Pelvis and Hip - Age Related Joint Changes & THA

Question 1

What is age related joint changes?

Answer 1

Structure breaking down, becoming disorganized, thinning, fissuring, bones takes on more load

Question 2

What are some functional questionnaires for age-related joint changes?

Answer 2

• Western Ontario and McMaster Universities Osteoarthritis Index
• Lower Extremity Functional Scale
• Harris Hip Score
• Hip OA/THA - HOOS (hip dysfunction and OA Outcome Score)

Question 3

What is the prevalence of age-related joint changes in the hip?

Answer 3

• MOST common cause of hip pain

Question 4

What percentage of adults have age-related joint changes in the hip?

Answer 4

up to ~25%

Question 5

What are risk factors for age-related joint changes in the hip

Answer 5

• over 50 years of age
• previous joint injury such as labral tears
• may be preceded by FAIS by ~10 years but not always
• Increasing BMI
• Occupational activity such as deep squats or stairs
• NOT exposure to sport or physical activity which may be protective

Question 6

What can predict subsequent age-related joint changes in those with hip disease?

Answer 6

LBP

Question 7

What are symptoms of age-related joint changes?

Answer 7

• like FAIS plus …
• AM stiffness > 30 mins
• less tolerant to WBing activities and sitting with possible limping
• C-sign of pain
• may be nociplastic pain

Question 8

What is the C-sign of pain?

Answer 8

groin, lateral hip and buttock, may even refer to knee

Question 9

What are signs of age related joint changes in observation?

Answer 9

• Like FAIS plus…
• asymmetrical gait- trendelenberg gait or lateral pelvic tilt while walking
• weight shift in standing

Question 10

What are signs in ROM of age-related joint changes in the hip?

Answer 10

• Like FAIS plus…
• ≥ 3 planes of motion restricted (high spec)
• capsular pattern of restriction NOT consistent in hip, inconclusive

Question 11

What does Dutton indicate with ROM?

Answer 11

IR > Flx > abd = ext

Question 12

What will we find with combined motion in the hip with age-related joint changes?

Answer 12

consistent block

Question 13

What will we find with resisted/MMT with age-related joint changes in the hip?

Answer 13

• pain and possible weakness with ABD (high spec)

Question 14

What will we find with stress tests with age-related joint changes in the hip?

Answer 14

• compression possibly positive
• distraction possible relieving

Question 15

What will we find with accessory motion with age-related joint changes in the hip?

Answer 15

• hypomobility

Question 16

What are some special tests for age-related joint changes in the hip?

Answer 16

• OA CPR
• OA combined results
• Impaired Functional Performance testing
• Impaired Balance Tests

Question 17

What are the tests with OA CPR? (Is it present?)

Answer 17

1. hip pain with squatting
2. lateral hip pain with hip flexion
3. hip pain with hip extension
4. IR ≤ 25˚
5. Positive scour and FABER

Question 18

What are the tests with OA combined results? (is it NOT present?)

Answer 18

1. hip pain
2. hip IR ≤ 15˚
3. IR pain
4. AM stiffness ≤ 60 minutes
5. 50 years of age

Question 19

What are some functional performance testing that can be impaired with age-related joint changes in the hip?

Answer 19

• 6 min walk test
• TUG
  etc.

Question 20

What are some tests that will show impaired balance with age-related joint changes in the hip?

Answer 20

Berg Balance Scale, etc.

Question 21

What do we need to accomplish with treatment of ARJC in the hip? How?

Answer 21

• Integrity of Cartilage
• Mobility
  > regular, easy, frequent movements then strength elements as tolerated

Question 22

Is it okay to have more symptoms with age-related joint changes in the hip?

Answer 22

NO

Question 23

What is the PT rx for age-related joint changes?

Answer 23

• POLICED
• Modalities for pain/inflammation
  > no more than 2 weeks, only short term pain influence

Question 24

What can we use an AD for with age-related joint changes in the hip?

Answer 24

• to minimize/avoid limping

Question 25

What can we educate the patient on with age-related joint changes in the hip?

Answer 25

- limit hip flexion < 90˚ > avoid low seats and sit on a wedge > no knee to chest stretched - weight management

Question 26

What are JM for with age-related joint changes in the hip?

