Physical Therapy For A Left Total Hip Arthroplasty Surgery

HISTORY OF PRESENT ILLNESS: Patient is a candidate for a total right hip revision. She has 2 units of directed packed red blood cells. It is not autologous. She does had Hepatitis B. She has arthrogryposis. She had a right total hip replacement many years ago by Dr. Dodd at the University of Miami. She has had multiple other surgical procedures as follows. A: She had bilateral foot surgery In the remote past. B: She had left hip surgery a year ago. C: She had right foot

Based on the progress report dated 08/23/16, the patient complains left knee pain upon walking. Discomfort was described as aching, tingling, intense, severe, continuous, pain, discomfort, increasing with movement and varying with activity. Pain is rated as 5/10 without medications and 4/10 with medications.

Based on the progress report dated 03/02/16 by Dr. Ozaeta, the patient has had a right knee corticosteroid injection one week ago. She had to take a Norco yesterday for right knee pain. She saw Dr. Cantrell, who requested 8 additional physical therapy sessions. She has low back discomfort, notable when sitting. She takes nortriptyline and an antihypertensive.

The patient is a 74-year-old female who tells me she did see Dr.[____] and she did get a shot into her hip. She states symptoms are "1000 times better". She does tell me he was done ultrasound and thought she might have a [____] tear, which at this point, if this does not work, she will need likely to have a hip replacement, as he did not think this is fixable at her age.

One afternoon a 67 year-old man presented to the emergency department of a small, rural hospital complaining of severe left leg and hip pain following a fall at home. The patient had no past history of falls. He had a history of impaired glucose intolerance, prostate cancer, hypercholesterolemia and hyperlipidemia. The patient’s current medications were atorvastatin and oxycodone for chronic back pain. The patient stated his pain was ten out of ten on a scale of one to ten with ten being the worst. The left leg appeared shorter than the right, edema was present in the calf, as was ecchymosis and he had limited range of motion. After an evaluation in triage by a registered nurse and a subsequent examination by the emergency department physician, a plan was established to sedate the patient using moderation sedation protocol and perform a manual reduction of the hip.

At today’s visit she is seen at Tiffany hall SNF. She is found in her room. She is awake and alert and oriented. She c/o of pain in her hips and knees, that she describe as achy with a severity of 5/10, the pain does not radiate but does affect her ability to ambulate, she is using a wheelchair. Her pain regimen is Lortab 7.5 mg p.o every 4 hours. She reports that she has increased hip pain when she sleeps on her mattress because she sinks in her mattress. She is schedule to follow up with her orthopedic doctor Dr. Shute.

Three factors that create the need for screening are side effects of medicine, comorbidities and Visceral pain mechanisms (Goodman & Snyder, 2013). Physical therapists as direct access providers, have the responsibility to communicate with attending physicians when one of these factors are obvious or even suspected in a patient. Each factor can affect the outcome of a plan of care.

Mrs. A, 76 years old, first came to the orthopedic surgeon with her painful hip in 2013 because she had progressive pain and functional limitations. Pain medication was not sufficient anymore. Because of a history with severe muscle- and joint pain, degenerative deviations of her back and breast cancer, she was first referred to a rheumatologist and for a bone scan to rule out other diagnoses. The diagnosis hip OA was confirmed by Xray and use of injection of local anesthetics in the hip. Mrs. A. has deliberately chosen her doctor, because of his surgical technique, the anterior minimal invasive surgery (AMIS) and the good experiences she heard from other people. Both the patient and the orthopedic surgeon agreed on planning THA.

As stated earlier, the patient admitting challenge was right total knee replacement related to history of osteoarthritis as evidenced by unrelieved pain. Osteoarthritis (OA) is a disease that “results from cartilage damage that triggers a metabolic response at the level of the chondrocytes” (Lewis, Dirksen, Heitkemper, Barry, Goldsworthy & Goodridge, 2011, p. 1881). As it progress, it causes the cartilage to become “dull, yellow, and granular” instead of being “smooth, white, translucent” (Lewis et al., 2011; Gulanick & Myers, 2014, p. 1881).As a result, it eventually becomes softer, less elastic, and less capable to resist wear during heavy use. Moreover, as the “central cartilage becomes thinner, cartilage and bony growth increases at the joint margins … that results to uneven distribution of stress across the joint” that contributes to a decrease in motion. (Lewis et al., 2011; Gulanick & Myers, 2014, p. 1882). According to this patient, OA has been giving her pain for about two years that lead her to the decision of having the knee replacement.

