1. MANAGEMENT OF HIP DISORDERS AND SURGERIES
Need to Know
Pathologies
Surgical procedures
Precautions
Presenting impairments
Functional limitations
Possible disabilities
surgical procedures
precautions

2. JOINT HYPOMOBILITY: NONOPERATIVE MANAGEMENT
Related Pathologies and Etiology of Symptoms
Osteoarthritis (Degenerative Joint Disease)
Rheumatoid arthritis
Aseptic necrosis
Slipped epiphyses,
Dislocations, and congenital
deformities
Post immobilization Hypo mobility

3. Common Impairments Pain experienced in the groin Stiffness after rest.
Limited motion with a firm capsular end-feel
Antalgic gait
Limited hip extension
Limited Knee extension
Impaired balance and
postural control

4. Non-Operative Management

5. Common Functional Limitations/Disabilities
Jobs
Household work
Arising from a chair
climbing stairs
Weight Bearing
Restricted routine ADL

6. Management: Protection Phase
Decrease Pain at Rest
(grade1 or 2 mobilization)
Decrease Pain During Weight-Bearing Activities
(Provide assistive devices for ambulation)
Decrease Effects of Stiffness and Maintain Available Motion
(Range of motion exercises)

7. Management: Controlled Motion and Return to Function Phases
Progressively Increase Joint Play and Soft Tissue Mobility
Joint mobilization techniques
Passive stretching, neuromuscular inhibition, and self- stretching techniques

8. Anterior Glide to Increase Hip Extension and External Rotation

9. Posterior Glide to Increase Hip Flexion & Internal Rotation

10. Increase Extension During Weight Bearing
Improve Muscle Performance
in Supporting Muscles
Patient Education

11. Total Hip Arthroplasty

12. Indications for Surgery
Severe hip pain with motion and weight bearing
Joint deterioration and loss of articular cartilage
Osteoarthritis
Rheumatoid or traumatic arthritis
Ankylosing spondylitis
Osteonecrosis (avascular necrosis)
Nonunion fracture
Bone tumors
Failure of conservative management or previous joint reconstruction procedures

13. Contraindications to Total Hip Arthroplasty
Absolute
Active joint infection
Systemic infection
Chronic osteomyelitis
Significant loss of bone
Neuropathic hip joint
Severe paralysis of the muscle
Relative
Localized infection
Progressive neurological disorder

14. Procedures Prosthetic designs and materials
An inert metal (cobalt-chrome and titanium) modular femoral component
A high-density polyethylene acetabular component
Metal-on-metal systems and systems that utilize ceramic surfaces in the design.

15. Standard surgical approaches
Posterolateral approach
Most frequently use
Preserves the integrity of the gluteus medius and vastus lateralis
Trochanteric osteotomy is not necessary
Disadvantage
Postoperative joint instability
Risk of postoperative
dislocation,

16. Standard surgical approaches
Direct lateral approach
Release proximal insertion of the gluteus medius
Longitudinal splitting of the vastus lateralis
Detachment of gluteus minimus
Trochanteric osteotomy is not necessary
Disadvantage
Postoperative weakness
Gait abnormalities

17. Standard surgical approaches
Anterolateral approach
Involves complex reconstruction
Indicated for patients with muscle imbalances
Osteotomy of the greater trochanter
Soft tissues disturbed

19. Conventional hip replacement
Healthy hip
Cuts
Implant components
Implanted

20. The BHR* System
Healthy hip
Cuts
Implant components
Implanted

21. Conventional vs. the BHR* System
Total hip cuts
BHR System cuts

22. Cemented or Cement less

23. Cemented versus cementless fixation
Cemented Fixation
Acrylic cement allow early postoperative weight bearing
Disadvantage
Aseptic (biomechanical) loosening
of the prosthetic components at the
bone–cement interface in younger,
physically active patients

24. Procedures Cemented versus cementless fixation
Cementless (biological) fixation
porous-coated prostheses
cementless press-fit technique
Smooth (nonporous) femoral components with cementless arthroplasty
Coating of a bioactive compound
called hydroxyapatite
Under 60 year of age
Disadvantage
Late weight bearing