Answer 26

cartilage integrity and mobility

Question 27

What techniques must be used with JM for arjc in the hip?

Answer 27

- thrust techniques and stretches need to be incorporated in addition to non-thrust techniques and ADDED TO EXERCISE

Question 28

What can JM do for age-related joint changes in the hip?

Answer 28

- better than usual care out to 1 year - moderate support

Question 29

What is MET for with age-related joint changes in the hip?

Answer 29

- mobility, cartilage integrity, and muscle function

Question 30

What is MET effective for with age-related joint changes in the hip?

Answer 30

- improving pain and function > better than usual care out to 1 year

Question 31

What can be beneficial with MET for age-related joint changes in the hip?

Answer 31

- aerobic component - including trunk and hip anti-gravity muscle groups - balance training as WBing is tolerated

Question 32

How often should we do MET for age-related joint changes in the hip?

Answer 32

1-5x. a week for 6-12 weeks

Question 33

What is there insufficient evidence with for age-related joint changes in the hip?

Answer 33

- chondrotinin and Glucosamine supplements - hyaluronic acid injections - synvisc

Question 34

What is the pre-op PT purposes for a Total Hip Arthroplasty?

Answer 34

- assistive devices - planning for recovery, such as initial HEP - expectation management

Question 35

How many sessions is pre-op PT for a THA?

Answer 35

usually 1-2 sessions

Question 36

What is positive about pre-op PT for THA?

Answer 36

Cost reduction vs. no pre-op PT

Question 37

What are the incisions for THAs relative to?

Answer 37

The greater trochanter

Question 38

What kind of approaches are there for THAs?

Answer 38

- anterolateral approach - posterolateral approach

Question 39

What should we know about the anterolateral approach for THA?

Answer 39

- no trauma to anti-gravity musculature but smaller view - mini / smaller incision with same components so takes more MD skill

Question 40

What should we know about the posterolateral approach for THAs?

Answer 40

- larger view but trauma to anti-gravity muscles - more common

Question 41

What are surgical considerations with THAs?

Answer 41

- cut capsule/extra-capsular ligaments - forces and cut adjacent structures - dislocate and replace hip - stitch capsule and cut muscles - full range under anesthesia

Question 42

What prosthetics are used with THAs?

Answer 42

- acetabulum is rasped out and the head of the femur is cut off - metals, ceramics, plastics

Question 43

How are the prosthetics fixated?

Answer 43

Cemented

Question 44

What are some complications with THAs?

Answer 44

- arthroplasty related readmission: heterotrophic ossification (1-5%)

Question 45

What is arthroplasty related readmission: heterotrophic ossification?

Answer 45

- formation of bone in abnormal locations due to disease and/or direct trauma - AKA as myositis ossificans if bone grows into muscle

Question 46

Why are painful PROM/JM with abrupt end feels contraindicated with THA?

Answer 46

bone on bone

Question 47

What is a hemiarthroplasty of the hip?

Answer 47

- replace head without replacing acetabulum

Question 48

Wha kind of patient is a hemiarthrplasty usually used for?

Answer 48

non-arthritic patient like with Legg-Calve-Perthes disease

Question 49

What are we NOT trying to improve with MET after a THA?

Answer 49

Cartilage integrity

Question 50

What are traditional precautions after a THA?

Answer 50

- avoid hip flexion last 90˚ - avoid hip adduction past neutral - avoid rotation

Question 51

What kind of rotation was thought to have been needed to be avoided after a THA with traditional precautions?

Answer 51

- IR past neutral with a posterolateral incision - ER past neutral with anterolateral incision

Question 52

Why were these THA traditional precautions initially implemented?

Answer 52

due to dislocation concerns

Question 53

What percentage of THAs dislocate?

Answer 53

less than .5%

Question 54

With recent research, what precautions are there with an anterior approach THA?

Answer 54

- no precautions, no increased incidence of dislocations

Question 55

How many dislocations were there with an anterior approach THA with no precautions?

Answer 55

- 4/2600 hips - at an average of 5 days and no later than 12 days

Question 56

What should we know with dislocations with THAs of either approach?

Answer 56

- greater in precaution group - no precaution group progressed faster with function

Question 57

What is the prognosis with a THA?

Answer 57

6-8 months post-op physical functioning had generally recovered to about 80% of that of controls