THR

Question 1

Presentation of hip arthritis

History

Answer 1

• pain: OPQRST
• start up pain: limp
• previous treatment
• Functional limitiations

Question 2

Presentation of hip arthritis

Physical Examination

Answer 2

• Gait pattern: trendelenbeg
• loss of internal rotation
• painful PROM at motion limits
• leg length discrepancy: ddx

Question 3

Presentation of hip arthritis

Pelvis X-ray

Answer 3

• joint space narrows
• subchondral whitening = sclerosis - osteophytes formation
• subchondral cysts

Question 4

Non-surgical treatments for arthritis

Answer 4

• Activity modification
• weight reduction/exerrcise
• Shoe wear: shock abosrbing sole
• medication (tylenol, NSAIDs)
• vitamins/supplements
• goals: relieve pain, restore, maintain function of joint

Question 5

Therapeutic injections: corticosteriods

Answer 5

• Intra-articular anti-inflammattory agen
• potent and targeted
• rx acute arthritic flare up

Question 6

Therapeutic: Viscoelastic Gels

Answer 6

• Hyaluronic acid
• Augments joint fluid
• lubrication/anti-inflammatory
• chondro-protective
• selective candidates

Question 7

Surgicals Technique

Answer 7

• Patient position
• surgical aproach: anterior, anterolateral, direct lateral, posterior

Question 8

Therapy goals

Answer 8

• Safe transfers
• early WBAT ambulation
• Giat and balance with AD
• guard against dislocation
• muscles response
• gain functional ROM and strength
• Normalize Gait
• gradual strengthening
• avoid SLR and reciprocating stairs x 6 weeks

Question 9

Post op rehab

Answer 9

• Walker –> cane
• pain and strength
• hip flexors/extensors
• abductors: trendelenburg giat
• confidence/safety
• avoid increased rotational forces early
• isometrics
• cane until limp resolves

Question 10

THR complications

Answer 10

• dislocations
• infection
• DVT
• fatal PE
• dislocation and infection (late)
• Loosening
• ostteolysis
• prei-prosthetic femur

Question 11

THR dislocation risk factors

Answer 11

• alcohol use
• cerebral dysfunction
• muscular weakness
• previous surgery
• obesity
• non-coompliant behavior

Question 12

How does a THR

dislocate

Answer 12

• posterior: adduction, flexion IR
• Anterior: abduction, extension, ER

Question 13

Surgical treatment for arthitis: indications

Answer 13

• pain significantly interferes with ADLs
• Quality of life unnaccepttable (variable)
• non-surgical inteventions are unsuccessful
• advanced joint disease visable on X-ray
• age limitation – relative
• patient driven decision