1-YEAR HIP FOLLOW-UP. Thank you for your attention to this matter. If you have any questions, please contact us for assistance. Thomas P.

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Roxanne Gaines
5 years ago
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1 1-YEAR HIP FOLLOW-UP It is imprtant t review the status f yur hip implant(s) during an ffice visit at six weeks, ne year, tw years, and every ther year pstperatively thereafter fr yur safety even thugh yu are feeling great. Lng distance fllw-up evaluatins fr ut-f- state patients are fine. We wuld like t ask yu t cmplete the fllwing evaluatin prtcl. 1) Hip questinnaire: We keep track f each jint separately in ur database. Therefre, I wuld like t request that yu fill ut a self rating frm fr EACH hip, even if bth are identical. Please send t us. 2) Physical Therapy: Add yur name t the physical therapy evaluatin request Give the rder and physical exam frm t yur physical therapist Send the results t us 3) Hip X-Ray: Add yur name t the x-ray request Have the x-ray f yur hip(s) dne at yur lcal hspital r radilgist and request a CD cpy f this x-ray be sent t us As sn as we receive all f the abve, I will review them and send yu a written respnse. If yu prefer t travel here fr an ffice visit fr evaluatin, please call ur appintment line t arrange this (803) (rutine ffice charges will apply). If yu are having significant prblems with yur hip, I will need t see yu in the ffice fr cmplete examinatin t best diagnse it. Thank yu fr yur attentin t this matter. If yu have any questins, please cntact us fr assistance. Thmas P. Grss MD Lee Webb, DNP, APRN, FNP-C 1

2 Attached Frms: 1. Fllw up hip questinnaire (page 3-8) 2a. Physical exam frm (page 9-10) 2b. Physical therapy evaluatin letter (page 11) 2c. Physical therapy evaluatin request (page 12) 3. Hip x-ray request and radilgist's instructins (page 13-15) Call: (803) FAX: (803) If yu dn t have any questins, please fllw the prtcl and fill ut each frm belw, then FEDEX the packet t: Dr. Thmas P. Grss Attn: Hip fllw-up Midlands Orthpaedics & Neursurgery 1910 Blanding St. Clumbia, SC

3 Hip Fllw-Up Frm Name: Date Fllw-up Infrmatin 1. Where was this frm cmpleted? Office Phne Mail-In Internet 2. This questinairre is fr the evaluatin f my (side) hip. Left Right 3. I have had prblems with my (side) hip(s). Left Right Bth 4. Dr. Grss has perated n my (side) hip(s). Left Right Bth 5. Anther surgen has perated n my (side) hip(s). Left Right Bth 3

4 6. Dr. Grss perfrmed the fllwed peratin(s) n me: Ttal hip replacement Hip resurfacing Revisin hip surgery Other: Cmplicatins 1. List any cmplicatins yu had pst-surgery: Nne Wund Infectin Deep Venus Thrmbsis Pulmnary Emblus (Bld clt travelling t lungs) Partial Sciatic Palsy (Nerve injury) Dislcatin Fracture Lsened implant Other: 2. Did yu have any cmplicatins that required further surgery? Yes; Please explain: N Clinical Functin Scre 1. What categry mst clsely represents yur pain level? Nne, r s insignificant that I ignre it Regularly slight Mild Mderate Severe Disabled 4

5 2. My hip pain is lcated in my (check all that apply): N pain Grin Frnt f thigh Buttck Side f thigh Side f hip, near scar Other pain: 3. Please circle yur regular pain level n the fllwing scale. a. 4. Please circle yur highest hip pain level n the fllwing scale. a. 5. Please indicate the severity f yur limp, if any. Nne Slight Mild Mderate Severe Disabled 6. Please indicate yur use f supprt, if any. Nne required Use f a cane r a stick fr lng walks r high activity nly Use f a cane r a stick almst always Use f ne crutch almst always Use f tw crutches r a walker Unable t mve acrss the rm 5

6 7. I am able t walk withut a break: Over ne mile/unlimited 6 blcks r rughly 30 minutes 2-3 blcks r rughly minutes Indr walking nly Bed and chair nly 8. Which f the fllwing describes hw yu take stairs? Nrmally ft-ver-ft withut NEEDING the railing Nrmally using the railing Leading with nn-painful hip ne step at a time Cannt take the stairs 9. I am able t put scks/shes n. With ease With difficulty Unable t put scks r shes n withut help 10. Under what circumstances can yu sit cmfrtably? Any chair/1+ hur High chair/30 minutes Unable t sit cmfrtably 11. Are yu able t get in and ut f a vehicle withut help? Yes N 12. Please list any unrelated rthpaedic issues that yu believe might effect yur hip functin scre (i.e. bad back, arthritis in ther hip, nn-hip pain, etc.) Yes; please list: N 6

7 13. Hw is yur hip jint nw cmpared t befre surgery? Better than my nrmal, healthy, pre-arthritic/damaged hip Feels just like my nrmal, healthy, pre-arthritic/damaged hip Much better than befre surgery, with minr aches and pains Smewhat better than befre surgery Abut the same Wrse than befre surgery Activity Scre 1. Which best describes yur current level f activity? (Please circle ne.) a. 2. Please list any activities that yu participate in regularly. 3. Please list any vigrus activities that yu ccasinally participate in. 4. My activity is nw cmpared t befre surgery. Higher Similar Lwer 7