Through a debilitating scoliosis resultant of poliomyelitis, my grandmother found herself in need of a total hip arthroplasty. Following her journey and meeting the doctors, surgeons and nurses responsible for her procedure and recovery offered my first insight into the medical profession. All members of the team displayed vital interpersonal skills I have since developed in myself, through work experience and volunteering. They presented information in a clear, understandable fashion, and were compassionate and attentive; listening to everything she said.

Arthritis or rheumatism is the leading cause of disability [1]. Arthritis is inflammation of one or more of the joints and the main symptoms of arthritis are joint pain and stiffness, which typically worsen with age [1]. More than 20 million individuals with arthritis have severe limitations in function on a daily basis [2]. Majority of the patients, who goes through this disability, finds their solution by doing Total Hip Replacement (THR) surgery. More than 285,000 hip replacements are performed in the U.S. each year [3]. It is estimated that by 2030 there will be an increment of 175% in the THR surgeries rising the numbers to 0.5 Million [3].Thus, these numbers portray the importance of hip replacement surgeries in the near future. Hip joint deterioration can lead to pain, stiffness or difficulty walking. When these symptoms do not respond to conservative treatment, such as physical therapy, patients may be advised to undergo total hip replacement or hip resurfacing. As part of this treatment, they may receive a “metal-on-metal” hip implant in which the “ball and socket” of the device are both made from metal as shown in Figure 1. These metal implants have been used in total hip replacement (THR) surgeries and hip resurfacing procedures. Because of metal's durability, MoM devices were expected

Physical therapy has come a long way in the last couple of decades, literally transforming the way pain, functional limitations and recovery from surgery is treated. But just as with any other healthcare provider, it’s the people behind the front door - and their treatment philosophy - which makes the critical difference in the patient experience.

The current statutes and directives from the different states will illustrate the dissonance in the present status on PT and medication management in the US (American Physical Therapy Association [APTA], 2013). The APTA recognizes the role of PTs in the medication reconciliation and use of certain medications, but has no official position regarding the ESP of medication prescription for PTs (APTA, 2013). In stark contrast to the stance of the CSP from which from the start fought for prescriptive rights of PTs in the UK since 1999 (CSP, 2013). Currently, no US state or territory accords prescription privileges to PTs. Hence, the author firmly believes that a federal law or the individual PT state practice acts must be amended for PTs to be able to prescribe certain medications relevant to the scope of practice. The scope of practice of the PT profession is dynamic. Therefore the existing regulations and laws should be adapted to the needs of the profession and most importantly the

Despite contrary belief, hip replacement is not necessarily negative. Many Americans believe that in order to have a hip replacement, your condition must be terrible. A survey conducted in 2012 said that almost 1/3 of respondents to the hip replacement survey felt they would have benefited from having their surgery done earlier. This procedure has and continues to change the lives’ of many people in our world. Hip replacement, or arthroplasty, is a surgical procedure in which the diseased parts of the hip joint are removed and replaced with new, artificial parts. These artificial parts are called the prosthesis. The goals of hip replacement surgery include increasing mobility, improving the function of the hip joint, and relieving pain. According to the Centers for Disease Control and Prevention, 332,000 total hip replacements are performed in the United States each year. “Hip Replacement.” Questions and Answers about. N.p., n.d. Web. 21 Oct. 2013.

From firsthand knowledge as a patient for many months’ patient education is the most important tool. I did not know what would worsen or improve my pain or injury until I had a well-developed treatment plan. A physical therapist can work in almost any environment or setting from elderly patients to sports medicine.