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.