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Orthopaedic Physiotherapy > Hip Surgery & Rehab > Flashcards

Hip Surgery & Rehab Flashcards

1
Q

What is arthroscopy?

A

Any surgery performed through portals and using an endoscope

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2
Q

What is considered prior to hip arthroscopy?

A
  • History (symptoms, impairments)
  • Examination of the hip (complete examination, medical imaging)
  • Interpretation/diagnosis
  • Intervention plan
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3
Q

What are ultrasounds, MRIs and CT scans used for in the hip?

A
  • Ultrasound: Tendinopathies
  • MRI: Labrum tears esp. in acetabulum, soft tissue lesions
    CT: 3D image of bone
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4
Q

What conditions are associated with hip arthroscopy?

A
  • Femoral acetabular labrum (FAI): neck of femur impinging on acetabular labrum
  • Labral tears
  • Debride hyaline cartilage lesions
  • Extra-articular pathology: Glut med tears, chronic IT band snapping syndrome, snapping psoas syndrome
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5
Q

What are the different types of femoral acetabular impingement (FAI):

A
  • Controlled action motion (CAM) impingement: Bump on femoral head/neck
  • Pincer impingement: Overgrowth on acetabular side
  • Mixture of both
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6
Q

What types of patients will commonly need debriding of hyaline cartilage lesions?

A

Patients with OA

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7
Q

What types of patients commonly get pincer FAI?

A

Young people, approx 20-35 years (not associated with OA)

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8
Q

What is the common clinical presentation of FAI?

A
  • Groin pain
  • Pain on high flexion activities, e.g. crouching
  • Weight-bearing activities e.g. running, jumping
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9
Q

What is FABER?

A

Flexion, abduction, external rotation

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10
Q

What does the FABER position help diagnose?

A
  • Labral tear
  • OA
  • Greater trochanteric pain syndrome
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11
Q

What is FADIR?

A

Flexion, adduction, internal rotation

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12
Q

What does the FADIR position help diagnose?

A

Labral tear, FAI

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13
Q

What is a negative consequence of debriding an acetabular labral tear of the hip?

A

Accelerates OA

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14
Q

How do surgeons increase visibility in a hip arthroscopy?

A

Inflate the joint with water

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15
Q

How is an osteoplasty used for FAI?

A
  • Femur: to reshape femoral head/neck treat CAM
  • Acetabulum: Reshape the acetabular rim to improve pincer impingement
  • Results in improved ROM & function
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16
Q

What is micro fracture or abrasion chondroplasty?

A
  • Debride bad hyaline cartilage
  • Drill small holes in bone
  • Causes inflammatory response, bringing fibroblasts to area
  • Fibrocartilage is laid down in the area
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17
Q

What are the 2 positions a hip arthroscopy can be performed in?

A
  • Supine: Easier operating room setup, but more difficult on obese patient
  • Lateral: More complex room setup, requires special table attachment to position the leg, provides excellent access
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18
Q

What is the surgical procedure of a hip arthroscopy?

A
  • Portals penetrate TFL, glut med or sartorius & rec fem
  • Anterolateral portal established, then anterior portal
  • Avoid injury to femoral cutaneous nerve
  • Central compartment: Loose bodies, cartilage injuries etc
  • Peripheral compartment: Labrum, acetabular rim, femoral neck
19
Q

What are the common restrictions for hip arthroscopy rehab?

A
  • AROM/PROM
  • Weight-bearing status
  • Cannot flex hip past 90 degrees
20
Q

What are some of the issues that complicate decisions about hip arthroscopies?

A
  • OA
  • Tendinopathies
  • Bursitis
  • Core strength
21
Q

What needs to be considered during hip arthroscopy rehab?

A
  • Pain control is important for mobilisation
  • Maintaining WB status is important for protecting healing structures
  • Sudden stiffness/mechanical signs: Check complications, may be re-injury, rapid onset OA, avascular necrosis etc
22
Q

What is involved in the initial postoperative exam for hip arthroscopies?

