Hip Arthroplasty and Osteoarthritis Overview

Hip Arthroplasty Overview

• Hip arthroplasty is a surgical procedure replacing damaged hip joint surfaces with prosthetic parts.

Hip Pain Patterns

• Groin pain occurs in 43% of cases.
• Trochanteric pain in 18% of cases.
• Gluteal pain in 12% of cases.
• Groin/trochanteric pain in 16% of cases.
• Pain in all locations in 3% of cases.

Differentiating Hip from Lumbar Pain

• Common signs of hip pain include limping, groin pain, restricted hip medial rotation, and a positive "sign of the buttock."

Osteoarthritis: A Cause of Hip Pain

• Osteoarthritis is the most common hip joint disorder.
• It often results from wear and tear of the articular cartilage.
• Degeneration causes loss of joint space, impacting older people more.
• Factors linked to hip osteoarthritis include age, obesity, and prior hip damage.

Hip Osteoarthritis Evaluation

• Hip pain that radiates to buttocks/knee, exacerbated by long term hip loading and worsening in cold weather.
• Positive Patrick's/FABER test (flexion, abduction, external rotation of hip).
• Limited hip internal rotation (<15°).
• Limited hip flexion (<115°).
• Morning stiffness of <1 hour.
• Osteophytes (bone spurs) on x-rays.
• Narrowed joint space on x-rays.

Hip Osteoarthritis Management

• Patient education, particularly in primary care.
• Muscle strengthening exercises.
• Maintaining a healthy weight.
• Switching to low-impact activities.
• Minimizing activities that worsen pain.
• Medications like NSAIDs and corticosteroids (intra-articular injections).
• Total hip replacement (in end-stage disease).

Total Hip Arthroplasty (THA)

• Surgical replacement of both damaged hip joint surfaces with prosthetic components.
• Indications: Osteoarthritis, rheumatoid arthritis, avascular necrosis, congenital hip dysplasia, unfixable femoral neck fractures
• Contraindications: Inadequate bone mass, serious medical risks, infection, and poor patient compliance with the rehabilitation plan.
• Surgical Procedures: Acetabulum reaming and new cup fitting, femoral head removal and replacement with prosthetic stem and head.
• Types of Implants: Metal-on-polyethylene, ceramic-on-polyethylene, metal-on-metal, ceramic-on-ceramic.

Surgical Approaches

• Posterolateral (Gibson): Accesses the hip between the gluteus maximus and medius, preserving these muscles for easier rehabilitation.

• Anterolateral (Watson-Jones): Offers improved visibility without the high risk of dislocation with advantages like better exposure and reduced damage to the musculature, faster rehabilitation, and reduced necessity for routine dislocation precautions. The approach also maintains muscle attachments other than the rectus femoris muscle.

• Anterior: Patients are positioned supine, starting 3cm lateral from ASIS in a distal and lateral direction, dissecting between sartorius and tensor fasciae latae muscles which are supplied by the femoral and superior gluteal nerves. The procedure involved anterior dislocation of the hip.

• Complications: Dislocation (especially post posterolateral approach), Nerve injury, infection, deep vein thrombosis, pulmonary embolus, leg length discrepancies

Post-Operative Considerations

• Postoperative Precautions: Avoiding crossing legs, hip flexion past 90°, abduction past midline, internal rotation,
• Rehabilitation: Physical therapy and exercises to regain strength, range-of-motion, mobility, and gait.
• Duration of recovery: Generally, takes 6-8 months for patients with a willingness to go through the rehabilitation to improve strength and range of motion.

Pre-Operative Training

• Focuses on educating patients about THR precautions for safe movement post-surgery.
• Includes a basic exercise program for the recovery phase of surgery.

Phase I(Pre-operative training Session) Exercises

• Ankle pumps
• Gluteal sets
• Active hip and knee flexion
• Isometeric hip abduction
• Quadriceps sets.

Phase IIa (Hospital Phase)

• Goals: prevent complications, improve leg function control, and reinforce THR precautions.

Phase IIb (Hospital Phase)

• Goals: promote transfer and gait independence, reinforce THR precautions, and prepare for discharge.

Phase III (Return to Home)

• Goals: Home safety evaluation, return to work/activities planning.
• Criteria: Independence in transfers, exercises, gait on level surfaces (100 feet), stairs.

Discharge

• Provide essential post-operative care instructions, including specific precautions and exercises, to aid recovery and prevent complications.

Prescription for Post-Surgery Hip Rehabilitation

• Includes exercises , adjusting abduction pillow, patient education, cough and incentive spirometer usage, begin bed mobility and transfer training, and weight bearing as the physician approves
• Types of exercises include isometrics (quadriceps sets and gluteal sets), active range of motion (AROM) exercises (ankle pumps), gait training, and stair training.

Explore the intricacies of hip arthroplasty and the common patterns of pain associated with it. This quiz will help you understand the differentiating factors between hip and lumbar pain, as well as the evaluation of hip osteoarthritis. Gain insights into causes, symptoms, and evaluations related to hip health.