Hip Flashcards
(37 cards)
1
Q
Hip bones
A
Femur
- head
- neck
- trochanters (x2)
Pelvis
- acteabulum
- ischium
- pubis
- illium
2
Q
Hip ligaments (x3)
A
- ischiofemoral
- iliofemoral
- pubofemoral
3
Q
Anterior-Medial Hip Muscles (x5)
A
- Iliopsoas
- rectus femoris
- adductors
- tensors fascial latae
- sartorius
4
Q
Posterior-Lateral Hip Muscles (x2)
A
gluteal muscles
hamstrings
5
Q
Main causes for Hip fractures
A
90% due to falls
70yrs and up = falls
50yrs and under = serious accidents
- fall from height
- car accidents
6
Q
Risk Factors Hip fractures (x6)
A
- body size characteristics
- inactivity
- weakness
- impaired cognition
- chronic illnesses = osteoporosis
- gender = female
7
Q
Consequences from hip fractures (x2)
A
- 20-37% mortality w/in first yr
- 50% longstanding disability
- mortality higher for the elderly
- pneumonia, due to increased immobility
8
Q
Acute management (x2)
A
- analgesic to control pain
- surgery
9
Q
Types of fractures (x2)
A
- Intracapsular
- Extracapsular (intertrochanteric or subtrochanteric)
10
Q
Intracapasular fracture
A
- Subcapital (below femoral head) fracture
- blood supply to femoral head may be disrupted
- lead to avascular necrosis
11
Q
Extracapsular fracture
A
- intertrochanteric or subtrochanteric
- may be subject to pull of hip muscles on bony attachment. Can pull fracture out of alignment = risks of malunion
12
Q
Surgical management (x3)
A
- ORIF = Open reduction and internal fixation
- hemiarthoplasty
- hip arthoplasty
13
Q
Femoral head fractures (x2)
A
Nondisplaced = multiple parallel pins or screws Displaced = hemiarthoplasty or arthroplasty
14
Q
Intertrochanteric fracture
A
- dynamic hip screw and lateral side plate
OR - interlocking nail fixation
15
Q
Subtrochanteric fracture
A
Interlocing nail fixation
16
Q
Post-Op Complications (x5)
A
- infection
- DVT
- chronic pain
- avascular necrosis (more w/ femoral neck #)
- non-union (more w/ femoral neck # or w/ unstable #)
17
Q
Post-Op management
A
# healing = 12-15 wk Rehab time = 15-20 wk aim for early post-op WB
18
Q
Post-Op surgeon considerations (x5)
A
- age
- bone quality
- # location and pattern
- Type of implant used for fixation
- degree of stability achieved w/ surgery
19
Q
WB considerations
A
Ranges: NWB, TTWB/FeWB, WBAT
- undisplaced # w/ screws
- stable intertrochanteric # w/ dynamic hip screw
- subtrochanteric # w/ intramedullary nail
20
Q
Activities that creat forces or WB on hip (x5)
A
- rolling
- sitting up
- PROM
- active exercises
- bridging
21
Q
Goal of early exercise is to prevent complications such as … (x4)
A
- DVT
- pulmonary complications
- pressure sores
- de-conditioning
22
Q
Maximum protection phrase exercise
A
- up to 6 wks
- begin exercises on the first day post-op
- ROM: 2-4wk 80-90 degress of active hip F w/ the knee F
- improve strength UE+LE
- AAROM, PROM hip and knee
- Resistance exercise - delayed until 6wk to allow soft tissue to heal
23
Q
Moderate - Minimum Protection phrase exercise
A
- after 6wks
- soft tissue has healed
- bone healing is apparent
- ambulation 2ww
- PWB -> FWB
- exercise @ home: flexibility of shortened muscles, improve strength and endurance in LE for functional activities, improve standing balance and posture, improve cardiorespiratory endurance, maximize ADL independence
24
Q
Reasons for hip arthroplasty (x5)
A
- severe hip pain that limits functional activity
- severe decreased ROM
- instability or deformity of hip
- failure of previous surgery
- failure of conservative management
25
Causes of hip pain (x4)
- osteoarthritis
- rheumatoid arthritis
- hip #
- avascular necrosis
26
Who is appropriate of Hip arthropasty?
- over 60yr (THR lasts 20yrs)
- no systemic infections
- no joint infections
- no significant bone loss
- no severe limitations of muscles around joint
27
Pre-op management. what the team will be teaching/assessing prior to surgery (x7)
- level of pain
- ROM
- muscle strength
- postoperative precautions
- functional training
- assistive devices
- early postoperative exercises
28
Components (x2)
- femoral
| - Acetabular
29
Types of fixations (x3)
- cemented
- cementless (allows osseous ingrowth
- hybrid (usually acetabular component)
30
Cemented fixation (pros&cons, beneficial cl)
Pros
- allows from early WB
- shortened rehab time
- least expensive
Cons
- loosening of prosthetic over time, usually actetabular
- recurrence of hip pain
Beneficial to Cl
- elderly
- poor bone stock
- osteoprosis
31
Uncemented fixation (pros&cons, beneficial cl)
Pros
- less loosening of prosthetic overtime
- allows from more physical activity
Cons
- longer time of NWB/PWB
- increased rehab time 3-6 months
- most expensive
Beneficial Cl
- young
- healthy
- active
- good bone quality
32
Hybrid Fixations reasoning
- used for acetabular loosening
- initial surgeries long-term results seem to indicate similar to cemented
- costs more that cemented, but less that uncemented
33
Surgical Approach
Posterolateral
- gluteus maximus split
- glut med and vastuc lateralis spared
- capsule cut on posterior surface
- hip is dislocated posteriorly
34
Post-Op Considerations (WB & ROM)
WB = depends on type of surgery and surgeon
- cemented: WBAT immediately
- uncemented: NWB or PWB for @ least 6 wks
ROM = depends on surgical approach
- ROM restrictions ~6wks
- decrease risk of dislocation
- no hip F past 90
- no ADduction post neutral
- no internal rotation
35
ADL Activities
- t/f to sound leg
- avoid low chairs/bed
- use a raised toilet seat
- avoid bending to pick up objects
- no bath
- lead w/ good leg upstairs, bad down
- avoid twisting when standing
36
MAX protection phase Post-op
4-6 wks
prevent : vascular and pulmonary complications, prevent post-op dislocation or subluxation, F contracture of the operated hip
achieve: indpt. functional mobility prior to discharge - bed mobility, t/f, ADL's, ambulation w/ a.d.
maintain - functional strength and endurance in UE and unoperated LE
exercise - AAROM operated LE w/in protected range
37
Mod-Minimum protection phase Post-op
6-12wk
regain: strength and endurance of operated leg, functional ROM of operated hip, correct gait
improve: cardiorespirtory endurance, balance
maximize ADL independnce
progress WB during ambulation
