items from the crisper in the fridge due to hip precautions.
• Cleaning: difficulty with all cleaning tasks that require bending, such as cleaning the toilet.

Question 9

What is the role of the OT in managing a THR?

Answer 9

• Examine specific client factors present within the person to understand their impact on occupational performance
• Client factors are an important consideration when working with a client who has had a THR to help them engage in daily occupations, such as dressing, working, managing the home and leisure pursuits
• The aim of the OT in orthopaedic rehabilitation is to help the client achieve maximum functioning of their body and limbs, to restore occupational performance
• OTs role is the relive pain, decrease swelling and inflammation, assist with managing wounds, maintaining joint or limb alignment and restore function in the hip region