Hip OA

Hip OA

1. Predisposing factors

   • Primary
     • LLD
       • Norm: 5 mm
       • One may cause the other (chicken egg)
     • BMI
       • 30+
       • 30+
     • Ethnicity
       • White Causation
     • Gender
       • Female
     • Congenital Dysplasia
       • Coxa Vara/Valgus
       • Femoral Ante/retroversion
       • Acetabular Ante/ Retroversion
       • Coxa Plana/ Profundus
     • Genetics
     • Occupation/ Sports
   • Secondary
     • Disease
       • Marfan
       • Down Syn
       • LCP
     • Trauma (Mechanical)

2. History

   • 50+
   • Pain with Sit to Stand
   • Morning Stiffness <60 mins
   • Prev Inj/ Insidious
   • C shape
     • Ant & Lat hip, Post butt & groin

3. Physical Exam

   • Pain
     • Squatting
     • Active Flexion & Extension
     • Gait (Antalgic)/ WB tolerance
     • Capsular Pattern
       • ABduction, IR, Flexion
     • Refer to Medial Knee
     • Ant& Lat Hip Post Butt Groin
   • Limited
     • IR & Flexion (more than 15 than opp side)
   • Weak
     • ABduction

4. Intervention

   • Modalities
     • FOR Pain: US or E-stim in Posterior musculature or External Rotators NO in Femoral Triangle
     • Ice and heat
   • Manual Therapy
     • Short term effects for PAIN relief and mobility/ function
     • Post glide
       • to improve IR, Flex & ABd
   • LLD
     • Heel lift for more than 5mm difference
   • Posture
     • Improve the Ant Tilt (DECREASE it to decr lordosis)
   • Stretch
     • Hip flexors
       • **pt has + thomas test
   • Strengthen
     • Glut Med & Max in OKC
   • Balance Training
     • Impaired in SLS
   • Gait training
     • Need assistive devise
   • CardioVascular
     • Stationary Bike - Constant glide femoral head post!
   • Weight Control Program
     • Refer to get wt under control
       • Primary Risk Factor is 30+ BMI
   • Pt Education
     • Recreational: discontinue (sport) until we get the ms back/stronger and flexibility
     • Functional: - sleep on opp side w pillow btw knee - If sleep on back: pillow under knees - dont cross leg and make sure chair is high enough
     • Work: get up and move around more NO Prolong stand/ squatting Teach how to Don/doff shoes And Lift
   • Aquatic therapy
     • Swim
     • Backward/Forward Run
     • Heel to butt run
     • Knee to Chest Run
     • Prone/Supine Flutter Kick
   • Meds
     • NSAIDS
       • Temporary pain releif
     • Viscosupplementation
       • Synvisc, Supratz, Orthovisc
       • Hyaluronic Acid Derivative
       • 3-5 injections
     • Cortisone Injection
       • Benefits for 3 months with catabolic effects

5. Prognosis

   • Slow Progression END in THA
   • THA predictive factors
     • Moderate Osteophytes
     • Moderate Joint Space Narrowing
     • High Global assessment of pain
     • Previous trial of NSAIDs
     • Pain Level 4.7 +/10

6. Test/ Measures

   • POsture
     • Lordosis With Ant Pelvic Tilt
   • Can you even Squat Bro?
     • You Can't Fully with report of groin pain
   • Muscle length
     • + Thomas test
   • Gait Analysis
     • Antalgic with DECREASE stance time on affected LE
   • Palpation
     • Greater Troch and POST muscles could have Tenderness (but WONT do CFM)
   • Balance assessment
     • Cannot perform Single Leg Balance without support
   • Self Report Instrument
     • LEFS

7. CPR

   • Squat
   • Active Flexion -> lat hip pain
   • Active Extension -> hip pain
   • +Scour test
   • Passive Hip IR: 25 or less

8. Special Test/ Medical Test

   • Scour
     • ADd & Flex TO ABd & Ext WITH IR & ER 2 Full arc
     • +: Pain and/ or click
   • FABER/ Patrick
     • Passive movement of affected limb' foot on OPP knee
     • +: pain AND knee is above straight leg
     • Assess perpendicular distance of knee to table
   • Jt Space
     • Moderate 2.5 Severe 1.5 with osteophytes / subchondral sclerosis
       • NORM: 3-5 mm
   • ESR
     • LESS than 20 mm/hr

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