8 Cnclusins 5. Overall, are yu happy with yur decisin t have this surgery? Yes N 6. D yu have any cmments? 8

9 HIP FOLLOWUP PHYSICAL EXAM Thmas P. Grss M.D Midlands Orthpaedics 1910 Blanding St Clumbia SC Name f patient being evaluated: Date f Surgery: Right: Left: Type f Surgery: Right: Left: Interval frm Surgery: Right: N/A Left: N/A 6 weeks 6 weeks 1 year 1 year 2 year 2 year Or Or Office Use Only Date Received: / / Office Recrd Number: TO BE COMPLETED BY A PHYSICAL THERAPIST 1. Patient Charnley Categry: A1: Unilateral with ppsite hip nrmal A2: Bilateral with satisfactry functin f ppsite hip B: Unilateral ther hip impaired C: Multiple arthritis r medical infirmity 2. Range f Mtin: Right Left a. Flexin Cntracture* b. Flexin t** c. abductin at 45 degees f flexin t d. adductin at 45 degrees f flexin t e. external rtatin at 45 degrees f flexin t f. internal rtatin at 45 degrees f flexin t g. IR with knee flexed t 90 degrees *** * Enter 0 if the leg is able t lie flat n the exam table. ** D nt push past 100 degrees befre 1 year ***D nt perfrm this ne until ne year after surgery please 3. Gait: Nrmal Antalgic Trendelenburg Shrt Leg Other 4. Trendelenburg Sign: 9

10 Psitive Negative 5. Active SLR painful? N Yes If Yes Where? 6. Strength SLR (grade 0-5): 7. Strength Abductin (grade 0-5): 8. Leg Length: Equal Left shrt Right shrt 9. Tender: N Yes If yes, where? 10. Cnditin f incisin: Physical Therapist Signature: Date: Print Name: Address: Please give a cpy t the patient and mail ne t me at the abve address. Thank yu. Updated 1/31/08 10

11 (803) Fax: (803) Blanding St. Clumbia,SC Lake Murray Blvd. Irm,SC Dear Physical Therapist: The persn presenting this frm has had a hip surface replacement perfrmed by Dr. Thmas P. Grss weeks/years ag. We are asking that yu bjectively evaluate his/her hip and send me a reprt. If the patient is less than ne year pstp, the hip cannt be pushed int extreme flexin, adductin and internal rtatin. (See frm). Please recrd the range f mtin that can be achieved by gentle examinatin in this case. If the patient is apprximately six weeks pstp, please review and assist them with my Phase II Hip Exercise Prgram. The patient has been instructed t bring this with him/her in this situatin. Thmas P. Grss M.D Please FAX t: and give the patient a cpy. 11

12 (803) Blanding St. Clumbia,SC Lake Murray Blvd. Irm,SC FOR RADDRESS DATE Please evaluate bth hips in the abve patient fr range f mtin and strength and prvide a reprt n my standardized frm included. Thmas P. Grss M.D Please FAX t: and give the patient a cpy. 12

13 (803) Blanding St. Clumbia,SC Lake Murray Blvd. Irm,SC R FOR ADDRESS DATE Please select/circle ONE sectin (either 1, 2, r 3) t ensure the apprpriate xrays are btained frm the patient s radilgy facility. 1. LEFT a. Diagnses: i. Ostearthritis (OA) f the hip M16.12 ii. Hip pain M RIGHT a. Diagnses: i. Ostearthritis (OA) f the hip M16.11 ii. Hip pain M BILATERAL a. Diagnses: i. Ostearthritis (OA) f the hip M16.10 ii. Hip pain M Views (please include all f the fllwing): 1. AP Pelvis Standing (Please label as STANDING ) 2. AP Pelvis Supine (Please label as SUPINE ) 3. Jhnsn Lateral Please prvide the patient with a CD digital cpy f these x-rays fr my review, and mail t: Midlands Orthpaedics & Neursurgery ATTN: Grss fllw-up 1910 Blanding Street Clumbia, SC

Instructins fr Jhnsn Lateral fr patients pst hip resurfacing The perfect true lateral: Visualize the anterir and psterir neck, just inferir t the

True-lateral (Jhnsn r crss-table) lateral view. (A) Psitin f patient.

14 Instructins fr Jhnsn Lateral fr patients pst hip resurfacing The perfect true lateral: Visualize the anterir and psterir neck, just inferir t the femral cmpnent. The mre neck Anteversin, the mre the hip needs t be flexed Need t see crtex at Cmpnent-Neck junctin C Fig True-lateral (Jhnsn r crss-table) lateral view. (A) Psitin f patient. The lng axis f the left femral neck is lcalized by imaging a line drawn between the antersuperir iliac spine and the superir brder f the symphysis pubis, determining the midpint f the line, and then palpating the greater trchanter and imaging a pint 1 inch 14

15 distal t it. A line drawn between these tw pints parallels the lng axis f the femral neck. (B) The cassette is placed in the vertical psitin with its cephalad brder in cntact with the bdy at the level f the iliac crest; it is parallel with the lng axis f the femral neck. The central ray is perpendicular t the lng axis f the femral neck and cassette and is centered 2.5 inches belw the pint f intersectin f the lcalizatin lines. (C) Rentgengram f hybrid surface arthrplasty. The ischium is tward the bttm f the image. (Fig. B, frm Ballinger PW: Merill s Atlas f Radigraphic Psitins and Radilgic Prcedures, 6 th Ed., Vl. 1. CV Msby, St. Luis, 1986, with permissin.) 15

HIP FOLLOW-UP. Thank you for your attention to this matter. If you have any questions, please contact us for assistance. Thomas P.

HIP FOLLOW-UP. Thank you for your attention to this matter. If you have any questions, please contact us for assistance. Thomas P. HIP FOLLOW-UP It is important to review the status of your hip implant(s) during an office visit at six weeks, one year, two years, and every other year postoperatively thereafter for your safety even