School of Kinesiology

Hip Arthroplasty

Research Paper For Course Preclinical II Student Name: Christopher Cordero Rosas Teacher: klgo. Andres Silva

Introduction

Total hip replacement or known in medical terms as hip replacement, orthopedic surgery lies in looking to replace all or part of the hip joint with an artificial implant called a prosthesis.

Since the first arthroplasty performed in 1826 by John Rhea Barton this surgical technique has undergone many transformations. JM Carnochan in 1840 had the idea to bring a material between joint surfaces, using fascia, muscle and skin. Although in 1890 a German surgeon suggested the possibility of using ivory as a material for joint replacements, the first time he mentioned the possibility of fixing the implants with cement. However, it was not until 1937 that Smith-Petersen MN introduced the first glass pan (mixture of chromium and cobalt). In 1940 he used the first metal prosthesis, reaching in 1948 and methylmethacrylate politretrafluoroetileno (Teflon) in 1958. At this time came another challenge, design, trying to get to one that includes a fixed acetabulum combined with a femoral head that reduces friction and distribute the forces. (Papatheofanis 1994). In the last decade, one of the innovations was the uncemented prosthesis to achieve fixation by bone growth itself.

At this time hip replacement is one of the most commonly used in the United States are performed annually more than 120,000 total replacement of this joint [Papatheofanis 1994], 40,000 in Great Britain [Fitzpatrick 1998], 10,000 in Switzerland [Grind 1992 ] and 14,036 in Spain (Minimum Data Set 1997).

Theoretica framework Anatomy of the Hip

The hip is made of two iliac or innominate bones called, which are strongly welded together the front and back together by the sacrum, it says that the iliac bone is flat and articulates with the sacrum which runs a wedge between the two iliac.The union of these is the lap, where they are staying very important organs in our lives.As interesting details can be named to the acetabulum, which is a spherical cavity is intended for the accommodation of the femoral head to form the hip joint. Articular surfaces acetabulum Acetabulum or the hip (outside of the Coxal): located on the outer face of the bone, presents some crescent-shaped articular and non articular part is the background of the cavity. Is circumscribed by the acetabular eyebrow at its lower edge is interrupted by the recess ischiopubic. The acetabulum is oriented downward and forward Head and neck of femur convex surface, corresponding to two thirds of a sphere. In its center the fovea of the round ligament for insertion of the ligament. The head holds the shaft through the femoral neck, which is facing up, inside and out. acetabular Impeller: fibrocartilage that is inserted in the eyebrow acetabular and its function is to extend the acetabulum to allow better congruency with the femoral head. A notch ischiopubic level, the impeller forms a bridge and is inserted into the transverse acetabular ligament, which is fixed at the ends of the notch. Joint capsule: It's more for the front, anchored in the acetabular eyebrow, the uppermost joint labrum and the transverse ligament. In the femur is inserted in a previous and posterior intertrochanteric line a little above the intertrochanteric crest. acetabular impeller, which serves to expand and joint containment

Ligaments Round ligament: runs from the fovea fovea capitis called round ligament in the femoral head to the bottom of the acetabulum. This is the ligament that holds the joint. iliofemoral ligament or "Y" Bertin, also called the ligament of Bigelow: a powerful ligament that goes from the anterior iliac spine and hip bone Bottom has two portions which are inserted into the anterior intertrochanteric line of the femur (which is why it seems to a "Y"). It is considered the strongest ligament in the body. ligament pubofemoral: As the name suggests, comes from the superior pubic ramus and inserts, slightly below the previous, so that they intersect the appearance of a "Z". It functions as a reinforcement of the bottom of the joint. ligament ischiofemoral: Sale of the ischium and is inserted into the digital fossa of the acetabulum to the femur. annular ligament, called annular (ring) because the sleeve around the joint capsule Biomechanics of the Hip The hip joint is a very strong ball and socket joint coaptation. It has a smaller range of motion in relation to the shoulder joint, but has greater stability. The axes of movement 1. axis, located in a frontal plane, are performed flexion-extension movements 2. Anteroposterior axis, located in a sagittal plane, are made abduction-adduction movements 3. Vertical axis allows the movements of external rotation, internal rotation.

