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US for THR
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US for THR - October 20, 2005 4:38:00 PM
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erika
Posts: 3
Joined: January 10, 2003
From: long island city, new york, usa
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your comments are highly appreciated:
???US application to the hip ext.rot. of a THR pt. (sec. to pain and tightness)???
thank you!!
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Re: US for THR - October 21, 2005 4:49:00 AM
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JLS_PT_OCS
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From: USA
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If ultrasound worked, perhaps this would be a worthwhile discussion about indications/ contraindications. Since it doesn't work, then don't bother with it.
Surely there are lots of other things you are thinking of doing for this patient that will pay you better dividends.
J
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Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: US for THR - October 21, 2005 3:01:00 PM
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jma
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From: NY
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Haven't heard or seen anyone do US on a THR, not even written on a script.
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Re: US for THR - October 27, 2005 8:56:00 AM
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truthseeker
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If you must, be sure to direct it away from the prosthesis. It can cause cement to fail
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Re: US for THR - October 27, 2005 10:24:00 AM
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ehanso
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From: Minnesota
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I believe that certain US frequencies have been shown to weaken the matrix of the cement. I just talked with an Orhtopaedic Surgeon and he said they use a specific US unit to weaken the cement to remove hardware from joints. The unit is called an Ultra-Drive made by Biomet. I was unable to find the frequency they use from the product info available online. Hope this doesn't muddy the water too much. Ed
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Re: US for THR - January 3, 2006 1:51:00 PM
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clydesdale6
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erika, I think it may actually be a contraindication or atleast a precaution. US over implants is not a great idea. I would avoid it. I agree that it doesnt really work. I would stick with the basics of strenghening and stretching and most THRs will be on their way. Good luck
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Re: US for THR - February 2, 2006 10:48:00 AM
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ehanso
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From: Minnesota
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I received an referral for US to a trochanteric bursitis on a pt with a THA. I called the Biomet company and found the frequency used to remove the cement is either 28 KHz or 40 KHz depending on the company that makes the cement remove tool. If I remember correctly, the higher the frequency the lower the penetration for US. The question remains pertinent. Will either frequency that we use have a negative impact on the cement? Is there a better modality for treatment of trochanteric bursitis?
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Re: US for THR - February 2, 2006 2:14:00 PM
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FLAOrthoPT
Posts: 1011
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From: West Palm Beach
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why would you add heat to a bursitis period
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Re: US for THR - February 2, 2006 3:12:00 PM
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bp2317
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From: Columbus, GA
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i use ultrasound for bursitis all the time, but only pulsed so as not to produce a thermal effect. the clinical educators of our company told us there was a study done (i'm currently trying to get a copy of it to better understand/critique it) that stated that using pulsed ultrasound at .5 W/cm2 showed good results at reducing inflammation. so far, i've had good results with it. as far as US for a THR, i actually got an order for it this week for a patient with hip bursitis and s/p bilateral THR. but so far i haven't tried the US on her.
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Brian Phillips, PT
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Re: US for THR - February 2, 2006 3:35:00 PM
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jma
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From: NY
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I'm curious to know what that study was concerning the pulsed ultrasound and its effect on reducing inflammation as well.
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Re: US for THR - February 2, 2006 3:42:00 PM
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certMDT
Posts: 154
Joined: April 5, 2004
From: Durham, NC
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Brian -
Could you just post the reference?
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Charles Sheets PT OCS Dip MDT
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Re: US for THR - February 2, 2006 4:39:00 PM
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bp2317
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From: Columbus, GA
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we were never told what journal the study was from. all we were given was the person's last name who i guess was the lead investigator. i can't remember what her name was off the top of my head. i have it written down at work and will post it tomorrow. i remember doing a search for the article a few weeks ago but there was a ton of results for that particular last name when i did an author search. i didn't have time to go through them all and forgot to email our clinical educator who told us about it, to get the name of the article. this discussion is a good reminder for me to do so tomorrow when i go in since my first patient for the morning canceled this evening!
