wk9 Lower limb Flashcards
any evidence for post op management of THA/TKA?
Study done by Chen, suggested that early mobilisation on day 0 post op is better than the day 1 post op.
Limitations of Chen’s study?
- Mixed group - i.e. THA and TKA
- No specific intervention was described
- Total number of group received intervention (Day0) was significantly less than the control group (Day1)
4 major components of implant/ prosthesis
- Cup
- Cup liner
- Stem
- Ball
pros of rehabilitation for THA
- improving mobility
- reducing pain
- reducing limp
cons of rehab for THA
- wear and tear (longevity)
2. surgical risk (e.g. dislocation, break-down wounds)
types of materials used for THA implant
- Metal on Plastic
- Metal on Ceramic
- Metal on Metal
- Ceramic on Ceramic
precaution for selecting Metal on metal implant?
check metal sensitivity - it might increase metal concentration in the blood
Advantage and disadvantage of metal on metal
adv-long lasting
disadv- incr risk of metal concentration
Advantage and disadvantage of ceramic on ceramic
adv - lighter than metal, no risk of increased metal concentration
Disadvan- can be broken off following a trauma
is risk or complication following THA high?
No, very low approx 5%, even if occur, can be managed well
what are possible complications for THA
Infection
Dislocation
Blood clot or DVT
incidence rate of blood clot or DVT
30%
when is Dislocation risk highest?
in the first 6 weeks - maybe due to muscles around hip joint is not stable enough to hold
Management of DVT or blood clot
- Early mobilisation
- Elastic stocking
- Aspirin for 6 wks
Why have a hip joint replacement?
pain with activity pain at rest loss of movement loss of strength Limp OA/RA/Fracture (displaced intra-capsular fracture NOF)
Brief description of THA surgery
- dislocation of head of femur from acetabulum
- remove the head of femur
- replace acetabulum with cup and cup liner
- insert stem and ball into femur
- relocate it in place
Incision site (surgical approach) for THA
over Greater Trochanter
Anterior approach
Posterior approach
movements increasing risk of dislocation for each of Anterior and Posterior approach
Anterior = Extension, Adduction, External Rotation Posterior = Flexion, Adduction, Internal rotation
Role of Physio post op management
- Education - precaution with activity, teach how to get in/out of car
- mobilisation
- Exercise programme - strengthen GLUT and QUAD
Hours of surgery
1-2 hours
Average blood loss
400 - 600 mls
incidence of blood tranfusion
25%
what is anaemia
Decrease in number of RBC
post-op anaemia last approx – weeks
4-6 wks
Total length of hospital stay
3-7 days
Discharging requirements for THA
- able to transfer independently
- able to walk with crutches
- able to do steps
- medically stable - wound healing and normal temperature
pros of Minimally invasive technique
less exposure
cons of Minimally invasive technique
- longer procedure
2. more chance of mal-positioning
surgeon’s age preference for THA
> 50 year old because it last around 10 year in term of wear and tear.
Earlier than 50 yr can shortens the life of implant.
Later than late 50 yr can cause Pain Centralisation and REDUCED ROM
Acceptable results
leg length differnce less than 1.5cm
normal gait pattern without a limp
What is Birmingham hip joint Resurfacing?
resurfacing femoral head without removing femoral head
Age requirement and criteria for Birmingham hip joint Resurfacing
under 60 years
must have good femoral bone stock and blood supply
Patients selection - consideration for THA
quality of bone stock renal insufficiency leg length discrepancy <1cm obesity infection
Aetiology of fractured neck of femur (NOF)
External force - twisting while foot fixed, knocked over
Internal force - collapse of bone due to osteoporosis, ischemia or cancer
which population is at most risk of fractured NOF
Elderly women especially after menopause. as estrogen decreases, bone cell loss –> increase osteoporosis
classifications of fracture NOF
- Intra-capsular and Extra capsular
Intra-capsular
Sub-capital (beneath Head)
mid-cervical ( between head and surgical neck)
Extra-capsular
per-trochanteric (above)
inter-trochanteric (btw)
sub-trochanteric (below)
Surgical management of Undisplaced Intracapsular Fracture
screws - better fixation than pins
Surgical management of Dispaced intracapsular fracture
Arthroplasty has lower re-operation rate than internal fixation - Unipolar Hemi-arthroplasty
surgical managment of extracapsular fracture
sliding hip screw (dynamic hip screw) is better than fixed nail and plate
what is Hemi-arthroplasty
only replace head of femur with stem and ball implant/prosthesis but not acetabulum
evidence of PT management for hip fracture (fractured NOF)
Limited literature on acute care
interventions are NOT detailed
But focus is on EARLY mobility in acute care to restore independent return to ADLs
what is ORIF?
Open Reduction Internal Fixation
A method of surgically repairing a fractured bone - using plate, screws or intramedullary nail
what are some common post op problems for hip fractures?
pain
difficulty with IR/ER
HIgh rate of dislocation (Emergency THJR as opposed to elective THJR)
who is at the most risk of fracture of SHAFT of femur
Young MALE patient- involving high impact injury such as Road Traffic Accident (RTA)
Post operative Weight Bearing Status for Fracture of SHAFT of femur is dependent on 3 Factors. What are they?
- Type of fracture (oblique, transverse, spiral,comminuted)
- Quality of bone stock (healthy bone)
- Quality of surgical repair
what is Knee arthroscopy is used for?
- Examine
- Diagnose
- Treat - Meniscal tears, Cartilage, Ligament (ACL)
