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involves the removal of the damaged head of the femur, and the
replacement of the acetabulum on the pelvis.
During the surgery, the head of the femur, the acetabulum, where
the head of the femur inserts, and any other damaged hip structures
are removed. A metal stem is then placed into the hollow center of
the upper end of the femur either by cement or press to t, which
is a pressure tting. A piece is also attached to the hip to replace the
damages acetabulum. Attached to the stem, is the new head of the
femur that will then t into the new acetabulum joint.
There is also a procedure that is only half of a THA called a partial
hip replacement. For a partial hip replacement, the acetabulum is
not damaged; however, there is damage to the femur, such as a fracture on the surgical neck or head of the femur. Only the head of the
femur will need to be replaced.
The total hip was not introduced to the United Stated until 1969,
since then it has become one of the biggest surgeries in orthopedic
practices across America. When the procedure was rst introduced
to our country, polymethylmethacrylate cement was used to hold
the joint together however, this type of cement is no longer used in
this procedure.
Osteoarthritis (OA) is the most common pathology which may require a THA. Secondary OA conditions that may benet from a total
hip include: Developmental Hip Dysplasia , Pagets Disease, Osteonecrosis of the femoral head
There are several prerequisites a patient must have before becoming
a candidate for a THA, including:
Physical Therapy
NSAIDS for pain,
Weight loss,
Trouble with ADLs,
Use of assisted device must be used with no positive outcome,
Age (mostly 60 years or older).
The goal of the THA is to decrease pain, increase range of motion,
and to make activities of daily life easier. As a THA is a drastic procedure, there are certain activities a post-THA patient will not be able
to do such as jumping, running, and move into positions that may
hurt or cause discomfort to the new joint, such as crossing your legs.
Precautions are taken to increase the life of the new hip and allow for
better movement in other positions such as standing, siting, or walking.
As with any surgery, it is important to monitor swelling, inammation, and heat at the incision site. The surgeon may also prescribe
medication such as blood thinners and antibiotics to help prevent
infection and clotting.
Physical therapy after the surgery should begin immediately. The
physical therapist would start a treatment plan to help with comfort,
strength, and endurance for the new hip. Post THA exercises might
include:
Glut Sets
Hip Abduction
Heel Slides
Quad Sets
Although OA is irreversible, many treatment options are available to avoid pain and disability and to slow its progression.
These options include rest and joint care, use of a cane, nondrug
pain relief techniques, exercise and losing weight, and medications such as a non-steroidal ant-inammatory drug or a prescription pain medication. Other more severe treatment options
include surgeries such as hip resurfacing or hip replacement.
Physical Therapy treatment also plays an important rule for
patients with OA. The main goal is to improve mobility and
lifestyle by controlling the pain and improving the function of
the hip. A PT program should consist of gentle, regular exercise
that may include swimming/water aerobics or cycling as well as
Theraband and foam balance pad exercises. The focus of PT is
to improve strength and ROM, but balance exercises are also
used to help with proprioception and postural stability.
OSTEOARTHRITIS
Jon Watson
Cali Nagy
Tillie Miller
Sara Koskey
Rebecca Stevens
Total Hip
Arthroplasty
Slipped Capital
Femoral Epiphysis
Dysplasia
Osteoarthritis
Legg-Calve-Perthes
Disease
PTA 103
Spring 2013
SLIPPED CAPITAL
FEMORAL EPIPHYSIS
DYSPLASIA
Hip dysplasia, developmental dysplasia, or congenital dysplasia of
the hip is a congenital or acquired deformation or misalignment of
the hip joint. The cup-shaped socket (acetabula), which holds the
ball-shaped top (femoral head) of the thigh bone (femur). When
the tight t between these two pieces is lost, the top of the femur is
able to move within or outside the hip. It can be loosened within
the joint, able to move to easily in and out of the joint (subluxated)
or totally out of the joint (dislocated). As bones keep forming,
sometimes the cup-shaped cavity doesnt grow deep enough to
hold the femoral head.
About 1 in 1,000 babies will either be born with hip dysplasia or
develop it in the rst years of life. It can also show up later in life,
in the teen years or even adulthood. It tends to run in families and
is predominant in girls, rst born children, babies born in breech
position, and in cultures who swaddle their newborns with hips
adducted.
Signs include:
LEGG-CALVE-PERTHES DISEASE
Legg-Calve-Perthes Disease (LCPD) is a disease that aects
children between 3 and 12 years old. The blood supply to the hip
is cut o causing necrosis of the femoral head. The femoral head
begins to fracture and deform due to the ischemia. The disease
progresses in four stages: (1) Femoral head necrosis, (2) Femoral
head and acetabulum fracturing and deformation (3) Femoral
head and acetabulum healing, and (4) Femoral head and acetabulum remodeling.
LCPD is an idiopathic disease. The disease aects children between 3 and 12 years old, although the primary ages aected are
5-8 years old.
have a higher risk of the disease, as are extremely active children, those with ADDD or ADHD, and those exposed to
secondhand smoke.
Waddling gait
Therefore, the