LE - hip (OA, RA, & THA)

Hip OA is

A chronic degenerative condition and

Hip OA is the most common hip disorder characterized by

progressive joint space narrowing and osteophyte formation.

Progressive joint space narrowoing is related to

worse function

Normal joint space:

3-5 mm.

Moderate DJD

<2.5mm

Severe DJD

<1.5 mm

What is the significance of losing >0.5 mm of joint space per year?

It indicates rapid progression / poor prognosis of hip OA.

Which of the following is NOT a primary risk factor for hip OA?

prior ankle injury / surgery

Hip OA can results in a deficient

acetabular roof, abnormal femoral torsion ± an abnormally shaped femoral head

Symptoms during weight-bearing activities in Hip OA may be the result of

compressive forces of BW / strain on capsuloligamentous

Which of the following is NOT a common history of symptoms for Hip OA?

Acute onset of hip/groin P! w/ gait, stairs, and squat

Early hip OA may result in P! during

end of day / after polonged activity that loads hip

Late hip OA may result in P! during

rest or night

Which of the following is NOT a primary diagnostic criteria for Hip OA?

P! w/ passive hip ER

Which ranges of motions have more limitations in hip OA than the others?

FLX / IR > ABD / ER

Which of the following is NOT a common exam finding in Hip OA?

increased hip flexor length

Which of the following is NOT a strength deficit seen with hip OA?

core

Hip OA can result in ____ deviations.

gait

Loss of hip ext ROM can alter gait, resulting in:

DEC step length, push off, pace

Weakness in gluteus medius can result in a

Trendelenburg

P! w/ WB can result in a

compensated tendelenburg

The lack of push off at terminal stance due to loss of hip EXT range can lead to

secondary weakness of ankle PF

What special tests are likely to be positive in Hip OA?

Scour, FADIR, FABER, 6 min walk

Which of the following is NOT a differential Dx for hip OA?

prox HS tendinopathy

What is the cornerstone of care for Hip OA?

Physical therapy.

How can weight loss impact hip joint stress in Hip OA?

A 10 lbs reduction in BW = 60 lbs DEC in hip joint stress.

Stretching & Manual therapy to improve capsular mobility can improve

motion, gait deviations, & functional activities, Like dressing

Balance exercises for hip OA should be included and progressed to

individual or group activities like tai chi.

Which of the following exercise is NOT recommended for Hip OA?

WB high impact plyometrics

What pharmacological interventions are used for Hip OA?

COX-2 inhibitors (e.g., Celebrex), NSAIDs (e.g., Mobic),

and intra-articular steroid injections.

What are the expected outcomes for patients with Hip OA?

Improvements in impairments and function, though it is a progressive condition.

What should be done for patients failing conservative interventions for Hip OA?

referral to an orthopaedist.

What is the importance of footwear assessment in Hip OA management?

for safety and shock absorbance.

Primary Diagnostic criteria for hip OA are hip P! along w/:

- Hip IR

24 deg or below

Primary Diagnostic criteria for hip OA are hip P! along w/:

- Hip Flx ____________ less than the nonpainful side or less than __________ if bilateral

15 deg,115 deg

Primary Diagnostic criteria for hip OA are hip P! along w/:

- P! w/ passive

hip IR

What conditions are treated with Total Hip Arthroplasty?

End-stage OA / RA + hip dysplasia in younger pts

THA involves resection of

femoral head and acetabulum, followed by replacement w/ metal or polyethylene

Hemiarthroplasty is a partial hip replacement that replaces either

femoral or acetabular comp

Hemiarthroplasty is often performed after

specific types of proximal femur fractures.

The vast majority of THAs are

cemented allowing for immediate full WB

What is recommended for all patients after THA and why?

AD due to muscle inhibition, P!, & balance deficits

10-year survival rate for THA ____: 25-year survival rate _____.

95%; 78%.

What is the most common reason for failure of a Total Hip Arthroplasty?

Aseptic loosening of the components.

What is the dislocation rate for Total Hip Arthroplasty?

1-15%,

most commonly occurring w/in first 6 wks

Which of the following is NOT a characteristic of the Posterior/Posterolateral approach in THA?

hip dislocated POST to gain access to acetabulum

What are the postoperative precautions for the POST Approach?

Limit motions that stress the posterior capsule to prevent dislocation.

Which of the following is NOT a characteristic of ANT approach in THA?

allows femur to be dislocated POST

What are the benefits of the Anterior Approach in THA?

It is technically demanding but spares direct trauma to the gluteus medius and allows anterior dislocation of the femur.

What must be protected after the Anterior Approach?

must be protected short-term by limiting aggressive movements into hip extension.

What are some issues associated with the Lateral approach in THA?

DEC hip ABD strength, lower functional scores, and higher P! levels.

What is the standard duration for following THA precautions postoperatively?

6 weeks

What are three advances in Total Hip Arthroplasty?

- Mini-open tech for smaller incisions / less tissue damage.

- Joint resurfacing to preserve femoral bone stock.

- OP surgery for eligible patients.

Mini-open technique involves all of the following except:

larger incision

Joint resurfacing places a(n)

artificial cap on to create a new joint surface & has a large implanted femoral stem

- Preserves the pts femoral bone stock

- Easier for surgeon to make revisions

What are the benefits of joint resurfacing?

Preserves the pts femoral bone stock / Easier for surgeon to make revisions

Outpatient surgery is typically used for

younger pts w/ few or no comorbidities are now a

What are the benefits for outpatient surgery?

able to go home the same day, No difference in major complication rates, Cost saving

What should preoperative physical therapy for THA include?

Education recovery process, postOP precautions, functional implications, AD usage, and postoperative exercises.

What is emphasized in postoperative physical therapy after THA?

gait w/ AD, strengthening of the hip and lower body, and neuromuscular electrical stimulation to the quads.

Post OP physical therapy for a THA should involve all the following except?

mobilizations w/in the first 6 wks

Exercises for strength training after THA should include all of the following except:

WB/NWB exercises for hip only

Heavy weight training for a THA should be worked up to

3 sets, 8 reps, 85-90% of 1RM

All of the following are progressions that should be involved with rehab of THA?

power

What are the expected outcomes of hip replacement surgery?

DEC in P!, improvements in strength, gait, balance, and function,

ability to walk w/o AD in 4-6 wks

Cemented components allow for what type of weight bearing?

Immediate full weight bearing

Why is an assistive device typically recommended after THA, even if WBAT?

Due to muscle inhibition, pain, and balance deficits

• Posterior/posterolateral Approach

- Avoid combo motion of

hip flx >90 deg, ADD, IR in conjuction w/ WB

______________ are contradicted for 6 wks

Early MOBS

Walk without AD in

4-6 weeks