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Effects of OA
- pain with WB
- decreased ROM
- crepitus
- decreased strength d/t inactivity
- gait deviations d/t ROM
- functional limitiations
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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
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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
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Proximnal Femoral Osteotomy
intertrochanteric osteotomy-surgically changing the femoral neck-shaft angle to expose healthy cartilage and improve joint congruency
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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
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THR Cemented
- polymethylmethacrylate provides immediate fixations
- useful for pts over 65
- osteoprosis
- Earlier WB
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THR Non-Cemented
- Biological tissue in-growth prosthesis.
- bone grows into beaded or mesh like surgace.
- Longer WB limitations
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Posterolateral Approach
- Most common technique
- intergrity of vastus lateralis, gluteus medius & minimus
- highest incidence of dislocation
- (MR/ADD/Flex will dislocate)
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Lateral Approach
- Incision of gluteus medius and minimus and vastus lateralis
- may cause post op ABD weakness & trendelenburg gait
- may involve trochanteric osteotomy
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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
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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
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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
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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
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Anterior Lateral ROM precautions
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