Thr

Front 1

-Clinical criteria consistent with radiographic findings of hip OA:

Back 1

Moderate pain in lateral or anterior thigh with WB; may progress to anterior thigh or knee painAdults > 50 years of ageLimited PROM in at least 2 of 6 hip directionsMorning stiffness which improves in < 1 hour

Front 2

contraindications

Back 2

-Active infection-Younger athlete-Obesity more prone to post surgical complications-Planned return to high impact sports or occupations-Arterial insufficiency-Neuromuscular disease-Mental illness because of risk of dislocation

Front 3

-Posterolateral Approach

Back 3

-Gains access to the hip joint by splitting the gluteus maximus muscle-Femur dislocated posteriorly-Allows for maintenance of abductor strength but generally results in a higher postsurgical dislocation rate

Front 4

-Anterolateral Approach

Back 4

-Numerous variations -All approach the hip through the interval between the TFL and the gluteus medius-Some portion of hip abductor is released and the hip dislocated anteriorly

Front 5

-Direct Lateral Approach

Back 5

not done very often.-Leaves posterior portion of gluteus medius attached -Preferred in more non-compliant patients to prevent postsurgical dislocation

Front 6

DVT

Back 6

most common-Peak incidence is 5 – 10 days post-op -Period of increased risk can be up to 3 months post op -Even with preventive therapy – rates were 10-20%

Front 7

Heterotopic ossification

Back 7

begins as soon as 16 hours post and is maximal at 36-48 hours post

Front 8

dislocation

Back 8

more common in women, elderly people, or patients with a history of trauma, developmental dysplasia, cerebral dysfunction, or excessive alcohol intake

Front 9

Neurovascular injury

Back 9

varies from 0.08% to 7.6%, with an overall prevalence of 1% -Injury to the peroneal division of the sciatic nerve is most common, but the superior gluteal, obturator, and femoral nerves can also be injured.

Front 10

Uncemented hip replacement

Back 10

more likely to be unstable. Allows for better healing-Physician-specific-By 8 weeks, you should be weight bearing with only a little support.

Front 11

-Cemented or hybrid hip replacement

Back 11

research says they are better than uncemented. BJ sees more of these. Can WB earlier.-Using a cane or walker, you can put some weight on the leg immediately, but should continue to use some support for 4 to 6 weeks to help the muscles recover.

Front 12

how long to use abduction pillow?

Back 12

6 weeks

Front 13

precautions

Back 13

no adduction, IR, or flexion past 90 -use an adduction pillow – pillow between legs -no rotation – keep toes straight, avoid pivoting and twisting -no flexion past 90 – scoot to the edge of their chair to stand up, no putting on shoes, etc

Front 14

swimming begin?

Back 14

-Swimming is also recommended; you can begin as soon as the sutures have been removed and the wound is healed, approximately 6 to 8 weeks after surgery

Front 15

mini squats eta?

Back 15

mini squats

Front 16

week 2-8 goals

Back 16

-Pain 5/10 or less (if they are having a lot of pain, but don’t like to take pain meds, you need to really encourage them to take it anyways so they can get through therapy and get stronger)-Hip ROM = 70 – 90o hip flexion-Independent with all transfers-Strength 3/5 to 4/5 of involved LE-Normal gait with assistive device on level surface-Superficial thermal modalities may be used in this phase ok to use hot and cold packs

Front 17

SLR?

Back 17

-BJ says SLR puts a lot of stress through the hip joint, and there are better exercises to work the hip

Front 18

phase 3 week 9+

Back 18

-Pain 2/10 or less-Hip ROM to 90o flexion-Involved LE at 4/5 strength-Independent with stairs-Functional independence with ADL’s-Return to employment or previous hobbies, as indicated

Front 19

Hip Flexion Contracture-Symptoms –

Back 19

-Deep anterior hip pain-Abnormal gait-Difficulty with sexual relations-Low back pain

Front 20

True Limb-Length Difference

symptoms-

-physical findings

Back 20

-Trunk lean gait-Contralateral knee flexion posture-Increased PF stress and pain on contralateral side-Tightness of contralateral QL

Front 21

Apparent Limb-Length Difference-

Symptoms –

-Physical findings –

Back 21

-Back pain-Abnormal gait-Unable to participate in light sports or recreational activity

-Pseudo-Trendelenburg gait-Ipsilateral TFL contracture-Contralateral adduction contracture-Contralateral hip or knee flexion contracture

Front 22

motion necessary to put on socks and shoes by 6 weeks after surgery?

Back 22

-Will have needed 160 degrees of combined hip flexion, abduction, and ER