Total Hip Arthroplasty

Total Hip Arthroplasty

removal of the proximal and distal joint surfaces of the hip with subsequent replacement by an acetabular component and a femoral implant

Etiology:

• an elective procedure

• often associated with the need for total hip arthroplasty include osteoarthritis, rheumatoid arthritis, osteomyelitis, and avascular necrosis

Signs and symptoms:

prior to surgery, there is:

• severe pain with weight bearing

• loss of mobility

• gross instability

• limitation in ROM

• failure of non-operative management or a previous surgical procedure

Treatment:

• focus on decreasing inflammation and allowing tissues to heal

• emphasizing adherence to hip precautions

• minimizing muscle atrophy

• regaining full passive ROM

Anterolateral approach:

• access to the hip occurs through the interval between the TFL and the glute medius

• some portion of the hip abductors are released from the greater trochanter and the hip is dislocated anteriorly

Hip precautions for anterolateral approach:

Avoid:

• flexion > 90 degrees

• extension

• lateral rotation

• adduction

Direct lateral approach:

• leaves the posterior portion of the glute medius attached to the greater trochanter

• requires longitudinal division of the TFL and vastus lateralis

• release of the anterior portion of the glute medius

• minimizes the probability of dislocation and may be ideal for noncompliant patients

Hip precautions for direct lateral approach:

Avoid:

• flexion > 90 degrees

• extension

• lateral rotation

• adduction

Posterolateral approach:

• splitting the glute max muscle in line with the muscle fibers

• short external rotators are then released and the hip abductors are retracted anteriorly

• maintains the integrity of the glute medius and vastus lateralis

• femur is dislocated posterioly

• most commonly used approach

• results in a high post-surgical dislocation rate

Hip precautions for posterolateral approach:

Avoid:

• flexion > 90 degrees

• medial rotation

• adduction