Total Hip Replacement

Total Hip Replacement is surgery to replace a hip joint damaged or diseased.The hip joint is described as a ball and socket type joint, which "fits" the head of the thighbone (femur) comfortably supported in the pelvic cavity (acetabulum). The surface of these bones are covered with cartilage (articular cartilage) soft and compressible. When there is arthritis, the articular cartilage wears away and exposes the underlying bone, this causes the joint surfaces become more harsh and distorted, and that by consulting the patient feels pain and limitations in movement. Hip Replacement Total hip replacement femoral damaged by a stainless steel ball mounted on a stem and re-fill the cavity (acetabulum) with a special polyethylene socket. These components generally adhere to the bone with a type of cement called methylmethacrylate. In special cases you can use other types of stem (a prosthesis), which is always a surgeon's discretion. The new joint for pain relief, decrease stiffness and, in most cases, restore the leg length, thus helping to improve mobility. Osteoarthritis of the hip is generally a disease that occurs in older people, but within the most common causes are also the Rheumatic Diseases such as Rheumatoid Arthritis, Systemic Lupus Eritemaso and ankylosing spondylitis, congenital and developmental diseases Hips: Developmental dysplasia of the hip, Legg Calve Perthes, Epifisiolistesis proximal femoral and sequelae of fractures, hip fractures, infectious, Rescues joint failures during hip surgery, periprosthetic fractures and bone tumors.

Types of arthroplasty Currently, the duration of a total hip prosthesis is approximately 15 years, the selection of which type of implant should be placed, must be a separate decision for each individual. In general terms can be summarized as follows: - In young patients (under 65 - 70 years) recommend the use of uncemented prostheses titanium. The advantages of this type of prosthesis is that it allows the patient's bone to grow and adhere to the prosthesis providing a durable hold. Furthermore, the new technology allows in case of wear of the prosthesis, can change the items worn and not have to make a complete denture. - In older patients (age 70) recommend the use of prosthesis that attaches to the bone with cement. This is because bone quality is worse in older patients and therefore do not have the ability to adhere to the prosthesis.

- In some people can also make joint prosthesis in which one part is fixed to the bone without cement and other cement. These prostheses are called hybrid prostheses. Arthroplasty It replaces the two components of the joint. Partial replacement It replaces only the femoral component. Interposition arthroplasty Remove the femoral head and acetabular cartilage is removed without placing any implant. tissue can be placed so that no patient contact enters the osseous components, this surgery is limited to patients who are severely ill and who are not candidates for another procedure. Bipolar arthroplasty It is a special type of partial replacement where the femoral component has the head in a cup in which tour

Cemented total prosthesis This is the procedure that revolutionized the treatment of osteoarthritis of the hip tune of the decade of 50, but not the total and definitive solution, as was believed at the beginning of your application. Charnleyquin was in 1958, began the current era of total hip replacement for osteoarthritis. He had the virtue of experience to evaluate their cases before publishing their results. He designed a cemented prosthesis. This cement has two components, one liquid (monomer) and a powder (polymer), that together make a dough that, when hardened, anchor both components and fixed to the acetabulum and the femur respectively. This cement is methyl, it is not adhesive, but when filling the cavity fixed prosthetic components. The prosthesis consists of two components: one part polyethylene acetabular high molecular weight high-strength, who came to solve the rapid wear of the old prosthesis. The femoral head was designed Charnley is 22 mm in diameter and was designed to be fitted for a low friction, which was actually achieved.Charnley made the same minimum age as the indication of the prosthesis 65.According to him, should not be placed on minors, the risk of loosening. This concept was corroborated by experience, and that was that when the prosthesis was placed in younger people, is used by them indiscriminately and thus loosening occurs earlier. In this sense, is much more efficient when used for a very normal life of a person over 65 years.

