Procedure 2

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Author:
Anonymous
ID:
175498
Filename:
Procedure 2
Updated:
2012-10-04 09:55:11
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Exam
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Description:
THR
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  1. Effects of OA
    • pain with WB
    • decreased ROM
    • crepitus
    • decreased strength d/t inactivity
    • gait deviations d/t ROM
    • functional limitiations
  2. OA Acute/Protection Phase indications
    • decrease pain at rest
    • -grade 1 & 2 occilations
    • decrease pain with WB
    • -AD
    • decrease effects of stiffness
    • maintian ROM
    • -pt education
    • -pool therapy
  3. OA Subacute/Chronic indications
    • maintian or prgressively increase ROM
    • -P/AROM stretches
    • M/P increase joint play
    • -grade 3&4 MOBS
    • M/P improve strength
    • -OKC, PREs, functional
    • Patient Ed
  4. Proximnal Femoral Osteotomy
    intertrochanteric osteotomy-surgically changing the femoral neck-shaft angle to expose healthy cartilage and improve joint congruency
  5. Proximal femoral Osteotomy Rehab
    • Protect the joint form loading forces
    • -Limited WB state (8-12 weeks post op)
    • Pain management
    • ROM
    • Strenthening
    • -quad + glut sets, ankle pumps, gentle AROM
  6. THR Cemented
    • polymethylmethacrylate provides immediate fixations
    • useful for pts over 65
    • osteoprosis
    • Earlier WB
  7. THR Non-Cemented
    • Biological tissue in-growth prosthesis.
    • bone grows into beaded or mesh like surgace.
    • Longer WB limitations
  8. Posterolateral Approach
    • Most common technique
    • intergrity of vastus lateralis, gluteus medius & minimus
    • highest incidence of dislocation
    • (MR/ADD/Flex will dislocate)
  9. Lateral Approach
    • Incision of gluteus medius and minimus and vastus lateralis
    • may cause post op ABD weakness & trendelenburg gait
    • may involve trochanteric osteotomy
  10. Anterolateral Approach
    • provides excellent hip stability but mostly used in difficult cases suchs as complex reconstructions
    • significant disruption of soft tissues-gluteus med, min, TFL, rectus femoris, vastus lateralis, and Iliopsoas.
    •  -may cause osetotomy & reattachment of greater trochanter
  11. THR Complications
    • Persistent thigh pain-antalgic gait (20%)
    • Thromboembolus
    • Loosening components 10-40%.
    • -younger, RA, obese, Prior hip surgery
    • post op dislocation. 1-4% time of most risk=up to 6 wks post-op
  12. ROM precautions with Posterior Lateral approach
    • Hip ADD past midline
    • Hip IR past neutral
    • Hip flex greater than 80 degree
    • *especially avoid combos of these motions 4 months post op
    • could be FOREVER
  13. Posterior Lateral ADL Precautions
    • transfer to sound side
    • dont cross legs
    • dont sit in low surfaces
    • sit with knees slightly lower than hips
    • use raised toliet seat
    • avoid bending over trunk when moving
    • showers
    • Stairs:up with good, down with bad
    • standing on/ rotating to bad side
    • Sleep supine with ABD pillow: Avoid side-lying
  14. Anterior Lateral ROM precautions

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