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Total Knee/Fractured Hip
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Total Knee/Fractured Hip - August 9, 2004 2:02:00 PM
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Redge
Posts: 6
Joined: June 7, 2004
From: Salt Lake City, Utah
Status: offline
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I am a 51 yr old PT working in home care. I had a TKA in Feb 2002. I crashed my bike this year on 22 May and sustained a cominuted, unstable intertrochanteric hip fracture with a reverse oblique angle. This was repaired with a plate, sliding nail and seveal screws, and we achieved a good alignment of the fragments. My orthopod started me with progressive wt bearing after 8 weeks of toe touch. I continue to feel that there is something not quite right with my TKA. Films show no bone or metal component damage, and I should have more symptoms, I think, if I damaged the polyethelene. I am now thinking that, with the hip fracture, there has been a change in alignment at the knee, and that is contributing to my sense of something wrong at the knee. Do any of you have experience with anything like this? Any thoughts on other possible factors contributing to a perception of knee instability?
Thanks
Rick
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Re: Total Knee/Fractured Hip - August 9, 2004 8:45:00 PM
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Synergy
Posts: 592
Joined: March 11, 2004
From: Texas
Status: offline
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I don't have ANY experience with this at all Redge, but one thing that comes to my mind is the screw-home mechanism and it's functional implications. Instead of there being a problem with the hardware, maybe it's more of a biomechanical issue, i.e. the screw-home mechanism. It may have been altered after receiving the TKA as well as the hip repair. When joints do not rotate on their instant center of rotation, dysfunction can occur.
Having limited thoughts on this, I'm anxious to see what everyone one else has to say.
_____________________________
Chris Adams, PT, MPT
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Re: Total Knee/Fractured Hip - August 23, 2004 1:10:00 PM
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Redge
Posts: 6
Joined: June 7, 2004
From: Salt Lake City, Utah
Status: offline
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Short update. I am now 13 weeks out from my hip fracture/repair. The ortho allowed me to start riding my bike again last week, and I've been on several 15-20 mile (slow) rides. I still walk with a cane due to hip/knee weakness. Knee is slowly improving as patella finds its way with the new alignment (did not utilize the patellar component of the total knee).
Have any of you treated young hip fracture patients? How long before they got off their canes? Did they ever get over their Trendelenburg gait? Any magic exercises to get the gluteus medius going faster?
Thanks!
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Re: Total Knee/Fractured Hip - August 23, 2004 1:13:00 PM
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Redge
Posts: 6
Joined: June 7, 2004
From: Salt Lake City, Utah
Status: offline
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Synergy-I forgot to mention that I think you are right on. The screw-home mechanism was not "normal" after my TKA, and is even less present following the changes in alignment caused by the hip fracture/repair. I am working quite a bit on terminal extension with both open and closed-chain activities. Any suggestions?
Thanks
Rick
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Re: Total Knee/Fractured Hip - August 23, 2004 11:42:00 PM
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Alex Brenner PT MPT OCS
Posts: 1057
Joined: February 29, 2004
From: Kentucky
Status: offline
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Rick,
Without formally evaluating you, I would only be speculating. I would think that your proprioception would be largely decreased and that this decrease in hip/knee proprioception would cause the hip and or knee to not feel right. Along with your gait training/strength training and rehab I would consider working on some proprioception drills/exercises.
ArmyPT
_____________________________
Alex Brenner, PT, MPT, OCS
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