Total hip replacement/Arthroplasty Flashcards
What are the indication for a THA?
- severe joint deformity causing sever pain
- loss of motion
- loss of function
- joint deformity
- failure of previous hip surgeries
What is a psoterolateral surgical approach?
- most common
- provides good exposure, leaves abductor muscle intact
- results in joint instability and higher incidence of dislocation in early post operative phase
- capsule is incised
- hip joint is dislocated
- head of femur is removed and replaced with intramedullary femora stem prostehsis
- acetabulum replaced with high density plyethylene cup
- bony ingrowth fixation or cement fixation
What is an anterolateral surgical approach?
- becoming more popular
- similar process followed including replacement of both joint surfaces and dislocation of hip
Don’t forget total hip precautions!
posterior: no hip flexion >90 (60 preferred), no hip IR beyond neutral, no hip adduction beyond neutral
Anterior: no hip extension beyond 0, no hip ER beyond neutral, no hip abduction beyond neutral
What equippment could be used following a THA?
- reachers
- long handled shoe horn
- sock aide
- raised toilet seat
Describe the Maximum protection phase of a THA
- Supine exercises (PROM, AAROM, AROM): AP, Heel slides, Isometric (submaximal)- quads, hams, glutes, Hib abduction, bridging, ER in hip flexion, SAQ, SLR
- Think about arm exercises
- Avoid pillow under knee
- Patient education
- Functional mobility
- More aggressive protocol than other max protection phase
Describe the moderate proctection phase of a THA
- need moderate proctection for 6 weeks post op–> allows soft tissue healing, bone healing, adequate bioingrowth for fixation of prosthesis
- Factors affecting exercise progression:
- type of fixation
- if trochanteric osteotomy performed (rare)
- if hip abductors were reflected and resutred (partially/totally), active abduction against gravity restricted at least 6 weeks
Describe the minimum protection phase of a THA
- usually outpatient ortho
- hip precautions often still in place
- often focus on gait
- hip abduction strengthening as appropriate
- don’t forget the two specific precautions for this phase
When do they do a hemireplacement?
- for subcapital fractures of the femur
- degeneration of head of femur but relatively normal acetabulum
- not as common, often will do a total hip
Describe a hemireplacement
- lateral or posterolateral incision
- femoral head removed and replaced with prosthesis
- exercise progression is the same as THA
What are the precautions for a hemireplacement
- sames as THA
- ALSO avoid glut setting and SLR rais due to increased compressive forces of the unreplaced acetabulum (ilio has to genearte large forc to begin moving limb)
What are the type hip fractures
- subcaptial femoral neck fractures- intracapsular
- intertrochanteric
- subtrochanteric
Describe subcapital femoral neck fractures
- elderly often have weakened bone in this area, predisposing them to fractures here
- risk of disruption of blood supply to femoral head
- fixation: hemireplacement if vascular supply disturbed
a) austin moore allows immediate WB (not used very often anymore)
b) bipolar prostesis limits movement of femoral head component in acetabulum
What is the treatment for a subcaptial femoral neck fracture?
- must follow hip precautions
- Anterior or posterior depending on the surgery
Describe intertrochanteric fractures
- fracture located between greater and lesser trochanter
- does not require access to joint capsule to complete ORIF
- fixation is compression screw or gamma nail
- does not require hip precautions
