Sunday, April 11, 2021
Monday, March 8, 2021
Lateral (or trochanteric) hip pain is a very common presenting complaint. Patients often report the insidious onset of pain over the hip bone (trochanter). Occasionally, this can be caused by trauma or direct injury to the prominence. Complaints include activity-related increases in pain as well as occasionally pain at rest. Often there will be difficulty lying on the affected side for sleep. Pain is usually described as sharp and burning. It may radiate down the lateral aspect of the thigh along the course of the iliotibial band.
Avascular necrosis (AVN) of the femoral head is a debilitating disease that usually leads to osteoarthritis of the hip joint in relatively young adults (mean age at presentation, 38 years). The disease prevalence is unknown, but estimates indicate that 10,000 to 20,000 new cases are diagnosed in the United States per year, and up to 18% of total hip arthroplasties performed annually are for osteonecrosis of the femoral head.
FEMOROACETABULAR IMPINGEMENT/HIP LABRAL TEARS
The recognition and diagnosis of hip pain in the non-arthritic state has been an evolving process over the past 15 years. Patient complaints often include insidious onset of deep nonpalpable pain. This may be described as deep in the groin or, less commonly, in the buttock area. Activity-related hip pain is the norm, because this is believed to be a condition of the active population. The most common offending activities include but are not limited to running and sitting for long periods of time, with the common mechanism being hip flexion past 90 degrees with some rotation. Patients will often commonly complain of laterally based pain as well, making a true diagnosis difficult to make.
REHABILITATION AFTER TOTAL HIP REPLACEMENT
On the day of surgery, the patient performs deep-breathing and coughing exercises and isometric gluteus and quadriceps-setting exercises. Calf-pumping exercises are initiated to decrease the risk of thrombophlebitis. Lower limbs are maintained in position with an abduction splint. Active-assisted to mild resistive exercises are prescribed for unaffected joints and limbs. On the first postoperative day, the patient begins active-assisted range of motion of the affected hip and knee in all planes, with hip flexion limited to 80 degrees and extension limited to neutral. The patient is instructed in proper transfer techniques and is assisted in getting out of bed to stand for 15-minute periods.
Hip resurfacing is a surgical alternative to total hip arthroplasty. This procedure was performed in the past; however, the results were inferior to that of total hip arthroplasty. More recently, newer technology has allowed for better longevity of hip resurfacing, leading to a renewed interest in this technique.
Tuesday, February 16, 2021
TOTAL HIP REPLACEMENT: INFECTION
Subfascial (deep) infection, whether acute or latent, is a serious complication in joint replacement surgery. It is important to identify the type of infection because prognosis and treatment differ. Also, because any implant can become a focus for infection, patients with a hip prosthesis should be given preventive antibiotics when undergoing dental, urinary, or gastrointestinal procedures.
TOTAL HIP REPLACEMENT: COMPLICATIONS
Although many complications may follow total hip replacement, their incidence is fortunately low. The most common postoperative complications are deep venous thrombosis, neurologic complications, loosening of prosthetic component, dislocation, fracture, and infection.
DYSPLASTIC ACETABULUM AND PROTRUSIO ACETABULI
Reconstruction of the dysplastic or deficient acetabulum presents a particularly difficult surgical challenge, because the anatomic landmarks commonly used as reference points may not be in their normal positions. Portions of the bony circumference of the acetabulum may be deficient as a result of old fractures or congenital dysplasia. For example, in a long-standing posterior fracture dislocation of the hip, the posterior wall of the acetabulum is usually severely deficient; in congenital dislocation of the hip, the acetabulum is shallow and poorly developed. If the femoral head has been dislocated for many years, it articulates with the iliac wing in a pseudoacetabulum. The true acetabulum is stunted, small, and shallow, but its anatomic configuration is usually preserved and identifiable once the contracted overlying inferior capsule is reflected.
TOTAL HIP REPLACEMENT: TECHNIQUE
The procedure for total hip replacement begins with preoperative planning, which includes a complete medical workup of the patient to identify any existing health problems. A rheumatologist or internist often works with the orthopedic surgeon in planning the appropriate medical therapy. The rehabilitation program should also be thoroughly discussed with the patient.
TOTAL HIP REPLACEMENT: PROSTHESES
Arthroplasty, or surgical reconstruction of the joints, has revolutionized the treatment of crippling diseases such as osteoarthritis and rheumatoid arthritis, which destroy the joint’s smooth cartilage surfaces and lead to painful, decreased motion. Relief of pain and improved hip function are dramatic advantages of reconstruction procedures. Hip arthroplasty not only benefits the older patient, but total hip replacement and other procedures using prostheses also now permit young and middle-aged patients with congenital, developmental, arthritic, traumatic, malignant, or metabolic hip disorders to lead active and productive lives.
Tuesday, February 9, 2021
HIP JOINT INVOLVEMENT IN OSTEOARTHRITIS
Osteoarthritis (OA) of the hip is a common problem in the United States and worldwide. As many as 1 in 4 Americans may suffer from OA in their lifetime. With the continued growth of the elderly population in the United States, and the desire for these patients to continue an active lifestyle, OA is a growing medical and economic concern. Appropriate management of OA, both medically and surgically, requires the physician to be able to accurately diagnose the condition.