Uncemented prosthesis As there is a significant number of people under 65 who have osteoarthritis of the hip, especially secondary to congenital hip dislocation, femoral head aseptic necrosis or trauma, has continued to seek a prosthetic solution for them. Have been made uncemented prosthesis, to remove the cement, considered one of the reasons given in loosening. The result has been very good in the socket, as the prosthesis is self-tapping or screw, is much less than the cemented prosthesis loosening, at least in the short time it takes in use. The femoral component has the disadvantage that a high percentage of patients, about 30%, persistent pain in the thigh, which yields partially within two years, leaving a smaller percentage of permanent pain. Patients who maintained their pain should undergo a second operation, usually to transform the uncemented femoral component in cemented. Total hip arthroplasty cementless requires greater experience of the surgeon and his technique is more accurate, because it has no editing or cement "fills" the lack of coaptation. For this reason, their rates are much more demanding. They are usually indicated in young patients up to age 65. Hybrid prosthetics Long-term studies of the group of Professor Charnley, England showed that the femoral component loosened little to 19 years term. This fact, coupled with the experience that cementless socket had excellent results, led many centers to perform hip arthroplasty hybrid that is placed acetabular cup without cement and the femoral component is cemented. This procedure has little follow-up time so that, as in the uncemented prosthesis, can not ensure long-term success. Their theoretical understanding that makes us think long-term results are better than those already known to the other types of dentures. It has been assembling the best qualities of many of the prosthesis and experienced Contraindications Very young patients. Current hip infection. Paralysis of quadriceps. Nerve disease. Severe mental dysfunction. Extreme obesity (150 kilos).

 uncontrolled diabetes Serious injuries or heart lung severely impaired blood clotting. Complications Infection. Pistons. Swelling or excessive bleeding. Injury to nerves or blood vessels nearby. Problems related to anesthesia. dislocation of the prosthesis.

Kines TREATMENT EARLY STAGE Lasts until the patient achieves walk with canes. OBJECTIVES: Maintain in good condition the respiratory system, avoid positions of hip instability, improve venous return, decrease postsurgical edema, maintain and / or improve joint and muscle muscles distal peri, improve hip mobility op. and maintain mobility of the lower limbs, Teaching up with batons. Day 1 Exercises Replies Demonstrations Active assisted ERIA op. Work is not intense. Day 2 Work passive hip Active assisted eg Assets free. Ex isometric mus. March. Day 3 Feel the patient. Free Active knee flexion and extension.

Day 4 bipedal position Balancing Work short time intervals Day 5 Increase in standing position Start up with two canes, walker or parallel INTERMEDIATE STAGE Since the patient begins ambulation with two canes, then one, and ends when it starts up without them. OBJECTIVES: Strengthen muscles, improve joint mobility, Delete aftermath of the 1 st phase: swelling, pain, ROM, Improvement of the march, Rehabilitation of the patient to their social environment. Recommended exercises for this phase: stabilizing muscles against resistance exercises. rotators and adductors: Ex isometrics. Strengthen quadriceps, hamstrings and triceps. Start with difficulty. Month and months removed a stick. 2 to 3 months up without poles LATE STAGE Patient leaves the sticks and begins a full functional independence. OBJECTIVES: Retraining the fly without compensation. Retrieve own motor patterns of walking. Integrate into a prosthetic hip movement in the normal way. Reassessment of the patient

