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Flashcards in ortho hip Deck (49)
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Surgical procedures to restore joint motion (hip function) and manage pain.

Damaged sections of the hip are removed.

New sections are constructed of metal, ceramic and hard plastic.

Hemiarthroplasty & Total Hip Arthroplasty (THA)


Most often for hip fracture.



Hemiarthroplasty involves replacing what portion of the hip joint?



hip socket



covers the surface of the femoral head and the inside of the acetabulum

About ½” thick

Made of tough, slick material-allows surfaces to slide

articular cartilage


Blood supply can be damaged with hip fracture:
Avascular necrosis (AVN) which can lead to

death of femoral head; bone can not maintain itself


Total Hip Arthroplasty (THA) replace the

Replace the acetabulum and the femoral head.


Total Hip Arthroplasty (THA)

Surgery performed to relieve arthritis pain or repair hip fracture.

Considerable improvement in function


Total Hip Arthroplasty (THA) is one of the most....

One of the most cost effective and successful interventions in medicine

Reliable relief of pain
in patients suffering with hip osteoarthritis or inflammatory arthritis


Quality of life (QOL) improvement from THA

THA can offer the osteoarthritis or inflammatory arthritis patient tremendous improvement in:
Pain, energy levels, sleep, social, and sexual function

Oxygen demands on activity
Walking ability

Overall quality of life

Most improvements seen within three months of surgery
Functional gains allow independence


Conditions That may Lead to a THA

Osteoarthritis (age related wear and tear)
Rheumatoid arthritis
Osteonecrosis (avascular necrosis: AVN)
Bone tumors


THA Indications

Dull ache pain to groin and buttock areas pain (especially at night) is the principal indication
post op relief as early as 1 week

Functional limitations
walking and particularly walking upstairs become difficult
bending at hips, putting on shoes, pedicure, etc.

Hip stiffness
Ankylosing spondylitis:
Abnormal stiffening/immobility of the joint due to fusion of the bones can leave patients with tremendous functional disability in the absence of pain.

Disability in this group can be caused by back pain
Pain in the knees or the
opposite hip (why do you suppose this occurs? Why the opposite knee?)
Disability imposed by the stiff hip


Other THA Indications (continued)

Age and radiographic change

most hip replacements performed in patients between 60 - 80 years old
some surgeons consider age over 80 as a contraindication
however, patients who are elderly that underwent THA have greater life expectancy

Radiographic change
severity of the radiographic changes of arthritis within the hip joint may or may not be an indication
severity of symptoms a more important indicator


The Hip Replacement Rehabilitation Team

Physician, Nurse, PT, OT


OT role in hip replacment

Reviews total hip precautions with the patients related to daily activities (sitting, posture, sleeping, etc.)

Assesses, educates, trains the patient about the adaptive equipment that is available (elevated toilet seats, etc.)

Teaches adaptive ADL

Home modifications needed for safety


Anterior vs. Posterior Hip Replacement: Differ in location of the incisions:

Anterior: Incision in the front of the hip
Posterior: Incision on the side and back of the hip


Anterior vs. Posterior Hip Replacement: Muscles affected: muscles must be pushed to the side or cut to access the hip’s ball and socket joint:

Anterior: Surgery pushes muscles aside to get to hip joint; it is a natural separation, minimal or no muscle cutting.
Posterior: Muscles and other soft tissue is cut


Anterior vs. Posterior Hip Replacement: Technical ease of surgery:

Anterior: Limited view of the hip; more challenging.
Posterior: Better view of the hip.


Anterior vs. Posterior Hip Replacement: Post-operative status:

Anterior: Less pain; faster recovery, fewer post-surgical precautions


Potential disadvantages of anterior hip replacement:

Obese or very muscular people are sometimes not candidates
Technically demanding for the surgeon


Posterior Approach: Total Hip Replacement provides better...

Approach is from the posterior aspect

Better visibility of the joint for more precise placement of implants

More invasive than anterior approach


Total Hip Replacement (Posterior) Precautions

Keep toes pointed forward and slightly out (do not rotate the leg too far; no internal rotation)

Move leg or knee forward, don’t move leg back

Keep your knees apart; don’t cross legs/midline (some people even say don’t cross at ankles- that is more so they are not tempted to cross at the knee).

Maintain 90 degrees of hip flexion


Tools to maintain 90 degrees

Keep knees below level of hip joint while standing or seated
Avoid low seats, deep soft seat cushions, low beds, rocking chairs
Use elevated toilet seat (if needed to keep hip at 90)
Do not reach for tub controls (bathtub)
Do not sit on the tub floor
Do not bend, squat to wash legs and feet (use long handle brushes)


Preparing home for THA post-op recovery

Arrange furniture for safe maneuvering with a cane, walker, or crutches
Minimize use of stairs
Place items you use frequently within easy reach to avoid reaching up or bending down
Remove throw rugs or area rugs, secure electrical cords to reduce fall risk
A good chair has a firm cushion and has a higher seat height
Shower chair, grab bar, and raised toilet seat in the bathroom
Use assistive devices such as a long-handled shoehorn, a long-handled scrub brush, reacher, dressing aids


Post-op Activity Guide

Follow doctor’s instructions about use of ambulatory aids (cane, walker, or crutches) and weight bearing schedule
full weight bearing may be allowed immediately, or may be delayed by several weeks, depending on procedure
Sleeping instructions may include avoiding certain sleeping positions or to sleep with a pillow between your legs for a length of time


Torn Anterior Cruciate Ligament is located and controls what?

ACL: Located in the center of the knee
Controls rotation and forward movement of the tibia (shin bone)


ACL Tear Causes

Get hit very hard on the side of your knee, such as during a football tackle

Overextend your knee joint
Quickly stop moving and change direction while running, landing from a jump, or turning

Basketball, football, soccer, lacrosse and skiing are common sports linked to ACL tears

Avulsion fracture: More common in children, caused by knee hyperextesion; separation of the tibial attachment of the ACL


Types of ACL injury

Grade 1 Sprain
Ligament is mildly damaged
Slightly stretched, but is still able to help stabilize the knee.

Grade 2 Sprain
Stretches the ligament to the point where it becomes loose, often referred to as a “partial tear”.

Grade 3 Sprain
Most common ACL injury
Commonly referred to as a complete tear of the ligament
Ligament split into two pieces, and unstable knee joint


Torn ACL mechanism of injury

Typically torn in noncontact deceleration that produces a valgus twisting injury
e.g., when landing on the leg and quickly pivoting in the opposite direction

Other forces can disrupt ACL with minimal injury to other structures are:
Marked internal rotation of tibia on femur
Pure deceleration


ACL and Patellofemoral DisordersGender differences

Rate of ACL injury 2 to 8 times higher in females than males who participate in the same sports.

Patellofemoral disorders can be divided into 3 categories:
Patellofemoral pain
Patellofemoral instability
Patellofemoral arthritis

Current studies do not answer the question of whether patellofemoral pain is more prevalent in females
however, clinicians have observed that anterior knee pain is more common among females