Orthopedic and Sports Medicine Case Studies for Advanced Practice Nurses by Myrick Karen M. DNP APRN FNP-BC ANP-BC;

Author:Myrick, Karen M., DNP, APRN, FNP-BC, ANP-BC;
Language: eng
Format: epub
Publisher: Springer Publishing Company
Published: 2016-07-19T18:00:00+00:00

FIGURE 5.1 Frog lateral radiograph of the left hip demonstrating degenerative joint disease.

FIGURE 5.2 Anterior–posterior radiograph of the left hip demonstrating degenerative joint disease.

FIGURE 5.3 Anterior–posterior view of both (bilateral) hips.

Diagnosis

Progressive (chronic) osteoarthritis (degenerative joint disease) of left hip and early osteoarthritis in left hip.

Interventions

Once you have made the diagnosis of progressive (chronic) osteoarthritis of the hip, there are several treatment options for the patient to consider. In the setting of primary care, physical and pharmacologic therapies were initiated but due to the patient’s increased physical symptoms and poor response to prescribed Naprosyn, you can consider use of an assistance walking device (cane) as needed and physical or water therapy. The patient feels he “has been down this route before and wants something done.” Another medical intervention presented to this patient is cortisone injections to decrease inflammation. The patient was informed about potential side effects that may occur with intraarticular corticosteroid injection procedure such as: pain with injection, postinjection flare, skin pigment changes, fat atrophy, and joint infection (Kruse, 2008). The patient decided upon an intraarticular corticosteroid injection into the left hip which was scheduled and was performed with fluoroscopic guidance.

Patient Education

For your patient to make an informed decision about treatment options, he or she should understand that once chronic osteoarthritis in the hip has been established, generally it worsens over time (Dubin, 2016). The goal of any treatment option is for the patient to be relieved of pain and to decrease their disability. Once achieved, the effort to improve strength and function to resume their desired activities of daily living is the goal.

Follow-Up Evaluation

This patient achieved pain-free status within hours of the injection. He was told to follow up as needed if or when the left hip causes pain or disability. Short-term reduction of pain is the goal of intraarticular corticosteroid injections. Some patients may experience less pain within hours, while with others the pain may return after the preprocedure local anesthetic has worn off. The duration of time the intraarticular corticosteroid injections last varies from patient to patient. It may last weeks to months. Most health care providers limit the amount of cortisone injections given in a specific joint to decrease the potential of further injury within the joint (Cole & Schumacher, 2005; Masala, 2010).

The patient was free of left hip pain and disability for 13 months. He followed up with the orthopedist for consultation, and for a possible second intraarticular corticosteroid injection. Repeat x-rays revealed increased loss of articular cartilage to the left hip. At this time, the patient was informed to consider a future left hip replacement.

REFERENCES

Cole, B. J., & Schumacher, R. H. (2005). Injectable corticosteroids in modern practice. Journal of the American Academy of Orthopaedic Surgeons, 13(1), 37–46.

Dubin, A. (2016). Managing osteoarthritis and other chronic musculoskeletal pain disorders. Medical Clinics of North America, 100, 143–150.

Kruse, D. W. (2008). Intraarticular cortisone injection for osteoarthritis of the hip. Is it effective? Is it safe? Current Reviews in Musculoskeletal Medicine, 1(3–4), 227–233.

Masala, S., Fiori, R., Bartolucci, D. A., Mammucari, M.

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