Get Hip to Hip Replacement By Anne Eby

Get Hip to Hip Replacement By Anne Eby, RN Nursing made Incredibly Easy! May/June 2008 2. 0 ANCC/AACN contact hours Online: www. nursingcenter. com © 2008 by Lippincott Williams & Wilkins. All world rights reserved.

The Hip

The Joint ¡ One of the body’s largest weight–bearing joints ¡ Consists of two main parts: l l The ball or femoral head Acetabulum (a rounded socket) ¡ Ligaments connect the ball to the socket, providing joint stability ¡ Articular cartilage covers the bone surfaces of the ball and socket joint, cushions the bones, and allows for freedom of movement ¡ The synovial membrane lubricates and eliminates friction in the hip joint

Causes of Hip Pain & Disability ¡ Most common cause is osteoarthritis ¡ Rheumatoid arthritis ¡ Femoral neck fracture ¡ Failed previous reconstruction surgeries ¡ Congenital hip disease

Types of Hip Fractures ¡ Classified as intracapsular or extracapsular: l l Intracapsular involves the femoral neck; 45% of hip fractures Extracapsular involves the intertrochanteric (45%) and subtrochanteric (10%) regions

Regions of the Proximal Femur

Classification of Hip Fractures ¡ Severity and degree of stability: l l Stable—nondisplaced and nondeformed; may not be detectable on X-ray and MRI may be needed Unstable—when femoral neck is displaced; detectable on X-ray

Examples of Unstable Pelvic Fractures

Risks for Hip Fracture ¡ Increasing age ¡ Asian or Caucasian ethnicity ¡ Chronic medical conditions, such as osteoarthritis, osteoporosis, and cancer ¡ Nutritional deficiencies, such as Vitamin D or calcium, or those caused by eating disorders ¡ Tobacco or alcohol use ¡ Certain medications, such as steroids and proton pump inhibitors ¡ Environmental hazards, such as loose rugs, poor lighting, and cluttered floors ¡ ¡ Female gender Decrease bone density ¡ Family history of osteoporosis ¡ Small, slim build ¡ Decreased bone mass density

Signs of Hip Fracture ¡ Pain in the affected hip ¡ Vague complaints of pain in the surrounding area: buttocks, thighs, knees, back, or groin ¡ Shortening and/or external rotation of the affected leg ¡ Swelling or bruising of the hip

Treatment for Hip Fracture ¡ Depends on several factors: l l l Patient’s general health Expected quality of life after surgery Stability of the fracture

Treatment for Hip Fracture ¡ Surgical stabilization with percutaneous hip pinning is the treatment of choice for stable, or nondisplaced, hip fractures ¡ Hemiarthroplasty and total hip replacement are treatment options for unstable, or displaced, hip fractures

Internal Fixation Devices for Stable Hip Fracture

Hemiarthroplasty ¡ A bipolar or unipolar implant is secured into the femoral head with the injection of bone cement around the prosthesis or by bony ingrowth into the prosthesis ¡ Associated with a smaller risk of dislocation

Picturing Hemiarthroplasty

Total Hip Replacement ¡ The acetabulum is resurfaced and fitted with a metal cup ¡ Articulation takes place between the metal cup and the head of the femoral implant ¡ May also be considered in patients without fracture if current treatment modalities aren’t working

Picturing Total Hip Replacement

Postoperative Nursing Care ¡ Monitor vital signs closely ¡ Monitor level of sedation ¡ If the patient has a drain: Expect 200 to 500 m. L of drainage during first 24 hours post-op, decreasing to 30 m. L after 48 hours ¡ Change the dressing daily and assess the wound ¡ Assess pain level and administer pain medications to achieve pain relief ¡ Help with deep breathing and coughing to decrease lung congestion ¡ Make sure hip precautions are in place ¡ Assist with ambulation and activities of daily living

Preventing Complications ¡ DVT prophylaxis with anticoagulant therapy lasting up to 6 weeks post-op and/or compression stockings ¡ Infection prevention with prophylactic antibiotics ¡ Postoperative pneumonia prevention with early ambulation and coughing and deep breathing exercises

Physical Therapy ¡ Consists of gait training and mobility ¡ First the patient learns correct weight-bearing practices ¡ Then skills such as going up and down stairs ¡ The patient is sent home with a list of exercises to perform after discharge

Patient Teaching ¡ Teach the patient about: l l l DVT prevention Pain management Hip precautions Prevention of future fractures Activities of daily living

Avoiding Hip Dislocation After Replacement Surgery