A
  • Bulky dressing & abduction pillow
  • May be in outpatient surgery centre or hospital
  • Overnight stay may be considered
  • Post op care based on surgery specifics
  • Patients can use passive motion machine, crutches or walker
23
Q

What are the 5 main things that need to be covered in a post-op exam?

A
  • Chest/respiratory exam
  • DVT: Check pain, swelling, redness in calves
  • Mobility
  • Other joints
  • Surgical site/limb
24
Q

What is the purpose of a hip open reduction internal fixation (ORIF)?

A

To stabilise a fracture by realigning the fragments under GA & open incision, then fixation with hardware

25
Q

What is a common complication with neck of femur fractures?

A

Avascular necrosis of head of femur (blood supply cut off by fracture)

26
Q

What does a dynamic hip screw (DHS) allow?

A

Compression in the joint

27
Q

What are cannulated screws used for?

A

Holding a head of femur back on

28
Q

What are the 3 types of hip fractures requiring ORIF?

A
  • Head or neck of femur (displaced/undisplaced)
  • Intertrochanteric (stable/unstable)
  • Subtrochanteric
29
Q

What is a complication of hip ORIF rehab?

A

Lots of co-morbidities due to population (older people, 80 years)

30
Q

What are the features of an ORIF for displaced/minimally displaced/compression femoral neck fractures?

A
  • Least severe of hip fractures
  • Stable, FWB immediately post surgery
  • No ROM limitations
31
Q

What is involved in an ORIF for displaced/minimally displaced/compression femoral neck fractures?

A
  • Incision down lateral side of hip (TFL, VL)
  • Cannulated screws
  • No major nerves/vessels at risk
32
Q

What is the treatment for displaced femoral neck fractures?

A
  • Femoral head separated widely from neck
  • Vascular supply to femoral head often severed (avascular necrosis)
  • Do not heal if reduced/fixed by screws
  • Fixation attempted in young patients
  • Older patients treated with THR
33
Q

What are the features of intertrochanteric hip fractures?

A
  • Usually most challenging
  • Gluteus max pulls fracture apart
  • Weight bearing often not possible immediately post op
34
Q

How are stable intertrochanteric hip fractures treated?

A
  • Stable = intact posteromedial cortex, fracture at base of femoral neck
  • Compression hip screw (pin & plate)
  • PWB post op
35
Q

How are unstable intertrochanteric hip fractures treated?

A
  • Dynamic hip screw through neck
  • Cross pins at bottom to prevent rotation (static lock)
  • Intermedullary pin through shaft
36
Q

What is the approach for placing DHS in intertrochanteric hip fractures?

A
  • Long lateral approach (through TFL, VL)

- Same for stable & unstable

37
Q

What is one difference in the ORIF for stable & unstable intertrochanteric hip fractures?

A

Unstable: Lesser trochanter often left floating, can lead to weakness (hip flexors)

38
Q

What are the healing rates for hip ORIF?

A
  • Skin: 2 weeks
  • Deep fascia/soft tissues: 6 weeks
  • Bone: 12 weeks
    (Older adults with OP, can be 4-6 months)
39
Q

What are the weight-bearing guidelines for patients with unstable hip fractures?

A

Weight-bearing should be delayed until good bony healing is demonstrated (some PWB allowed)

40
Q

What occurs in a subtrochanteric hip fracture?

A

Proximal fragment FABER, femoral shaft shortened/adducted

41
Q

What occurs in an ORIF for subtrochanteric hip fractures?

A
  • Intra-medullary nail & compression screw
  • Needs to oppose angular & muscular deforming forces
  • Poor blood supply
  • Lateral approach
42
Q

What are the weight bearing guidelines for subtrochanteric hip fractures post op?

A

PWB

43
Q

What are the post op day 1 considerations for hip ORIF?

A
  • Initial goal is getting out of bed, walking to bathroom using front-wheel walker (FWW)
  • Usually emergency surgery, so often confused/emotion, no pre op education
  • No ROM precautions
  • May be groggy/in pain

Orthopaedic Physiotherapy (11 decks)

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