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    Hip Case Study 1

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    superhoofy7186
    Arthur Black, a 67-year-old retired engineer, had a total hip replacement 6 days ago to treat osteoarthritis (OA) in his left hip. He is keen to return to cycling and running but is managing post-operative pain with NSAIDs. The physiotherapist will assess for stiffness, weakness, leg length discrepancies, and other potential complications from the recent surgery through examination of his skin, posture, range of motion, muscles, and functional tests like walking. The goal is for Arthur to regain mobility while avoiding reinjury as he recovers from his hip replacement and manages his underlying OA and diabetes.

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    Hip Case Study 1

    Uploaded by

    superhoofy7186
    372 views3 pages
    Arthur Black, a 67-year-old retired engineer, had a total hip replacement 6 days ago to treat osteoarthritis (OA) in his left hip. He is keen to return to cycling and running but is managing post-operative pain with NSAIDs. The physiotherapist will assess for stiffness, weakness, leg length discrepancies, and other potential complications from the recent surgery through examination of his skin, posture, range of motion, muscles, and functional tests like walking. The goal is for Arthur to regain mobility while avoiding reinjury as he recovers from his hip replacement and manages his underlying OA and diabetes.

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    Arthur Black, a 67-year-old retired engineer, had a total hip replacement 6 days ago to treat osteoarthritis (OA) in his left hip. He is keen to return to cycling and running but is managing post-operative pain with NSAIDs. The physiotherapist will assess for stiffness, weakness, leg length discrepancies, and other potential complications from the recent surgery through examination of his skin, posture, range of motion, muscles, and functional tests like walking. The goal is for Arthur to regain mobility while avoiding reinjury as he recovers from his hip replacement and manages his underlying OA and diabetes.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOC or read online from Scribd
    Download as doc
    372 views3 pages

    Hip Case Study 1

    Uploaded by

    superhoofy7186
    Arthur Black, a 67-year-old retired engineer, had a total hip replacement 6 days ago to treat osteoarthritis (OA) in his left hip. He is keen to return to cycling and running but is managing post-operative pain with NSAIDs. The physiotherapist will assess for stiffness, weakness, leg length discrepancies, and other potential complications from the recent surgery through examination of his skin, posture, range of motion, muscles, and functional tests like walking. The goal is for Arthur to regain mobility while avoiding reinjury as he recovers from his hip replacement and manages his underlying OA and diabetes.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOC or read online from Scribd
    Download as doc
    of 3

    Hip Case Study 1 : OA

    Arthur Black is an otherwise fit and healthy 67 year old who has had longstanding
    problems with his left hip. He was diagnosed with OA hip by his GP and has recently
    had a total hip replacement. He returned home 6 days post operation and has been
    referred to the domiciliary physiotherapist for assessment and treatment. Arthur is a
    retired engineer who usually cycles and runs alternate days; he is keen to return to his
    usual activities. He is managing his pain with NSAIDs. He has a medical history of
    insulin dependent diabetes and previous episodes of low back pain

    Anatomy & Pathology


    OA most common arthritis is caused by low grade inflammation and results in pain at
    joints – there is abnormal wearing of the cartlidge that covers and acts as a cushion
    inside the joints – also destruction or decrease in synovial fluid – pain on weight
    bearing ligaments – aetiology can be trauma or weight bearing.

    OA hip replacement – problems include thromboembolic , neurovascular injury,


    dislocation, leg length discrepancy and stiffness

    Subjective Examination
    Where\What : hip post op pain different from chronic sharp pain around hip

    When: aks patient

    How: post operative pain

    0-10 rating: lower range than before op

    24 hour cycle: ask patient

    Better for: better for light movement

    Worse for: too much rest = stiffness

    Type of pain: stiffness mild vs sharp chronic around hip

    Past Medical History/ General History:


    Ask about family history of OA
    Red Flags and general concerns: check for diabetes – low back pain indicates
    chronic OA – side effects of operation – DVTS, dislocation, leg length discrepancy.
    And neurovascular injury

    SH: typically active

    DH: ask about insulin , taking NSAID’s

    Patients main outcome: return to regular exercise

    Objective Examination

    Working Hypothesis: patient is recouperating with a background of OA

    Advice & Consent: give and obtain

    General Observations: walking - gauge severity of problem

    Acute Observations:
    skin colour
    swelling
    posture
    muscle bulk
    deformity - are there any signs of infection or vascular injury

    Active, Passive, and Resisted Tests:


    Throughout be aware of possibility of prosthetic dislocation , neurovascular injury –
    expect to find some stiffness – adductors and internal rotators are cut during operation
    – most painful – may pain active and resisted but noticeably less in passive. Expect
    muscles on affected leg to be weaker – especially the forceably cut and rested
    adductors and internal rotators.
    Flexion
    Extension
    Abduction
    Adduction
    Int rotation
    Ext rotation

    Special Tests:
    Homan’s test – passive dorsiflexion in supine – positive sign = pain in calf. A
    standard test for DVT’s – may be relevant

    Functional Tests: observe walking

    Palpation: examine seeking to confirm stiffness in hip as main presenting


    problem – solitary sign indicates a successful operation

    Measurements:
    True leg length ( asis to medial maleolus )
    Apparent leg length ( umblicius to medial maleolus )
    Record any movements in passive that are particularly stiff

    Advice & Possible Treatment:


    Tell possibility of OA in back – non weight bearing exercises will target stiffness .
    Wear related complications are rare – prosthetic lossening may still occur

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