Hip arthroplasty

What factors may have an impact on the client’s post-op care?
– pain
– functional mobility/ADLs
– balance
– gait (use of walking aids, exercise tolerance)
– other MSK issues
– falls
– sensory assessment

How should the home be set up prior to hip surgery?
– have equipment in place
– be able to use a walker or crutches
– can it be set up so that you don’t have to use stairs

What equipment would be useful post-op of a hip replacement?
– raised toilet
– shower bench
– hand held shower
– non-slip bath mat
– grab bars in tub and near toilet
– walker or crutches
– long handled reacher
– long handled shoe horn
– sock aid
– long-handled sponge
– supportive shoes

What are the weight limits for crutches and 2WW
250 lb – crutches
300 lb – 2WW

How high showed a seat be following hip replacement
seat should be 2 inches above knee caps

What are normal WBC levels?
4-11×10^9/L

What Hgb levels require transfusion?
< 75g/L requires transfusion 135 to 170 g/L (normal)

What are normal RBC and platelet counts?
4.20 – 5.80 tera/L (RBC)
150 – 400 giga/L (Platelets)

What are the precautions post hip replacement surgery?
For 3 months:
– no hip flexion greater than 90 degrees
– no ADduction past neutral
– no hip internal or external rotation for three months
– No active or resisted hip ABduction usually for 6 week

With the lateral approach, what nerve damage and what position is dislocation is more common?
– femoral nerve traction
– prone to dislocation in the extended, externally rotated position

With the posterior approach, what nerve damage and what position is dislocation is more common?
– sciatic nerve traction
– prone to dislocation in flexion, internal rotation

What might you expect to find acute post-op hip replacement surgery?
1) reduced mobility
2) reduced ROM and muscle strength in operated leg
3) pain and swelling in operated leg
4) reduced ADL

What is the typical protocol for a hip replacement surgery? (Post op day 0 to post op day 3)
Post-op Day 0 – dangle
Day 1 – up to chair with assistance, walk a short distance with walking aid, start exercise program
Day 2 – up to chair for meals, progress walking, exercise program in PT gym
Day 3 – home with home exercise program and home care or out-patient PT appointments arranged

What exercises would be appropriate post op 6 weeks?
– Active ROM at the hip (avoid active abduction for 6 weeks)
– strengthening (TA, hip flexors, abductors and extensors)
– stretching with precautions
– cardiovascular re-training
– balance and proprioception re-training
– gait
– transfers
– stairs
– progress to group exercise programs
– hydrotherapy

When can a person drive after hip replacement surgery?
– usually 4-6 weeks
– depends on surgeon’s clearance
– should attempt emergency braking manoeuver (in an empty parking lot) which should be pain free

What are the recommended sports post hip replacement?
Walking
Swimming, water aerobics, deep water running
Recreational cycling
Golf (when healing is further advanced)
Dancing
No-impact aerobic dance

What are activities to avoid post hip-replacement?
– Jogging/running
– jumping
– singles tennis, squash, badminton
– contact sports
– high impact sports
– horse riding
– waterskiing

What are complication specific to hip arthroplasty?
constipation/bladder infection
DVT
pulmonary embolism
infection
low hemoglobin
arthroplasty dislocation

What are the S&S of DVTs
pain
swelling
tenderness
discoloration
redness
increased temperature

What are the S&S of pulmonary embolism?
shortness of breathe
rapid heart rate
sweating
sharp chest pain
coughing up blood
hypotension

What are the S&S of arthroplasty dislocation?
sudden extreme pain in surgical leg
leg shortens and hip cannot be moved
unable to bear weight

What are the S&S of arthroplasty loosening?
prolonged pain in joint
inability to weight bear
reduced strength and feeling and instability
sudden loss of ROM
painful clicking in joint
surgical leg feels shorter
may be accompanied by S&S of infection

What are the S&S of trochanteric bursitis?
patient complains of lateral hip pain
hurts to roll on it
hurts to lie on it
burning pain
worse with activity

What are some appropriate outcome measures following hip arthroplasty?
WOMAC
Health-related Quality of Life
TUG
Pain scale
Oxford score (muscle strength)
6MWT

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