Ortho - Hip/Joint replacement

Pain is usu percieved in the outer aspect of the groin or inner thigh

Osteoarthritis of the Hip

The primary changes of Osteoarthritis of the Hip (3)

Loss of articular cartilage

Remodeling of subcondral bone

Formation of osteophytes

MCC of disability in pateints 65+

OA

OA is mc in m/w?

Women

MC location for OA

Knee

Osteoarthritis of the Hip - hips will show ___ joint space

decrease or obliterated

Pre-op for Hip athroplasty - _____ allows the predication of the femoral and acetabular component sizes

Templating

If patient is obese but needs hip arthroplasty

must lose weight before operate

Post-op complcaition that causes a posterior hip d/l

Pt bends over to pick up phone post hip repacement

____ have been linked to secondary OA

growth abnormalities of childhood like ricketts and obesity

Biggest risk factor for OA

old age

OA of knee - ___ should be evaluated to r/o referred pain to the knee

ROM (pt will have decreased ROM in OA)

Post op after total knee arthroplasty

do not place anything under the knee

keep the foot of the bed flat

knee should be kept in extension

Avg length of stay for total joint patients

1.9 days

Knee arhtroplasty - what do you need to be careful of?

Popliteal artery

Non-displaced hip fractures vs displaced

Non-dispalced they may be able to ambulate with pain

Displaced pts can not tolerate ambulation

______ is a very common and important diagnostic tool for hip fxs

radiation to the groin

In elderly and odd low impact fxs ask about

bisphosphonate use and rule out pathologic fracture

Hip fracture type 1

Femoral neck - intracapsular fx

Hip fracture type II

Extracapsular fracture

Hip fx type II

Subtrochanteric

Femoral neck fx tx

hemiarthroplasty

The MC sources of mets to the femoral neck

Breast cancer

MM

Garden classification

for fxs of femoral neck

kyle classification

for intertrochanteric hip fx

Seinsheimer classification

Subtrochanteric fxs

Winquist Classification

femoral shaft fxs

Muller classification

Supracondylar femoral fxs

Posterior hip d/l MOA

Knee strike on dashboard in MVA

Anterior hip d/l MOA

Usu the result of hyperabduction/extension

How will anterior hip d/l appear on XR

Femoral head larger

More medial to or inferior to acetabulum

How will posterior hip d/l appear on XR

Femoral head smaller

Overlaps the

___ nerve injury can cause a foot drop

Sciatic

In a posterior hip d/l the leg is

flexed

ADDucted

Internally rotaed

In an anterior hip d/l the leg is

flexed

ABducted

Externally rotated

Pts who hips have been reduced > 6 hrs after a d/l

full weight beasring is delayed for 8-12 weeks to reduce the risk of AVN

Pts who hips have been reduced within 6 hours

rest is recommended for several days to 2 weeks followed by mobilixation

Most patients w hip d/l are fully WB by

6 weeks

The MC complication after hip d/l

arthritis (esp in posterior)

Single pelvis fx

Pubic or ischial ramus fx is rare

Straddle injury

consists of all 4 pubic rami being fx

Vertical shear fractuer

can be a dissascoaited of the SI joint and pubic symphisis

Or Fx of posterior ilieum and fx of both pubic ramu