We use these guidelines if you received a work-related injury and are curious about the effect of “Scheduled Loss of Use (SLU) on your hip and femur. Then, you could be eligible for a compensation payment determined by the Workers’ Compensation Board’s regulations.
Our SLU report will conclude that you have permanently lost function in the injured body part due to your work-related accident. The determination of impairment is based on New York state Workers’ Compensation guidelines.
Objectives for Determining Hip and Femur Impairment
The hip is a ball and socket joint between the femur and pelvis. A ball and socket joint provides a wide range of motion. The hip and shoulder joints are examples of ball and socket joints.
We must objectively determine if the patient has permanent residual physical deficits due to an injury to the nearest degree through history and physical examination or appropriate diagnostic testing.
Permanent Hip and Femur Impairment Assessment Methods
We will evaluate the degree of permanent residual physical deficit when not expecting further healing during maximum medical improvement (MMI). We must determine the MMI based on the clinical treatment course outcome, expertise, and other additional treatment options.
In addition, we will consider the contralateral extremity and expected values. Typically, one year from the injury or the last surgery is required to determine the time from the injury to MMI.
We must not assess the permanent residual physical deficit severity of the mechanism of injury. Instead, use the time of MMI, including physical bone, muscle, cartilage, tendon, nerve, blood vessel, or other tissue damage.
Hip Range of Motion
Hip range of motion includes:
Abduction: ROM within the coronal plane rotating around an imaginary line through the femur head axis. The normal hip abduction range of motion is 45 degrees, where the lower extremity moves away from the midline.
Adduction: ROM within the coronal plane rotating around an imaginary line through the femur head axis. The normal hip adduction range of motion is 35 degrees, where the lower extremity moves across the midline.
Figure: Abduction and Adduction of the Hip
Internal Rotation: We place the lower extremity in a partial flexion position with the foot planted on the examination table. Then, we will rotate the hip, where the knee crosses the contralateral extremity. The normal hip internal rotation range of motion is 45 degrees.
External Rotation: We place the lower extremity in a partial flexion position with the foot planted on the examination table. Then, we rotate the hip, where the knee moves away from the contralateral extremity. The normal hip external rotation range of motion is 45 degrees.
Figure: Hip Internal and External Rotation
Flexion (forward elevation): ROM within the sagittal plane rotating around an imaginary line through the acetabulum. We will flex the knee and move in front of and above the waist. The normal hip flexion range of motion is 120 degrees.
Extension: ROM within the sagittal plane rotating around an imaginary line through the acetabulum. We place the patient in a prone position, lift the lower extremity over the examination table, and move the leg behind the body to 30 degrees.
Figure: Hip Extension and Flexion
Calculating Loss of Use of the Hip
We will begin to assess any special considerations to determine the overall schedule loss of use of the hip. If there are no special considerations, we add abduction/adduction (A) + internal/external rotation (B) + flexion (C) to the extent of other deficits and calculate the overall schedule loss of use of the hip.
Utilize the following notes when considering other deficits. The maximum loss of hip use must not exceed ankylosis when evaluating based on the range of motion.
Table: Hip: Percent Loss of Use of Hip
To determine deficits, add A + B + C, and we use the following table, values, and notes. The maximum loss of the use of the elbow must not exceed ankylosis. Proportionally adjust the schedule loss of use percentages for the range of motion values.
We use the lower figure if a single motion deficit exists, such as flexion or extension. However, we use the higher figure if both flexion and extension apply.
Notes:
- Abduction and Adduction: We use a 33 1⁄3% loss of use of the leg for complete loss of both deficits.
- Internal and External Rotation: Complete loss of both equals Utilize a 30% loss of use of the leg for complete loss of both deficits.
- We use a 71⁄2-10% leg use loss for posterior extension deficits.
Special Considerations for the Hip
We utilize the special considerations when evaluating enumerated schedule loss of use values or without a provided schedule value. The maximum schedule loss of use value must not exceed the ankylosis value.
- We use a 50% anatomical loss of use of the leg for excision of the femur’s head and neck without prosthetic replacement and add for mobility deficits.
- We utilize a schedule award of a 71⁄2% leg use loss for hip synovitis, bursitis (Iliopsoas bursa, trochanteric bursa, and ischiogluteal bursa. Then, we will evaluate at least two years from the date of injury.
- We determine a schedule award after two years of a fractured pelvis if residual hip impairment presents, such as hip joint mobility restriction or thigh muscle atrophy. The schedule may be a 15-20% loss of the leg.
- We use a 5% loss of use of the leg for 1/2 inch, 71⁄2% for 3/4 inch, and 10% for 1 inch with leg shortening or lengthening.
- Ruptured quadriceps: We evaluate a 15-20% loss for deformity and weakness, then add for mobility deficits. The average loss schedule award is a 20-25% loss use of the leg. However, we will consider a higher schedule for knee laxity.
- We utilize a 10% leg use loss for quadricep atrophy with weakness during knee extension.
- We use a 100% leg loss award for amputation and add other schedule awards for a second or consequential accident or injury, such as a hip fracture.
- Allow two years before conducting a final evaluation and schedule an award for hip fracture, surgical or non-surgical. We will receive an updated x-ray imaging study of the femoral head to assess for bone stock, loosening or displacement/malalignment of hardware. However, we evaluate for schedule award at least six months after removing metallic hardware and no sooner than two years of hardware insertion.
- Total or partial osteotomy, hip arthroplasty, or replacement: We aim to restore joint function and assess results at least twelve months post-operative. Clinical function changes may occur before.
We evaluate the schedule based on the medical assessment of a range of motion (hip flexion):
- leg position, including leg length discrepancy, measured in the supine position, from the umbilicus to the tip of the distal medial malleoli or malrotation
- atrophy, measured at the mid-thigh and compared to the contralateral extremity
- presence of chronic complications, according to the following table unless using classification
We use the following chart to determine the schedule loss of use values. An ideal outcome (Row A) is a 35% schedule loss of use. Then, we will add the value for other deficits to values that closely match the provided deficit in each column when deficits exceed those listed in Row A to the base value of 35% to calculate the total schedule loss of use award value.
Table: Full or Partial Hip Replacement: Schedule Loss of Use
Example:
A patient underwent corrective hip replacement surgery. We determined during MMI that the patient will heal with a fair outcome, limited flexion range of motion at 45 degrees, 0.8 inches leg discrepancy at 20 degrees, and malrotation.
Therefore, we assess hip loss of use by beginning with the hip replacement value (35%), then:
- Add a 10% loss for a higher flexion deficit (45 degrees).
- Add a 10% loss for malrotation (20 degrees).
- The overall value is 55%.
Hip Amputation
We use a 100% loss of leg use for an amputation between the hip joint and the knee.
Please refer to your state’s Workers’ Compensation Board website or speak with your Workers’ Compensation attorney for more information.
