Flashcards in 03 Hip 4 Deck (31):
What would be cause for getting a THA?
advanced OA with loss of cartilage space
What should be done before getting a THA?
prehabilitation with PT before joint replacement surgery
Why is PT important before getting a THA?
- diminishes the need for postop care by nearly 30%
- saves an average of $1215 per patient in post-op care
What is done during hip resurfacing? What is the outcome, generally?
- put a cap over the femoral head
- usually just buys time, doesn't last long
What are the surgical approaches for a THA?
What is the traditional approach for THA?
Lateral approach for THA
not as common as the others
Anterior approach for THA
- goes in front of the greater trochanter
minimally invasive surgery
What is the benefit to a MIS?
- much smaller incisions
- retract the tissue instead of cutting through
Size of incisions for posterior vs. anterior approach of a THA
- posterior: 10" incision
- anterior: around 3" incision
If you only get one side of the hip replaced (either the femoral head or the acetabulum), what is it called?
The acetabular component of a THA is usually made of
What is put inside the acetabular component of the THA?
plastic liner, usually made of polypropylene
What is the femoral head component usually made of?
What is the new innovation with respect to femoral heads in THA?
- removable femoral heads
- can change out to find the right fit during surgery
Components of a THA
- acetabular component
- plastic liner
- femoral head
Two types of prosthesis fits for THA
- uncemented (press fit)
How do they fit a cemented prosthesis THA?
- drill into the medullary canal
- put cement into the canal
- push prosthesis into the bone
- cement solidifies
What is the cement that is used?
Why does the press fit prosthesis have a bumpy appearance?
bone grows into the prosthesis
After a THA, what positions should be avoided
- don't bend hip above 90˚
- don't cross legs in sitting
- don't bend forward to pick up objects
- don't rotated leg when standing (keep straight)
What is a potential problem you need to avoid with rehab?
could force the femoral head posteriorly and dislocate the hip
Rehab guidelines for a THA with posterior approach
- no flexion past 90˚
- no horizontal adduction past 0˚
- no IR past 0˚
Rehab guidelines for a THA with anterior approach
- no extension past 90˚
- no abduction past 0˚
- no ER past 0˚
For anterior THA rehab, why do you need to make sure you don't go into extension past 90˚?
puts more stretch on anterior structures
Benefits of an anterior approach vs. posterior
- no instances of hip dislocations
- lower risk of PE/DVT
- lower rates of transfusions
- shorter hospital stay
- increased D/C to home
3 major failure mechanisms of THA
- cup loosening
- wearing out of the joint material
- stem loosening
problem with using metal on metal
increased risk of metal poisoning
most common hip implant option now
metal and plastic