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Ortho-Hip

Joint Operative Overview

QuestionAnswer
What are the three types of hip arthroplasty? Total hip arthroplasty (THA), femoral resurfacing, hemi-arthroplasty
What are the indications for a THA? Pain limits daily activities, Pain continues while resting, Stiffness inhibits motion, Side effects from medications, Physical therapy fails to relieve above
What is used post-op for THA tx/therapy? pn meds, antibiotics, PT, mobility
In reality, what kind of activities can a pt expect after a THA? no jogging or impact sports, weight = wear, significant pain relief, Improved motion, Golf is OK.
What is the typical length of inpatient stay post THA? ~3 days
___ pt's have the highest risk for a pulmonary emboli. THA
What percentage of pt develope a DVT post THA without prophylaxis? 50-75%
Without prophylaxis mortality from PE is __-__% post THA. 3-6%
What percentage of TKA pt's develop a DVT post-op without prophylaxis? 40-80%
Paralysis or immobility, Serious illness, Presence of disorders that cause increased blood clotting, Trauma to venous vessels, Combined contraceptive pill, Hormone replacement therapy, and pregnancy are risk factors for what? DVT
Heparin, aspirin, coumadin, pneumatic compression, TED hose, ankle pumps, and intermittent plantar venous compression are used prophylacticly for what? DVT
pt at high risk for anticoagulation in total joint arthroplasty are pt's with? History of PE, DVT, Varicosities, Thrombo-phlebitis, Cancer, and Bilateral Total Knee or Hip Arthroplasties
Although unreliable, Homan's test can be used for what? clinical detection of a DVT
Partial weight bearing means the pt usually bears __-__% body weight? 25-50
Touch-down weight bearing means the pt bears how much weight? weight of the lower extremity only
What are the hip precautions for posterior approach to hip replacement? no hip flexion>90, no twisting/pivoting, no leg crossing
What is the most frequently used approach to hip replacement? posterolateral
Glut max is split in line with muscle fibers, ER tendons transected near origin, Glut med & vastuslateralis preserved, Capsule incised posteriorly to posteriorly dislocate hip...what approach to THA does this describe? posterolateral
Allows early post-operative weight bearing and shortens rehab period...cement or noncement? cement
Using porous-coated prostheses that allow osseous in-growth into mesh-like surfaces of an implant or with a press-fit technique...cement or noncement? noncement
Complication is loosening of components at bone-cement interface. This can cause recurrence of pain, especially in younger, active patients...noncement or cement cement
Also use smooth (nonporous) femoral components...cement or noncement? noncement
Typically used for osteoporosis and poor bone stock and with elderly patients...cement or noncement? cement
Typically used with patients under 60 years of age who are physically active and have good bone quality...cement or noncement? noncement
At greater risk for instability after surgery...which THA approach, posterolateral or anterolateral? posterolateral
Provides excellent hip stability after surgery...which THA approach, posterolateral or anterolateral? anterolateral
Trochanteric osteotomy not necessary...which THA approach, posterolateral or anterolateral? posterolateral
Requires trochanteric osteotomy...which THA approach, posterolateral or anterolateral? anterolateral
Posterior dislocation necessary...which THA approach, posterolateral or anterolateral? posterolateral
Anterior dislocation necessary...which THA approach, posterolateral or anterolateral? anterolateral
Gluteus maximus incised, but anterior musculature preserved...which THA approach, posterolateral or anterolateral? posterolateral
Gluteus medius, minimus, TFL, rectus femoris, iliopsoas, vastus lateralis, and anterior capsule interrupted, but gluteus maximus preserved...which THA approach, posterolateral or anterolateral? anterolateral
Indicated for the majority of THA cases...which THA approach, posterolateral or anterolateral? posterolateral
Indicated for patients with stroke or cerebral palsy who have muscle imbalances, patients needing complex reconstructions, and patients requiring hip revisions...which THA approach, posterolateral or anterolateral? anterolateral
When is the most dangerous time for dislocation after THA? when sitting or bending over
After THA, when looking down at your aperated leg if you can see the ______ of your thigh and calf, you are safe. inside
After THA, when looking down at your aperated leg if you can see the ______ of your thigh and calf, you are in danger. outside
Look at THA post-op goals too many to list
These exercises should be started immediately after THA. (Hint bed mobility exercises) Ankle pumps, quad sets, glut sets, hip ab/adduction
What are the indications for total knee arthroplasty(TKA)? Disabling arthritis, Intractable pain, Failed all conservative measures, Ideally > 65-yrs-old
What are the precautions for TKA? No pillow under knee, Flexion only to tolerance. If quads are not active no active knee extension and weight bearing only with knee straight.
What are the overall goals after a TKA? prevent medical complications(DVT, infection, etc.), ROM, function(bed mobility, transfers, gait)
Created by: txst sum 2009
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