YEARS POSTOPERATIVE PERIOD This exercise program after surgery must be performed to restore movement of the hip and go progressively strengthened the muscles of the leg. It is convenient to perform about 10 repetitions of each exercise, 3 times a day (unless otherwise stated in the explanation of each). The exercises should not cause shortness of breath, pain or excessively increase. If this happens with any of them, decrease the number of repetitions. FROM THE FIRST DAY AFTER THE OPERATION Early postoperative rehabilitation kinsica. Immediate rehabilitation goals To prevent dislocation of the hip prosthesis surgery. Begin progressive activation of the operated limb. Prevent complications resulting from respiratory and sleep. Maintain and improve joint ranges. Enable the trunk, abdomen and limbs remain. Relieve pain. Improve the affected extremity musculature and undamaged. Prevent and / or treat edema of the operated limb. Begin seated stage. the patient and start Stander partial discharge as prescribed or type of surgery. Retraining up with technical assistance (cane or walker). Educate the patient and family. It should do the following exercises: Flexion - Extension of the ankle: it is to move the ankle first and then nose down. There will be lying face up on a bed with your leg raised by putting a pillow under the ankle and 10 times an hour. This exercise promotes circulation. Lying on your back with legs extended, place a roll under the ankle. You must enter the front of the leg, bringing the fingertips toward the nose and trying to play with the back of the knee bed. Hold for 5 seconds and rest another 5. WHEN THE PATIENT CAN SIT (from the second day) will, in addition to previous years:

 Knee Extension: Sitting on the bed or a chair, straighten the knee as possible. Hold 5 seconds (count to 5 out loud) and relax others 5. Sitting in a chair, rest your hands on the armrests and then throwing up all attempts of the body weight on them. In this position for 5 counts aloud. Sit back and rest. This will help you regain strength in his arms. WHEN YOU TAKE THE HIGH to continue to pursue the previous years and add the following: Leg Raise: Lie on your back on the bed, fold the unoperated leg keeping the foot resting on the bed. Stretch the operated leg and lift a few inches of the bed. Hold 5 seconds (count to 5 out loud) and slowly lower the leg. Ambulation After the operation, depending on your general condition and ability, will be taught to walk with a walker or crutches, depending on each case, you must learn to walk on level ground and up and down stairs with these devices. If possible, begin to walk straight with crutches, but this guide also includes how to use a walker if necessary. It is important that you wear closed shoes without heel or wedge and with good traction to prevent slips and falls.

WALK WITH WALKER We recommend that you follow these instructions: POSITION: 1. Walker Height: usually, medical personnel will adjust the height of your walker. As a guide remember that when you stand, the handle should be at the height of your hip. 2. Take the walker for their handles firmly and make sure it is well supported on the floor. 3. It should be straight with your operated leg straight and right well, so that the toe of your foot does not deviate inward or outward, it must be facing forward. WALKING: 1. Forward first walker. 2. Take the operated leg not carry much weight on it. 3. Finally, take the good leg.

REMEMBER: "Walker, operated leg, leg." GIVING BACK: When stepping down, and to rotate to one side or complete turn around, follow these tips: 1. Move the walker to turn anywhere. 2. Take small steps first throwing side leg tour. In this way, will be turning around slowly, avoiding rotated on its feet, but runs the risk of falling. WALK WITH STICKS The rods are used to protect his surgically repaired knee and avoid too much weight put on it.

POSITION: 1. Height of rods: usually medical staff will adjust the height of the rods. For reference, remember that when you stand, the handle should be at the height of your hip and the armrest below his elbow. If so, its height is correct. 2. Stand straight and relaxed, with your operated leg straight and straight too, so that the toe of your foot is neither inside nor out, it must be facing forward. WALKING: 1. The stick forward first operated side and leg. 2. Second, take another stick and the operated leg. Do not leave behind the rods, since it will support you could fall. GIVING BACK: When you go walking and want to turn around or turn to one side, follow these tips: 1. Go small steps as we have taught to turn anywhere. 2. Do not turn on your operated leg. STAIRS You will be instructed when to start up and down stairs, as it depends on your particular case. UP STAIRS: To facilitate this, follow the steps described below:

