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PT 742 Common Medical Conditions > Total Hip > Flashcards

Flashcards in Total Hip Deck (31)
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1

What's the main reason to have a THA?

Pain due to
OA
RA
AVN
Trauma
Hip fracture
Bone tumor
Hip dysplaisa

2

What are some indications for a THA?

AVN or arthritis
Paget's disease
Legg-Calve-Perthes disease
JRA
Slipped capital femoral epiphysis - growth plate slips
Congenital hip dysplasia
Anemia
Alcoholism
Steroids
Idiopathic

3

How old is the average age for THA?

Age is 60-75 years old

4

What are some absolute contraindications for THA?

Active local, or systemic infection
Insufficient bone stock (repeated revisions)
Insufficient muscle control
Other medical conditions that increase risk of preoperative complications or death
Poor outcomes are related to comorbitities

5

What are some relative contraindications?

Obesity
Cognitive deficits (don't understand precautions)

6

What are some outcomes for THA?

Overall health related quality of life
Functional status
decreased pain (immediate most of the time)

7

How can you optimize the outcomes?

Prophylactic antibiotic therapy (prevent infections)
Anticoagulants in the perioperative period
Fixation techniques (lowered incidence of mechanical loosening)

8

What are some Pre-operative considerations?

Need to have an HEP (similar to TKA just more hip exercises)
Teach hip precautions

9

What is the most common surgical technique?

Posterior Lateral Approach
Compromises hip ERs
Spares ABD

10

Which surgical technique has a risk for posterior dislocation?

Posterior lateral approach (biggest risk)
Anterior Lateral approach

11

What happens with the Anterior Lateral Approach for THA?

Compromises glut med
capsule w/ hip ER reflected

12

What happens with the anterior approach for THA?

No muscles are cut (goes between TFL and glut med)
No hip precautions (just avoid extremes and end ROM)
Short term recovery may be faster but long term isn't any different

13

What's the most important piece of the prosthesis components when it comes to longevity of THA?

The liner

14

What are some post-op pt considerations?

Longer surgery time - (posterolateral approach is the longest)
There's going to be an increased blood loss (delirium more common)
Usually WBAT post-op (if not due to fracture)

15

What are some positions to avoid with posterior-lateral approach?

Greatest Risk
-hip flexion
-Hip ADD
-Hip IR
Don't bend at hip beyond 90 degrees
Don't cross legs beyond midline
Don't turn foot inward

16

What are some positions to avoid with anterior approach?

Hip extension
Hip abduction
Hip ER

17

What are safe positions for ADLs?

Stay between knees (like a frog)
Women- avoid standing and shaving legs in shower, avoid crossing legs
Sitting in front seat of car- avoid reaching begin to back seat

18

Can understanding your hip precautions be a discharge criteria in acute/home rehab?

Yes

19

What are some WB restrictions?

Typically WBAT per MD orders
Consider size and upper extremity strength with assistive device

20

What are some things you want to work on with rehab?

Scar massage
Flexibility-ER, and ABD
Progressive exercises- isometrics > active, Abd, ERs, Extensors
Gait training and stair climbing
4-6 weeks post-op - WB restrictions lifted, hip precautions lifted
Return to function

21

Name some exercises for THA.

Bridges
SLR
Heel raises
high marching
single leg balance
clamshells

22

What do you want to look out for in the return to activity phase?

It's similar to TKA - avoid high impact activities
Full golf swing breaks precautions - 4-6 months of healing should be sufficient

23

What are some common things that happen with THA?

Knee pain
Hamstrings, adductors, rectus cross both joints
Change in alignment or leg length will affect length tension

24

What do you want to focus on as PT's to the patient when it comes to leg length discrepancies?

QL tightness or flexibility
TFL ITB tightness
Low back pain
Educate patient on HEP

25

What happens if the hip dislocates?

Symptoms popping or slipping snesation
MEDICAL EMERGENCY

26

What increases the risk of dislocation?

Rare-highest risk first 1-4 week after surgery, occurs within first 3 months
Revisions
Weak periarticular muscles
Cognitively impaired (don't follow precautions

27

What are some other complications for THA besides dislocations?

New or recurrent pain
pain w/ walking
pain w/ rising from sitting
Weakness in leg
Decreased movement at hip joint
Decreased ability to stand on the leg
Redness and/or tenderness over the joint
Gradual or sudden shortening of the leg
Infections
Wear of joint surface
bone wear
loosening of imlant

28

What are some of the complication rates for THA?

Fracture-most common of femoral shaft
Vascular and Neurologic complications (.25%)

29

What's the biggest concern when it comes to longevity of the device?

Osteolysis or loosening
-Happens more likely at acetabulum than femur

30

What are some problems for revisions?

Complex and costly
Requires technical expertise (less bone stock)
Considerations include
-bone stock
-age of patient
-functional demands of pt
-reason for failure of the primary procedure