Hip Arthroplasty

Question 1

indications for an arthroplasty

Answer 1

hip OA, RA, some fx, osteonecrosis, tumors

Question 2

what is the difference between a cemented and non-cemented arthroplasty

Answer 2

cemented is porous and can be loose in the clinic, more of a mirror image of bone

Question 3

what is a primary THA

Answer 3

replacement of femoral stem and acetabulum

- acetabular cup, head & neck of femur

Question 4

hemiarthroplasty

Answer 4

• replacement of femoral stem

- typically used when ORIF is not possible or likely to be successful

Question 5

components of hemiarthroplasty

Answer 5

• head & neck of femur

- bipolar vs unipolar

Question 6

hip resurfacing arthroplasty

Answer 6

• RA, osteoarthropy
• replacement of acetabulum and articular surface of femoral head
• typically used for young, active patients

Question 7

components of hip resurfacing arthroplasty

Answer 7

acetabular cap or femoral cap

Question 8

revision arthroplasty

Answer 8

• replacement of pre-existing components

- indicated with complications of initial procedure (recurrent dislocations, infxn, fixation loss, etc.)

Question 9

who is more likely to get a revision arthroplasty

Answer 9

males 3x more

Question 10

hip precautions for revision

Answer 10

typically global precautions - anterior and posterior

Question 11

surgical approach for posterior hip replacement

Answer 11

• incision posterior to greater trochanter

- TFL incised, glute max split, short ER detached

Question 12

what is the advantage of posterior hip approach

Answer 12

hip abductors are not disrupted

Question 13

disadvantage for posterior hip approach

Answer 13

higher risk of dislocation

post-op precautions limiting for ADLs

Question 14

posterior hip approach dislocation precautions

Answer 14

no flexion >90 deg
no adduction past neutral
no IR past neutral

Question 15

direct lateral surgical approach

Answer 15

incision along greater trochanter

release of anterior glute med and min

Question 16

advantaages for direct lateral approach

Answer 16

decreased risk for dislocation

Question 17

disadvantages for direct lateral approach

Answer 17

prolonged hip abductor weakness

greater risk for HO

Question 18

direct lateral dislocation precautions

Answer 18

varies

avoid active hip abduction

Question 19

anteriolateral procedure approach

Answer 19

accessed btw TFL & glut med

Question 20

direct anterior procedure approach

Answer 20

accessed btw TFL & rectus femoris/sartorius tendons

Question 21

advantages of anterior & anteriolateral

Answer 21

ADLs less affected by dislocation precautions

decreased risk for dislocation

Question 22

disadvantages for anterior & anteriolateral

Answer 22

prolonged hip abd weakness if anterior glut med released for access

Question 23

post op precautions for anterior & anteriolateral

Answer 23

no hyperextension

no ER past neutral

Question 24

transtrochanteric surgical procedure

Answer 24

lateral incision

osteotomy of greater trochanter

Question 25

advantages of transtrochanteric

Answer 25

preserves attachment of hip abd

Question 26

disadvantages of transtrochanteric

Answer 26

WB limitations until bony union risk for non-union prolonged hip abd weakness

Question 27

post-op precautions for transtrochanteric

Answer 27

``` no active hip abd WB restrictions (TDWB or PWB) ```

Question 28

what is a potential post-op complication for THA

Answer 28

DVT | PE

Question 29

Well's criteria for DVT

Answer 29

- predict extremity for DVT

Question 30

values for Well's criteria for DVT

Answer 30

/= 3: high probability of DVT

Question 31

potential post-op complications

Answer 31

infection, dislocation, hardware failure, mechanical loosening, fx, nerve injury, vascular injury, leg length, discrepancy

Question 32

what are some outcome predictors that increases prognosis

Answer 32

- lower pre-op WOMAC scores - pre-op knee extensor strength - TUG score <10 at 14 wks post-op - younger age - male sex

Question 33

what are some outcome predictors that decreases prognosis

Answer 33

- greater number of comorbidities - higher BMI - increased age - female sex

Question 34

predictors for long term use of AD

Answer 34

- greater age >69yrs - female sex - high BMI - depression