Total Hip Arthroplasty (THA)

Question 1

Why Total Hip Arthroplasty (THA)?

Answer 1

• Osteoarthritis (joint space missing = hip pain)
• Hip fracture
• Bone tumors

Question 2

Which bones Total Hip Arthroplasty (THA)?

Answer 2

Femur

Acetabulum

Question 3

Components are made of THA?

Answer 3

Femur = metal
Acetabulum = polyethylene 

Usually fixed with cement

Question 4

THA post surgery complications?

Answer 4

• Femur fracture
• Peripheral nerve damage
• Implant positioned wrong
• Infection & wound healing problems
• Component loosening
• Deep vein thrombosis (DVT) -> Pulmonary embolism (PE)
• *Leg length discrepancy**
• *Joint Dislocation**

Question 5

Hip joint dislocation facts?

Answer 5

Usually 2-3 months post-op
1 - 10% of patients
Non-traumatic

Question 6

Risks that cause hip dislocation?

Answer 6

• Over 80yrs
• Hip fracture primary diagnosis (fell so needs repair anyway)
• Cognitive dysfunction/Dementia (won’t remember precautions)
• Posterior approach
• Small femoral head (small person)
• Surgeon inexperience

Question 7

Precautions to reduce hip dislocation risk?

Answer 7

• No 90 degree hip flexion
• No hip adduction past neutral
• No hip abduction
• No internal/external rotation

FOR 12+ WEEKS

Question 8

Maximum protection phase goals THA?

0-4/6 weeks

Answer 8

• *PREVENT POST-OP DISLOCATION**
• Prevent vascular/pulmonary complications
• Control pain
• Minimize reflex inhibition
• MAINTAIN or improve LE strength
• Regain mobility of operated LE
• Achieve independent FUNCTIONAL MOBILITY (considering WB status)

WALKING to prevent blood, vascular, pulmonary complications

Question 9

Factors that affect weight bearing status?

Answer 9

• Age
• Bone quality
• Type of fixation
• Stability
• Surgeon’s choice
• Fracture location & pattern

Question 10

Moderate protection phase goals THA?

4-6 weeks

Answer 10

• INCREASE knee & hip muscle strength & endurance (weak hip abduction/extension)
• Improve cardiopulmonary endurance
• Improve standing balance & trunk stability
• Restore ROM (within precautions)
• Improve gait pattern (watch for Trendelenburg)

Question 11

Minimum protection phase goals THA?

12+ weeks

Answer 11

• TASK SPECIFIC strengthening
• Posture & balance training
• Cardiopulmonary conditioning
• Gait training (symmetrical pattern)

Question 12

Risk factors for hip/pelvis fractures?

Answer 12

• Aging (decreased strength, flexibility, cognition, vision, bone density, meds)
• Falls risk

90% hip fracture in elderly are associated with a fall
(we don’t know if they fell or broke it first)

Question 13

How do we fix hip/pelvic fractures????

Answer 13

• If cannot repair = Arthroplasty
• If unwell/non-ambulatory = Hip traction
• If repairable = Open Reduction Internal Fixation (ORIF), fixed with nails, screws, pins, plates

Might replace full hip or just one piece, depends what is broken

Question 14

Death/Mortality rates 1 year post hip fracture repair?

Answer 14

12 - 36%

But most people within 1 year achieve same strength as non-fractured extremity