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Brian Phillips, PT
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Re: US for THR - February 3, 2006 2:01:00 AM
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bp2317
Posts: 55
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From: Columbus, GA
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i believe (if my notes were correct) that the investigator of the study that our speaker told us about was Mary Dyson. i have emailed him for the specifics of the article. i did a quick search on pubmed, but was unable to determine which article he could be referencing. i'll let you know when he responds to my email.
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Brian Phillips, PT
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Re: US for THR - February 3, 2006 2:44:00 AM
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FLAOrthoPT
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From: West Palm Beach
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I am not a jerk, just not so pro modalities for a variety of reason, mainly that their passive and I do not like what passive treatment does to patients' psyches. But come on now, if there is any contra- or supposed contra about US and a semented prosthesis, and knowing that US really doesn't do all that much, why would you be willing to try it. I mean if it was the end all be all in Tx and was what was going to make or break the patient you could weigh the pros and cons. But ot think we are having a 300 page discussion on whether or not to use US in any setting pulsed or continuous just makes me shake my head (not in a yes fashion). Would you like to be in a deposition going "umm well, I thought maybe the supposed effects of pulsed US and its effects on cell permeability in helping reduce inflammtion would be beneficial and would outweigh and contradindications regarding US and cemented prosthesis, and figured ice is just too long seeing that it takes a whole 10 minutes longer each time." I hope not.
Love,
Ben
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Re: US for THR - February 3, 2006 3:01:00 AM
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ehanso
Posts: 355
Joined: September 14, 2004
From: Minnesota
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Ben, How are you treating your 78 yo female patients who have a THA and bursitis?
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Re: US for THR - February 3, 2006 5:42:00 AM
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Shill
Posts: 1098
Joined: February 13, 2003
From: Madison WI USA
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A question.
If there has NEVER been demonstrated a case of US melting THA cement, why is everyone so paranoid? This says nothing about whether US is helpful in these cases, but has harm ever been demonstrated? If not, any deposition can include that no harm has ever been shown. Its a rumor, or hypothesis, and thats all folks. Im sure someone will correct me if I am wrong, but Ive never seen any REAL evidence of problems.
Pro modalities or not, if you can cite some sort of research to back the potential benefit or complete uselessness, well then you have a leg to stand on. The problem with use of US is that some throw arbitrary settings at the patient, rather than using the settings from the studies (whether they are good studies or not is not my current debate) that showed the purported benefit. Dont do this.
I dont believe US has been shown to reduce inflammation, but rather stimulate the progression from the inflammatory stage to the proliferative stage of healing. The study people are looking for in regards to this was done by Young and Dyson, in Ultrasound in Med and Biol., 1990, 16:261-269, The Effect of Therapeutic Ultrasound on Angiogenesis. The jist is that US at 0.5 w/cm2 causes macrophages to release factors stimulating fibroblast proliferation.
Enjoy your weekend,
Steve
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Steve Hill PT
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Re: US for THR - February 3, 2006 11:28:00 AM
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certMDT
Posts: 154
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From: Durham, NC
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Has there ever been a documented case of e-stim disrupting a demand cardiac pacemaker? This is one of the strongest contraindications we have, but I assume (or maybe I should say I hope) that it is based on the knowledge of how the electrical charges work, and not because someone had a heart attack after some cervical or shoulder e-stim.
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Charles Sheets PT OCS Dip MDT
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Re: US for THR - February 3, 2006 3:13:00 PM
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ehanso
Posts: 355
Joined: September 14, 2004
From: Minnesota
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Charles, Thanks for the reference.
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Re: US for THR - February 3, 2006 3:43:00 PM
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Shill
Posts: 1098
Joined: February 13, 2003
From: Madison WI USA
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Apples to oranges Charles. Apples to oranges.
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Steve Hill PT
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