A Total Hip Arthroplasty (THA) is a is a reconstructive surgery that

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

Osteoarthritis (OA) of the hip is a breakdown of cartilage tissue

in the hip joint due to inammation, injury, or prolonged wear
and tear. People with OA of the hip will sometimes have trouble
walking and can have pain appearing in dierent locations such
as the groin, buttocks, thigh, or knee. Pain can be a sharp stabbing or a dull aching, and the hip will be sti in most cases. The
two main types of OA are primary and secondary. Primary is
more generalized and secondary occurs after injury, inammation, or a previous condition.
The direct causes of OA are not known, but some factors that
contribute to the disease include joint injury, age, and being
overweight. Other causes may include joints not properly
formed, genetic defects in cartilage, or extra stress on joint. It is
also important to know that one can develop osteoarthritis without having any risk factors.
The cartilage that is broken down during OA is a rm and rubbery substance that covers the end of the bones in normal joints
and is made up of mostly water and proteins. It is a shock absorber for the joints that functions to reduce friction. Cartilage
has the ability to change its shape when compressed because of
its high water content and can somewhat repair when damaged,
but it does not form new cartilage when injured. When osteoarthritis occurs in joints such as the hip and the cartilage breaks
down, it will cause pain, swelling, and deformity within those
joints.
Signs and symptoms include:

Joint stiness getting out of bed and after sitting for an

extended period of time

Pain, swelling, or tenderness of hip joint

Pain aring when active and better at rest
A crunching sound or feeling of bones rubbing together
Possible bone spurs at edge of joint
Inability to move hip for ADL

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.

Disorders of the Hip

OSTEOARTHRITIS

TOTAL HIP ARTHROPLASTY

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:

Hear or feel a popping when diapering your child

Uneven hip height or leg length
Limp or waddle
Constant/debilitating pain in groin or front of hip

Doctors screen every baby for symptoms of hip dysplasia. When

its caught early, it can be treated with braces, casts and sometimes
surgery. But some forms of the condition can develop later in life.
They may cause little or no pain for years. If untreated eventually
can lead to osteoarthritis, deterioration of the joint, and the eventual need for total hip arthroplasty.
All treatment aims to delay the onset of arthritis, but no treatment
is fully successful in avoiding it. Other treatment can include the
following:

Using a can on the side opposite the sore hip to support

your body weight

NSAIDS such as ibuprofen or naproxen

Join a water exercise class. This is a great way to work out

without putting strain on your joints

Lose weight. Every 10 pounds you lose takes about 25

pounds of pressure o your hip

Physical therapy to increase exibility and strengthen the

muscles that support the hip

Slipped Capital Femoral Epiphysis is an unusual disorder of the

hip, but it is not rare. For reasons that are not understood, the
ball at the upper end of the femur slips o in a backward direction. This is due to weakness of the growth plate. Most often, it
develops during periods of accelerated growth, shortly after the
onset of puberty.
SCFE causes are still unknown. Often this condition will present
in obese adolescent males, especially young black males, and
sometimes females, with an insidious onset of the thigh or knee
pain with a painful limp. Hip motion will be limited, particularly internal rotation. Up to 40 percent of causes involve slippage
on both sides.
SCEF is a Salter-Harris type 1 fracture through the proximal
femoral epiphysis. Stress around the hip causes a shear force to
be applied at the growth plate. While trauma has a role in the
manifestation of the fracture, an intrinsic weakness in the physical cartilage is also present. The almost exclusive incidence of
SCEF during the adolescent growth spurt indicates a hormonal
role. The fracture occurs at the hypertrophic zone of the physical cartilage. Stress on the hip causes the epiphysis to move
posteriorly and medially.
Signs and Symptoms 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.

Children who are Caucasian, Asian, and Inuit

have a higher risk of the disease, as are extremely active children, those with ADDD or ADHD, and those exposed to
secondhand smoke.

Signs and symptoms include:

Limping
Trendelenburg or Duchenne gait patterns
Weakness of the Gluteus Medius
Pain (referred) in the groin, thigh, hip, or knee.

LCPD can be diagnosed by eliminating other conditions, such as

Waddling gait

septic arthritis and spondyloepiphyseal dysplasia tarda, and

Loss of motion of hip joint

through several diagnostic procedures.

External rotated foot

Pain in the knee/groin/hip and shortening of hip

The goal of treatment, which requires surgery, is to prevent any
additional slipping of the femoral head until the growth plate
closes. If the head is allowed to slip farther, hip motion could be
limited. Premature osteoarthritis could develop. Treatment
should be immediate within 24 to 48 hours. Fixing the femoral
head with pins and screws has been the treatment choice for
decades. If surgery is absolutely not possible for other reasons,
then placing the child in a type of body cast called a hip spica
may be an option. This is not as successful as surgery and is not
the preferred choice.
PT treatment is going to start out with modalities such as heat,
ice, ultrasound, or electrical current to assist with decreasing any
pain associated with the surgery. When comfortable, normal
range of motion exercises would be appropriate. The therapist is
then going to do some stretching and strengthening exercises to
prevent the disease from happening again. The patient will also
be assisted in using crutches until being able to walk suciently
without them.

X-rays, bone scans,

MRIs, arthrograms, and blood tests may all aid in diagnosis.

The overall goal of any treatment intervention is to preserve the
natural shape of the femoral head and to prevent undue deformation of the surrounding structures while the disease progresses. Surgeries for severe cases may include a tenotomy or osteotomy.
While bed rest, immobilization, activity restrictions, casting, and
surgery are all option to be considered, physical stress will increase the odds of correct bone remodeling.

Therefore, the

treatment options which include a physical therapy component

are highly eective and should be considered. In addition, since
many of the children aected with LCPD were previously physically active, the use of PT will increase their positive outlook on
the disease.
Physical Therapy treatments focus on increasing ROM, balance,
exibility, and strengthening the hip abductors, hip exors, hip,
and hip extensors using both isometric and isotonic exercises.
Typical exercises may include wall squats, bridging, the multihip, and gait training. If the child requires an assistive device to
walk, therapy will incorporate the device into gait training.