total hip arthroplasty

Question 1

what are some indications for total hip arthroplasty?

Answer 1

severe OA or RA
AVN
fractures of the femoral neck (especially in older individuals)
developmental dysplasia
tumors
LCP or SCFE (due to AVN)

Question 2

what is included in the THR pre-surgical phase?

Answer 2

discuss post-op rehab
assess functional status
discuss goals of the patient
instruct in post-op exercises
demonstration of amb with AD

Question 3

what is included in the historical inquiry post-op?

Answer 3

WB status?
cemented, non-cemented, or hybrid?
dislocation precautions? - posterolateral or anterolateral approach
intraoperative complications?

Question 4

if a patient has a cemented THA (cemented femoral and acetabular components) what is the weight bearing restrictions?

Answer 4

immediate post-operative weight bearing

Question 5

if a patient has a uncemented THA (uncemented femoral and acetabular components) what is the weight bearing restrictions?

Answer 5

restricted WBing for 6-12 weeks

Question 6

if a patient has a hybrid THA (cemented femoral and unacetabular components) what is the weight bearing restrictions?

Answer 6

immediate postoperative WB

Question 7

what are post operative precautions from a THA?

Answer 7

most dislocations occur posteriorly
no flexion > 90º or extension (anterolateral approach), no adduction across midline (both approaches), and no IR or ER (anterolateral approach) of hip
most important for 1st 6 weeks during healing but maybe for life
no sleeping on affected hip
abduction pillow/wedge

Question 8

what are the anterolateral surgical approach impact on rehab?

Answer 8

interval between TFL and rectus femoris/sartorius
has lower rate of posterior hip dislocations post THA
also less pain, fewer narcotics and better function at 90 days

Question 9

what are the posterolateral surgical approach impact on rehab?

Answer 9

gluteius max splitting and takedown deep ER
posterior capsule and tendons repaired
rehab progress is delayed secondary to decreased muscle function

Question 10

what are contraindications of posterolateral THA approach?

Answer 10

dementia, stroke, seizure disorder

Question 11

what are the ROM goals post-op?

Answer 11

advance rapidly most often
at discharge most will achieve extension to neutral, flexion to 90º

Question 12

at 6 weeks post-op what should we see in ROM?

Answer 12

no hip flexion > 90º
combined 160º of flexion/abduction/ and ER to don/doff socks/shoes

Question 13

what are the post-op instructions?

Answer 13

assistive device instruction to minimize adverse effects of bed rest
positional avoidance
deep-breathing/diaphragmatic and coughing exercises
ankle pumps to decrease risk of DVT

Question 14

what activities of daily life are you educating the patient on for a THR in the post-surgical phase?

Answer 14

raised toilet seats
THR precautions
seat level higher than knees
“stay upright”= avoid bending over to pick things up- keep it positive
“slip shoes on” no tying

Question 15

what is to be assessed following THR in the post-surgical phase?

Answer 15

functional profile, ambulation, AROM/PROM, strengthening, maximize function

Question 16

what are low load activities of daily life?

Answer 16

PROM
AAROM
submaximal quadriceps sets
bridging
NWB
TWB correctly
double-leg stance
bicycle (no resistance)

Question 17

what are high load activities of daily life?

Answer 17

getting in and out of low chairs
up and down stairs
accidental stumble
abductor resistance
jumping
running

Question 18

what are low impact sports recommended for patients?

Answer 18

golf, swimming laps, cycling, bowling, sailing, scuba diving

Question 19

what are some moderate impact sports that are intermediate for patients?

Answer 19

hiking, cross country skiing, speed walking, back packing, ice-skating, tennis, ballet, aerobics, volleyball, softball, alpine skiing

Question 20

what are some high impact sports not recommended for patients?

Answer 20

handball, racquetball, running, hockey, baseball, waterskiing, karate, basketball, soccer, football

Question 21

what are some THR complications?

Answer 21

thromboemboletic event- DVT (50% are asymptomatic so it is important for patients to do bed exercises like ankle pumps and wear pneumatic calf compression stockings and elastic stockings because they can result in PE)
dislocation of hip
leg length inrquality
infection
loosening (most common late complication)

Question 22

what are conditions that may lead to THR?

Answer 22

LCP disease
AVN
fractures

Question 23

what is legg-calve-perthes disease?

Answer 23

reduce the WB deforming forces
crutch ambulation
aquatic therapy, cycling
gentle ROM/strengthening
pt often immobilized in femoral abduction and slight IR (ER is limited)- scottish-rite orthosis

Question 24

what is AVN associated with?

Answer 24

excessive steroid use, alcohol abuse, excessive radiation, or trauma

Question 25

what surgery is normally done with AVN?

Answer 25

decompression/bone grating/ THA

Question 26

what is important post op for AVN?

Answer 26

acute symptoms, ROM, muscle performance, maximize function, education

Question 27

what are important considerations for fractures?

Answer 27

WB restrictions
gait training with appropriate AD
gentle progressive ROM
PRE’s- submaximal isometrics, concentrics… progress as appropriate
balance training

Question 28

what are some hip fracture facts?

Answer 28

about 5% pf fa;;s result in fractures
one of every 6 women will have a hip fracture in their lifetime (90% occur in persons 65 years of age and older)
risk for hip fracture increases with age