medsibridge LE surgery Flashcards
(30 cards)
what are the type of hip impingment
Pincer - acetabulum more common in males
CAM - over development of the femoral head, middle aged females
What anatomic variable should be taken into consideration when deciding if a hip impingement can be perform arthoscopically?
the amount of hip joint cartilage
- less than 2mm or cartilage does poorly with arthroscopy
What tissues are involved in a hip arthroscopy for impingments
- bone - debrided edges
- labrum - very week and is the weak point through the inflammatory and reparative stage
What precaution do you need to take into account during the inflammatory stage of hip impingement arthorscopy
- labrum is very week and you do not want to push the femoral head into the repaired tissues
- no hip extension or ER
- flexion no greater than 120 and abduction to 45
- limited weight bearing for a least 2 weeks
- avoid supine SLR and sidling abduction as these exercise are likely to be to hard at this time
Describe the state of the different tissues during the reparative stage of healing
reparative 5-7 weeks
- wound - scar tissue and revascularization
- bone - callus formation
- labrum - type III being replaced by Type II
when would you expect the debrided bone to change to lamellar bone post hip impingement arthroscopy
- 8-12 weeks post op
what complication are associated with hip impingement arthroscopy
- prolonged traction can injury blood vessels or nerve or result in AVN
- infection
- bleeding in to the hip
- cartilage or ligament damage
- blood clot
- heterotic ossification
- adhesion or joint stiffness
what is the success rate of hip arthroscopy
predictors - the lower the OA or degenerative changes the better
what outcome indexes have shown best prognostic value with hip arthroscopy
- Non-arthritic hip score
- Hip outcome score
versus - LEFS, internation hip outcome tool, and harris hip score
What diagnostic test series is best for diagnosis hip impingement syndrome
- hip impingement test
- FABER
- Fitzgerald test - Passively taken the patient through hip IR, start flex’d and ER move into IR and Add the extend the hip
what test is has been validated for return to sport following hip impingement arthroscopy
deep squat test _ Kivlan 2012 review of functional performance testing of the hip in athletes
Kivlan’s 2012 systematic review identified what functional performance test as valid assessments of hip dysfunction
- deep squat test - was valid for FAI
- single leg squat difference was valid for muscular impairment
- STAR excursion
- 30 second single leg stance pain gluteal tendonopathy and ruling out referral from other area
what are the common complications with hip and knee replacements
- bleeding
- periprosthetic joint
- wound complication
- thromboembolic event
- implant loosening
- malaligment
- fractures
- HIP specific heterotopic ossification, dislocation
- KNEE adhesion and extensor mechanism disruption
What comorbietes are most likely to negatively impact joint replacement outcomes
- obesity and weakness
- longer periods of pain
- history of anxiety and depression
what variable are most closely associated with patient satisfaction after knee or hip replacement
pain, ROM, distance walked, ability to rise from sitting ability to climb stairs and presence of flexion contracture
Risk factors
- physiologic - core and LE strength neuromuscular control
- anatomic
What is the difference between an ALC coper and Non-coper
copers return to normal function and performance without ACL
- non-copers don’t and tend to be older, non-contract injuries, female and have feelings of instability
what is the difference between autograft and alograft
auto - your body
alo - cadaver
how does the bone healing vary in the difference parts of a bone tendon bone ACL surgery
tunnels heal faster than the graft sites
Describe the healing process of the ACL autograft
1 - very strong when implanted, goes into inflammation
2- 4 weeks cellular proliferation, weakest point of the graft
3- 6 weeks vascular proliferation
4- vascular prunning
5- 3 months matrix remodeling
6- healed 12-16 months
Criteria for return to run
- no dynamic valgus collapse with repetitive single leg exercise
- 70% strength
- no complaints of giving away
How does the tensile strength of the new ACL compare to native ACL
1-2 years post op the repaired ACL has only 20-30% of native tensile strength
what component of the return to sport does the AC return sport injury scale assess
psychologic
How doe the healing phases of autologous chondrocyte implantation differ
- healing begins in the lab where harvested cells are grow
- femoral defects have longer weight bearing restrictions
- full ROM and strengthening don’t start until about 6 weeks