No handrail 1. Take the leg resting against the first step. 2. Place your operated leg on the same step that sound. 3. Forward the rods to be in the same step. Rails and a crutch or cane: 1. Lift the leg resting against the first step 2. Up at the same time the operated leg and the cane or crutch. DOWN STAIRS No handrail 1. Take first the rods. 2. Place your operated leg on the same step to canes. 3. Forward the leg up to the step. By rail: 1. Download the crutch or cane to the next step. 2. Download the operated leg. 3. Lower leg. REMEMBER: "Up with the good leg, down with the operated leg." DAILY ACTIVITIES When carrying out their activities during the day may have trouble bending the hip. We will try to give a series of suggestions to be as independent as possible after surgery. SITTING ON THE CHAIR You should always sit in a highchair!. It is also important to have armrests, because you can use them for support when you sit or stand. Do not try to cross your legs!. SIT: 1. Put the chair back until you feel the friction of the seat in your calves. 2. Go stretch your operated leg forward. 3. Put your hands on the armrests and take them your body weight. 4. With the help of his hands and his leg, lean forward a bit and get to touch the seat. 5. Once seated, position yourself correctly.

RISE: 1. Straighten your operated leg forward. 2. Hold onto your armrests. 3. Lean forward carrying the weight of your body over your leg and arms. 4. Please right once you are standing. Lying in bed Do not place a pillow under your leg, because it can cause stiffness in the hip and knee, making this stretch of the same. It is important to use a bunk, to avoid excessive hip flexion both at bedtime and upon rising. The easiest, at home, will put two mattresses. GO TO THE TOILET Sometimes the toilet in the home is a little low. Adapters are on the market about 10 cm high, whose function would be normal for one cushion chair. To sit or stand, follow the same steps as if it were a chair. BATH, SHOWER: You can choose between standing or use a chair in the shower. It is desirable to place a non-slip mat to prevent slipping. 1. Walk to the edge of the shower and turning around to go get back to the shower. 2. Keep one hand fixed and the other reaches the back of the chair. 3. Move the operated leg first and then the non-operated. BATH: It is recommended that initially use a chair inside the tub. You can install a grab bar for power and use a sponge bath long handle and a hand shower for washing. 1. Walk to the bath. Should be turned back until the tub. 2. Reach the chair wearing a hand back and keep the other fixed. 3. Sit in the chair. Lift your legs over the edge of the tub and place it facing the faucet.Should be washed in this position. To exit the bath: 1. Go twisting while lifting the legs over the edge of the tub. 2. Push off with your arms to stand outside the tub.

CAR Important: seat height supplement for preventing forced flexion of the hip. (Cushion, etc.) 1. Sit back. 2. Slowly lower to the seat. 3. Rotate the body and head wear HOME TIPS - Remove the floor mats, which will prevent falls. - In the market there are some special equipment to get things off the ground without bending over. If you have difficulty in this, you can get one that will facilitate this task.

In order to avoid risk situations in the prosthesis You should sleep on their backs using a bag (cushion or pillow) for 6 weeks. The first 2-3 days is recommended only to lie and sit on the edge of the bed. Sit on a sturdy chair with armrests and firm support. Avoid bending over 90 degrees When you sit always keep your knees below hips. Avoid bending at the waist, if you drop something to pick up. Avoid crossing your legs while sitting or lying position. It is recommended for the health aide. Do not kneel. You should avoid lifting heavy objects. It is not recommended impact sports. You should not drive until 3 to 6 months.

Conclusion The rehabilitation of the operated hip is guided by the history of the disease, preoperative symptoms and surgical technique, and then adjusts the result of successive assessments, which means that, apart from simple cases of surgery in primary intention is not possible to implement a protocol. The adaptation of rehabilitation for each case of hip surgery is often necessary, even mandatory in the 'operations' complicated and reoperations. There is manifest wealth of techniques and the importance of rehabilitation.Therapeutic modalities pay attention to surgical technique and the social context.Rehabilitation in a care facility is, in effect, a financial cost, but allows especially the most vulnerable patients, the most rapid recovery of an autonomy that permits the return to home without assistance and in the best possible