Week 2: Hip Flashcards
Osteoarthritis:
- A disease that affects…..
- …… ……. condition
- The whole joint
- Metabolic inflammatory condition
Risk factors for OA
- Age (40+)
- Female
- Overweight
- Prior joint injury eg ACL
- Hard physical work
- Overuse
- Family history of OA
CAM morphology is associated with a …. ….. increase in the risk of hip OA
10-fold increase
Symptoms of hip OA
Activity limitations of hip OA
Symptoms:
- Pain in weight-bearing
- Stiffness
- Often outer part of the hip or deep inside the groin
Activity limitation
- Shoes and socks
- Standing or walking
- Bending, squatting, vacuuming
- Standing up from a chair
- Getting in or out of a car
What is the general diagnostic criteria of the NICE guidelines for hip OA
Must have atleast two symptoms and one clinical risk factor eg functional limitation & stiffness (symptoms), crepitus/restricted movement/bony enlargement and female (or over 40 etc)
Article: Moderators of the effect of therapeutic exercise for knee and hip OA: A systematic review and individual participants data meta-analysis
- Decreases pain
- Improves physical function
Note: the effect is small (further diminishing effects are seen after 12 weeks)
When pursuing conservative management of OA what is important to note?
It will depend on the characteristics of the patient
eg knee OA only vs multi-joint, comorbidities, etc
Why are NSAIDS not recommended for people who have OA and co-morbidities. Explain the relationship with COX1/2 ….
Your non-selective NSAIDs eg Voltaren/neurofen they are not recommended for knee OA with comorbidities because of the likelihood of causing gastrointestinal bleeding, increase CV risk and also hypertension.
NSAIDS act on two enzymes COX 1 (lining of stomach) and COX 2 (all over body). If a patient has co-morbidities then COX2 should be prescribed because it targets all over the body. Most are not selective; they act on both COX1 and COX2 thereby increasing risk of stomach bleeding
Core treatments appropriate for all OA patients?
Land based exercise
Weight management
Strength training
Water based exercise
Self-management and education
Indicates for THR
Pain
- OA
- Rheumatoid athritis
- Post-traumatic arthritis
- Avascular necrosis
- Developmental abnormalities of the hip
Limited success with conservative management
Trauma (eg fall)
Types of hip replacement?
- THR
- Hemiarthroplasty (just replace the femoral head)
- Short stem
- Long stem
- Joint resurfacing
**Long stem is most common - . Acetabulum, head and neck of femur removed & prosthesis inserted to replace. The only difference with short stem is it doesn’t go as far down the femur (patients sometimes it increases perception that their hip is normal hip and less femur pain with short-stem). Joint resurfacing used for younger patients – acetabulum is in condition, mainly correcting the head of the femur.
What are the different approaches for a THR? And types of fixation?
Anterior ie through TFL
Posterior through glute max
Lateral
Fixation: cemented or uncemented
What are the precautions following THR? How long should these be followed for?
3 main:
- No twisting/rotation of the legs
- No hip flexion past 90 degrees
- No crossing legs
Additional
- No hip flexion past 110
- No hip extension past neutral
- Partial weight-bearing
- No hip abduction
No overall consensus but generally 6 weeks
By Day 2-3 post THR surgery the gait should be progressed to what? How far should they be walking?
Gait aid progressed from FASF to 2WF to crutches
Walk atleast 12m
By day 3-5 post THR surgery the patient should be able to walk how far?
30-50 metres
Also able to go up and down stairs, safely transfer in and out of car
