Chapter 28: Orthoses in total joint replacement Flashcards Preview

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Flashcards in Chapter 28: Orthoses in total joint replacement Deck (18)
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1
Q

Hip dislocation rates are higher in patients with what other factors?

A

History of dislocation
Poor abductors or adductor spasticity
Patient with anterior wall wakness or global instability
Acetabular transplants
Patient with two or more surgeries on the affected side.

2
Q

What type of hip dislocation occurs 85% of the time?

A

Posterior dislocation

3
Q

Posterior dislocation involves what actions?

A

Hip flexion
Adduction
Internal rotation

4
Q

What activities usually are associated with posterior dislocation of the hip?

A
Sitting and reaching toward the univolved side. 
Exiting a vehicle
Reaching for an object on the floor
Learning over to apply shoes
Rising from a low chair
Toilet seat or soft cushion.
5
Q

Anterior dislocation of the hip is associated with what movements?

A

External rotation

Extension

6
Q

What activities usually are associated with anterior dislocation of the hip?

A

Reaching up on a high shelf
Extending hips and trunk to move back into bed
Reaching behind the body while standing to put on a coat
Lying in bed with hips extended
Also with patients with hip dysplasia with excessive femoral anteversion.

7
Q

For a hip orthosis for posterior dislocations. What ROM should the hip be held at?

A
10-20 degrees of abduction
0-70 degrees of flexion
Another suggestion is
0-10 degrees flexion, externally rotated
15-20 degree abduction
8
Q

For a hip orthosis for anterior dislocations, what ROM should the hip be held at?

A
Block extension past -40 degrees
Flexion is blocked at 70Degrees
Another suggestion is
Flexion: 20-30 degrees
Internal rotation: 0-10 degrees
Abduction: 20 degrees
9
Q

What orthosis is usually attached to a HpO for an anterior dislocation of the hip?

A

A KAFO because the patient has global instability due to acetabular insufficiency and it will provide rotational control.

10
Q

When should a prophylactic orthosis be suggested in patients who are recovering from hip arthroplasty?

A

Patient’s with hip dysplasia
Poor bone quality
Patients unable to follow hip precautions.

11
Q

Which patient’s are at risk of recurrent dislocations at the hip?

A

patient’s with neuromuscular disease
Parkinson disease
Spasticity secondary to cerebral palsy or cerebrovascular accident
Or sensory neuropathy

12
Q

Patient’s who have undergone acetabular transplants should be placed in which orthosis and at what angles?

A

HKAFO
Restricted extension and flexion to (-40 to 70) degrees
Neutral hip alignment (no hip abduction or adduction)
Free knee ankle joints

13
Q

For elderly patients who are confused, and have had surgery for hip dislocation, what orthosis should be prescribed?

A

Knee immobilizer, so they can’t flex their knee and it prevents them from flexing their hip

14
Q

What orthosis is suggested for a fracture of the femural neck?

A

Pelvic band and KAFO to control rotation to the floor.

15
Q

What are common neurological complications from hip replacement surgery?

A

Femoral and sciatic nerve palsies. Motor deficits may resolve or be permanent.

16
Q

When their is injury to the peroneal portion of the sciatic nerve after hip replacement surgery what can be seen in the patient?

A

Decreased ankle dorsiflexion during swing

17
Q

When there is injury to the femoral nerve after hip replacement surgery, what can be seen in the patient?

A

Quadriceps, resulting in knee flexion instability.

18
Q

For patient’s with extreme weakness of the quads because of neuromuscular disease, what orthosis can be used?

A

A stance phase KAFO with free knee motion during swing or a double upright KAFO with appropriate locking mechanisms.
A KAFO with drop or bail locks, which requires circumduction.
A KAFO with posterior offset knee joints (more agile patients and those with more active knee extension may prefer this.)

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