TherEx Ch 20 Hip

• Hip Syndromes Controlled Motion Phase

  Develop a strong mobile scar and regain flexibility, develop a balance in hip muscle strength and length, develop muscle and cardiopulmonary endurance, patient education
• Hip Syndromes Protection Phase

  Patient education, control inflammation and promote healing, develop support in related areas
• ORIF Moderate and Minimum Protection Phase Goals and Interventions

  Increase flexibility, improve strength and muscular endurance, improve postural stability, neuromuscular response, standing balance and functional mobility, and increase aerobic capacity/ cardiopulmonary endurance
• ORIF Max Protection Phase Goals and Interventions

  Prevent vascular and pulmonary complications, improve strength, re-establish barnacle, postural stability, and safe independent functional mobility, prevent postop reflex inhibition, restore mobility and control
• Hemiarthroplasty Precautions

  Sub max levels, avoid compressive or shear force
• THA Minimal Protection/ Return to Function

  Continued training for restoration of strength, muscular and cardiopulmonary endurance, balance, and symmetrical gait pattern
• THA Moderate Protection Phase Criteria to Progress

  Pain free ambulation with or without an assistive device, functional ROM and strength, and independence of ADL
• THA Moderate Protection Phase Goal and Interventions

  Regain strength and muscular endurance emphasizing strength of hip abd and extensors, improve cardiopulmonary endurance, restore ROM, improve postural stability, balance and gait
• Criteria to progress max protection phase

  Well healed incision, independent level-ground ambulation with or without assistive device, ability to bear full weight without pain and with full knee extension, functional ROM, muscle strength of hip at least 3/5
• THA Max Protection Phase Goals and Interventions

  Prevent vascular and pulmonary complications, prevent postoperative dislocation or subluxation of the hip, achieve independent functional mobility prior to discharge, maintain functional level of strength and muscular endurance in upper extremities and nonoperative lower extremity, prevent relax inhibition and atrophy of muscular in the operative limb, regain active mobility and control of operative extremity, prevent flexion contracture of the operative hip
• THA Max Protection Phase Impairments

  Pain secondary to surgical procedure, decreased ROM, muscle guarding and weakness, impaired postural stability and balance, and decreased functional mobility
• Transgluteal Precautions

  Avoid hip add past neutral, no active antigravity hip abd, no weight-bearing, sleep in supine, don't cross legs
• Anterior/ Anterior lateral and Direct Lateral Precautions

  Avoid hip flexion >90, avoid hip extension, adduction and Er past neutral, avoid combined flexion abd, and er, don't cross legs, during early ambulation avoid hyperextension
• Posterior/ posterior lateral Precautions

  Avoid hip flexion >90, don't cross legs, knees slightly lower than hips when sitting, avoid bending trunk over legs when going from standing to sitting and sitting to standing, When ascending stairs lead with strong, when descending stairs lead with weak, sleep supine with Adduction pillow
• Controlled motion and return to function phase non-operative management

  Progressively increase joint accessory motion and soft tissue mobility, improve joint tracking and pain free motion, improve muscle performance in supporting muscles, balance and aerobic capacity, and provide patient education
• Protection Phase Hypomobility non-operative management

  Patient education, decrease pain at rest, decrease pain during weight bearing, decrease effects of stiffness and maintain available motion
• Femoroacetabular Impingement

  tears in acetabular labrum

  causes=trauma, acetabular labral impingement, capsular laxity, dysplasia, and degeneration
• Joint mobs

  -hip distraction

  -posterior glide

  -anterior glide
• Femoral Nerve


  injury may result from fracture of the upper femur or pelvis, congenital dislocation of the hip, or pressure during a forceps labor and delivery
• Obturator Nerve


  injury may be caused by prolonged fetal head pressure during labor or damage from forceps
• Retroversion

  decrease in the torsion causing femur to rotate laterally
• Anteversion


  increased torsion of the femoral neck causing the femur to rotate medially
• Ischiogluteal Bursitis


  pain when sitting down
• Psoas Bursitis

  Pain in the groin or anterior thigh sometimes in the patellar area if the psoas bursa is inflamed; aggravated by excessive hip flexion
• Trochanteric Bursitis

  Lateral hip pain near the greater trochanter
• ORIF Post-op Mgmt

  Acute: edema control, mobilization while protecting fracture site

  Post Discharge: subacute rehab or SNF or home progression of exercises

  NWB, TTWB, Partial, WBAT
• ORIF Indications

  Displaced or nondisplaced intracapsular femoral neck fractures, stable or unstable intertrochanteric fractures
• Hip Fracture Types

  -Intracapsular (proximal to the hip joint)

  -extracapsular (distal to the hip joint)

  -fracture-dislocation and acetabular trauma
• Hemiarthroplasty Indications

  Acute displaced intracapsular fractures, failed internal fixation, severe degeneration of the femoral head
• THA Complications

  -malpositioning of the prosthetic

  -infection, DVT, pneumonia, delayed wound healing

  -mechanical loosening of implant
• THA Postop Precautions-Transgluteal

  avoid hip adduction past neutral, no active, antigravity hip abduction for 6-8 weeks, no weight bearing exercises, sleep in supine, do not cross legs
• THA Postop Precautions-Anterior

  Avoid hip flexion >90, extension, adduction, ER past neutral, leg crossing, and hyperextension
• THA Postop Precautions-Posterior

  Avoid hip flexion >90, adduction, IR beyond neutral, crossing legs, and bending the trunk over the legs
• THA Indications

  Severe hip pain with motion and weight bearing, loss of articular cartilage, nonunion fracture, instability, deformity, or bone tumors
• Post-immobilization Hypomobility

  Restricted capsular and surrounding periarticular tissue mobility after joint immobilization
• Osteoarthritis


  Articular cartilage breakdown, capsular fibrosis, and osteophyte formation at the hip joint
• Sciatic Nerve Entrapment


  Occurs when the sciatic nerve passes deep to the piriformis muscle
• Leg Length Discrepancy


  May lead to functional or structural scoliosis and altered torsion of the femoral neck
• Tensor fascia latae dominance

  Causes postural impairments and overuse impairments such as trochanteric bursitis and IT band friction syndrome
• Hip abductor muscle weakness

  Associated with valgus collapse at the knee during weight acceptance activities and impairments throughout the lower extremity