25. Operative approaches Minimally invasive approaches

26. Step 1: Incision Removal of osteophytes
Avoid transverse acetabular ligament
Ref: Desert Orthopaedic Center
Ref:

27. Step 2: Removal of Femoral Head
Femoral head dislocated
Femoral head removed at neck

28. Step 3: Prepare Acetabulum
Drill and reamer used to remove cartilage and create cup shape
Anchorage holes made (cemented case)
Remove debris with brush

29. Step 4: Insertion of Acetabular Component
Held in place by friction, screws or cement
Pressurization carried out in cemented case
See Reference Section

30. Step 5: Preparation of Femoral Canal
Straight reamer creates hole
Remove debris
Insert distal plug
See Reference Section

31. Step 6: Insertion of Femoral Stem
Friction fit or cement
If cement used pressurize cement to create an even cement mantle
See Reference Section

32. Step 7: Attachment of Femoral Head
Attach femoral head to stem (by Morse taper)
See Reference Section

33. Step 8: Insertion of Head into Acetabular Component
Femoral head is located into acetabular liner
Range of motion is verified
See Reference Section

34. Features of Minimally Invasive Total Hip Arthroplasty
Incision location and muscles disturbed
Posterior approach
7- to 10-cm posterior incision
the abductor mechanism consistently is left intact
Anterior approach
10 cm incision beginning just lateral and distal of the anterior superior iliac spine
leaves all muscles intact
no postopertive precautions
Lateral approach
least commonly used
leaves the posterior capsule intact
eliminating the need to postoperative precautions

35. Postoperative Management
Immobilization
After THA there is no need for immobilization
The operated must be kept in a position of
slight abduction and neutral rotation when the patient is lying in bed in the supine position.

36. Immediate postoperative weight bearing as tolerated
Early Postoperative Weight-Bearing Restrictions After Total Hip Arthroplasty Method of Fixation
Cemented:
Immediate postoperative weight bearing as tolerated
Cementless and hybrid
At least 6 weeks from partial weight bearing to full weight bearing

37. Early Postoperative Weight-Bearing Restrictions After Total Hip Arthroplasty
Surgical Approach
Standard
Restricted immediately after surgery
Minimally invasive
Weight bearing as tolerated immediately after surgery

38. Exercise: Maximum Protection
Goals and interventions.
Prevent vascular and pulmonary complications.
Prevent postoperative dislocation or subluxation of the operated hip.
Achieve independent functional mobility prior
to discharge
Maintain strength and endurance in the upper extremities and unoperated lower extremity
Prevent reflex inhibition and atrophy of musculature
Regain active mobility and control of the operated extremity..
Prevent a flexion contracture of the operated hip.

39. Exercise: Moderate and Minimum Protection Phases
Goals and interventions
Regain strength and muscular endurance.
Improve cardiopulmonary endurance.
Reduce contractures while adhering to motion precautions
Improve postural stability, balance, and gait.
Prepare for a full level of functional activities.

40. Accelerated Rehabilitation After Minimally Invasive THA
Immediate postoperative therapy.(5 to 6 hours after surgery)
Postoperative bed and chair transfers
Ambulation with crutches
Ascending and descending stairs
Criteria for hospital discharge.
Transfer in and out of bed
Stand up from and sit down in a stand
Walk 100 feet
Ascend and descend a flight of stairs

41. Operative procedure A posterolateral approach is most commonly used
After removing the head of the femur, the metal-stemmed prosthesis is inserted into the shaft of the proximal femur

42. Exercise: Maximum Protection
Goals and interventions.
Prevent vascular and pulmonary complications.
Prevent postoperative dislocation or subluxation of the operated hip.
Achieve independent functional mobility prior
to discharge
Maintain strength and endurance in the upper extremities and unoperated lower extremity
Prevent reflex inhibition and atrophy of musculature
Regain active mobility and control of the operated extremity
Prevent a flexion contracture of the operated hip.