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Ortho-Hip
Joint Operative Overview
| Question | Answer |
|---|---|
| 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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