A case study of Total hip arthroplasty- A breakdown of rehabilitation process, final part

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A case study of Total hip arthroplasty- a breakdown of rehabilitation process, final part

This is a continuation to my post on
A case study on Total Hip Arthroplasty- A breakdown on Rehabilitation process part 3

So as I promised, I would he moving on to

Analysis of finding
Radiological findings
Plan of intervention/ treatment
Means of treatment

Let begin with analysis of finding

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So analysis of findings is basically a summary of what has been discovered so far during assessment and Examination. Dont forget that our assessment was done from the head to the neck down to the bilateral lowerlombs

For the analysis of findings this what we have:

Muscle bulk was reduced in the left lowerlimb
The Gross Muscle power at the right lowerlimb was 4/5 and that of the left was 2/5
Sensation was impaired at the left lowerlimb
Pain was present at the left lowerlimb (dont forget this was where the arthroplasty was done, so it make sense that he will feel pain in that limb 🦵)
limited Active range of motion (AROM) in the left LL ( I think we all understand the reason for this)
limited passive range of motion (PROM) in the left LL
swelling and oedema at the left lowerlimb ,note that this was a result of inflammation and impaired venous return at the left leg.
So from the functional assessment, we remember that cannot sit without support, however he could try using his hand as support . Also you have have to know that he shouldnt be ambulated, if he cannot sit independently, it is a progressive progress just like the way a baby develops, you definitely dont want to rush anything
Trunk weakness (He can't roll from side to side in bed) this need to be addressed

Now that all on that, lets move on to radiological findings:

Radiological finding before the surgery which in this case is hip arthroplasty shows proximal femoral bone loss which evidently has occurred due to severe vascular damage from the gunshot (we stated this in the history, if you cant remeber, check my previous posts )

Radiological findings done post-op shows that a hip replacement has been done which was hip arthroplasty (with a bipolar head).

Let me chip this in, the difference between a hemi-arthroplasty of the hip and total arthroplasty of the hip is the fact that the former doesnt involves a replacement of the acetabulum, while the latter involves a replacement of the acetabulum.

A total hip replacement is only done when there is a damage to the acetabulum also along side a severe damage to the the femoral bone.

Hip arthroplasty plasty is also mostly done in a case of avascular necrosis of the head of femur, where patient present with severe pain at the hip.

Let proceed based on our analysis of finding how dowe plan our intervention, what exactly do we want to do?

The plan goes does :

First thing first, you want to reduce pain as much as you can , imagine being treated in severe pain, therefore reduce pain first

Second - Reduce swelling , there are various ways you can do this, this I will later state in the means of achieving our intervention

Third- In our analysis of findings we have reduce muscle bulk in the left lowerlimb, so our plan for this is to basically improve muscle bulk for the left lower limb

Fourth - To improve the gross muscle power (GMP) for the left Lowerlimb

Fifth- To improve trunk strength, coordination and control

Sixth- To improve sensation at the left Lowerlimb

Seventh -To improve active and passive range of motion at the left lower limb

Eighth - you see we also want to improve the functional status of this man , first we need to make sure he can sit well before he actually start to walk.

Ninth - we would need to preserve the physiological properties of the musculature

Tenth - Then finally we really need to prevent other complications that might set in as a result of one reason or the other.

Now we just stated or plan of intervention for him, but how do we achieve this plan, what are the means by which these plans can be achieved?

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Means of treatment:

Like i stated relief pain first, here you can use topical Analgesics to relieve pain, you can also use therapeutic positioning to reduce pressure on affceted body part

To reduce swelling using deep effleurage, Therapeutic positioning by elevating the legs slightly to help with venous. In a situation where dorsiflexion and plantar flexion is possible a repeated dorsiflexion and plantarflexion of the ankle should be done this is also called ankle pump exercise . This help with venous return. In his case he has severe weakness of the dorsiflexors and plantarflexore . For this EMS to the dorsiflexor and plantarflexors can go a long way in improving muscle power at the ankle.

Tactile stimulation to improve muscle bulk and EMS to improve gross muscle power

Passive movement to the left lowerlimb

Deep effleurage to area of swelling, this certainly helps with venous return

Assisted and autoassisted exercises to the left LL to improve the strength of the left lowerlimb

Static quadriceps contraction to help strengthen and activate the quadriceps

Patella mobilization to improve left knee stiffness. This is done to preserve the integrity of the patella. Don't forget that the movement of the patella plays an important role in maintaining the normal mechanics of the knee.

Tendon achilles stretching- this definitely help to free up the tendon Achilles to prevent plantargrade deformity from setting in the left leg. In severe cases an ankle foot orthosis might be needed to correct or prevent impending deformity from setting in

Education- make sure to educate where necessary, this is very important

Some education to be done for this man are emphasis on position he can and he cannot assume. This is needed to avoid removal of the implant at the hips .

So this marks the end of this rehabilitation breakdown, but it not over until it is over, rehabilitation can take a lifetime, so expect more however it comes.