BIRMINGHAM HIP RESURFACING ON A 56 YEAR OLD MALE: A CASE REPORT

A Capstone Seminar Paper for PTY 768: Capstone Experience: Case Report Presented to the Faculty of the Physical Therapy Department The Sage Colleges School of Health Sciences

In Partial Fulfillment of the Requirements for the Degree of Doctor of Physical Therapy

Kathy Ruffinen May 2012

_________________________________ Laura Gras, PT, DPT, DSc, GCS Research Advisor

_________________________________ Patricia Pohl, PhD Program Director, Doctor of Physical Therapy

BIRMINGHAM HIP RESURFACING ON A 56 YEAR OLD MALE: A CASE REPORT Statement of Original Work: I represent to The Sage Colleges that this thesis/dissertation/capstone paper and abstract (title listed above) is the original work of the author(s) and does not infringe on the copyright or other rights of others.

(Student’s Signature)________________________ Kathy Ruffinen

________________ Date of Signature

Permission for The Sage Colleges to release work: I hereby give permission to The Sage Colleges to use my work (title listed above) in the following ways:  Place in the Sage College Libraries electronic collection and make publically available for electronic viewing by Sage-affiliated patrons as well as all general public online viewers (i.e. “open access”). 

Place in the Sage College Libraries electronic collection and share electronically for InterLibrary Loan purposes.

 Keep in the departmental program office to show to other students, faculty or outside individuals, such as accreditors or licensing agencies, as an example of student work.

________________________________________ Kathy Ruffinen

________________ Date of Signature

Birmingham Hip Resurfacing on a 56 year old male: A Case Report

Kathy Ruffinen Doctor of Physical Therapy The Sage Colleges

Abstract Introduction: Birmingham hip resurfacing (BHR) is a newer technique that is showing similar outcomes of a total hip arthroplasty with fewer limitations and minimal disruption of the patient’s proximal femoral bone stock. Case Description: The patient was a 56 year old police officer seen in an outpatient physical therapy office a month after surgery presenting with intermittent pain in his left hip, antalgic gait, and impaired hip range. Intervention: His plan of care included strengthening, stretching, balance and proprioception, and neuromuscular re-education through functional activities. Outcomes: After 4 weeks he was pain free, able to walk without gait deviations, ascended and descended stairs with a step over step pattern, and went back to his everyday activities Discussion The patient was perfect for this procedure because the BHR is an up and coming procedure that is used to help younger people with hip disorders stay active and prolong a total hip arthroplasty. Conclusion This patient demonstrates an excellent example of the possible results after a Birmingham hip resurfacing with a faster recovery and similar results as a total hip arthroplasty.

Suggested Keywords: Birmingham hip resurfacing, total hip arthroplasty, resurfacing hip arthroplasty

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Introduction In 2002 there were about 200,000 total hip arthroplasties (THA) in the United States.1 And according to Learmonth there has been 300,000 contemporary metal on metal THA over the past 10 years worldwide.2 The amount of THA and revisions are increasing and will continue to increase as the baby boom generation is starting to reach 65 years old. When THA first became surgically available they were mainly intended for the elderly patient population. However, younger adults are utilizing the availability of THA and total hip resurfacing options. According to the Nationwide Inpatient Sample in 2006, 46% of patients who had a primary THA and 40% of patients who had a THA revision were under the age of 65.3 The increasing number of young people who are getting THA is important to be addressed due to the prevalence of necessary hip revisions. There are a variety of different reasons people have THA. The primary indication for surgery is pain.4 This is often due to osteoarthritis (OA), inflammation, and overall wear and tear. OA is a main indication for THA. Other indications for THA are rheumatoid arthritis, osteonecrosis, injury or fracture of the hip joint or femur, and bone tumors that may break down the hip joint.5 One contributing factor that needs to be further researched is the impact of obesity on joint replacements. In the past decade obesity rates have drastically increased and this could be an additional reason for the increase in joint replacements.1 Reasons people would be deterred from having a THA would be poor health condition, morbid obesity, Parkinson’s Disease, and a high risk of infection.5 THA come with precautions. As with any post-surgical patient there is a risk for infection. Also patients who undergo THA with an anterolateral approach are required to limit range of motion of the hip to hip flexion < 90 degrees, hip internal and external rotation

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