Clinical Decision Making Process in a Patient with Severe Hip OA and PAD Complications of Contralateral Lower Extremity: A Case Report

Background and Purpose: Osteoarthritis (OA) is a degenerative joint pathology frequently treated in outpatient physical therapy (PT). However, patients with this joint disease occasionally present with multiple co-morbidities. Peripheral arterial disease (PAD) is an example of a co-morbidity which can impact the PT evaluation and plan of care. The objective of this case report is to highlight the decision-making process and outcomes for a patient with severe hip OA and history of PAD complications. Case Description: The patient is an 82-year-old male with Grade IV primary OA of left hip and history of a right popliteal aneurism in 2010 secondary to PAD. The aneurism resulted in significant ischemic and neurologic damage distal to the knee. This requires him to wear an AFO on his right lower extremity due to foot drop. The patient experienced progressively worsening left hip pain and dysfunction over the past four years. Despite the surgeon’s recommendation, he elected to forego L hip replacement and pursue conservative management in physical therapy. His goal was to reduce hip pain and improve ability to walk. Outcomes: Patient Specific Functional Scale (PSFS) ratings increased (6.3 – 9.5) and pain ratings on the Numerical Rating Scale (NRS) decreased (7 - 2) following 3 weeks of manual therapy, strengthening, and flexibility exercises. Likewise, moderate improvements were seen in both hip ROM and MMT scores. Discussion: Multiple considerations were made regarding this patient’s history and presentation when developing his POC. This POC was significantly effective in the acute relief of pain and improvement in patient-selected functional activities. Further follow-up with patient would help to determine success with long-term relief of pain and management of functional improvements