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THA precaution
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THA precaution - September 10, 2007 10:07:21 AM
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Kaden
Posts: 329
Joined: June 17, 2007
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I was curious what folks see in there region regarding the length of time total hip precautions are placed on each individual patient. I see figures from 6-12 weeks and as long as lifetime.
If more towards the latter how do folks address hip/buttock and lumbar stretching that might be needed especially with lumbar conditions, without violating precautions.
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RE: THA precaution - September 10, 2007 12:56:26 PM
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Shill
Posts: 1092
Joined: February 13, 2003
From: Madison WI USA
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Kaden,
This will depend on a number of things. First, the surgeon and his or her preferences. Secondly, and dependent on the first one as well, the type of prosthesis. Traditional metal on polyethylene versus large head metal on metal, versus resurfacing can also dictate what is allowed. With our LH MOM patients, no flexion beyond 90 for 6 weeks, then its OK, and extremes of ADD and IR should be avoided, as should combinations of ADD and IR, flexion with IR, and flexion with ADD, especially when done towards extremes above 90. Resurfacing is the same. Traditional THA are lifetime, especially ADD and IR. Flexion above 90 is sometimes allowed, but should be combined with some ER. The criteria of who gets to do this with a traditional THA and when is something I do not know. In regards to buttock and lumbar stretching, talk to the doc about whether he or she will allow this patient to be carefully flexed (with ER) while in your care, and see what they say. Otherwise, it simply needs to remain avoided.
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RE: THA precaution - September 13, 2007 12:19:57 AM
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smithcove
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I agree w/ shill, I would certainly contact the doc and communicate your POC and concerns. I'm seeing a pt 15 months post THA for periformas and scar tissue restrictions. The ortho has made it clear that the pt is well beyond her precautions stage and to go ahead and stretch the periformas. I frequently place the patient into flex/ADD and IR and stretch.
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RE: THA precaution - September 13, 2007 9:08:21 AM
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jma
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From: NY
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I agree. Discussing this with the MD is important. Some patients present with a lot of range and flexibility during the evaluation.
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RE: THA precaution - September 17, 2007 3:48:47 PM
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AdamP
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Joined: July 27, 2007
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Most physicians in my area say 6 months then they are free to go. I'll do knee to chest and everything after that time as long as it's without pain.
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RE: THA precaution - October 5, 2007 10:51:39 AM
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smithcove
Posts: 44
Joined: February 11, 2007
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How do you guys attempt to stretch the piri especially w/in 6 months of sx
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RE: THA precaution - October 5, 2007 11:38:57 AM
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Tom Reeves DPT ATC
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Joined: March 14, 2006
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in FWB, internally rotate the targeted hip, (remember, FWB) glide the butt back and into adduction (remember FWB) they should feel some stretch. The hip if probably flexed to 60 degrees or so, adduction to 10-15 degrees and IR 10-15 degrees. I generally don't work on stretching the piriformis that early, but if you must, it is the safest way because the weight bearing will maintain the congruency of the joint and keep it where it is supposed to be.
Talk to your surgeon first, often they will resect then reattach the piriformis. Maybe better to just work on standing hip IR/ER. hands on hips and point navel and nose to the right, then to the left. feels a bit like a lazy golf swing.
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