total hip replacement

Patient care

Preoperative: The patient is educated about the procedure, postoperative care, and the expected surgical outcomes. The patient may donate blood before the procedure for use if needed, and blood-saving techniques are used during the surgery. The patient is instructed about postoperative limitations, hip abduction methods, use of a trapeze, mobility regimen, gluteal and quadriceps setting, and triceps exercises. The importance of respiratory toilet is explained, and the proper technique for use of incentive spirometry is taught. Prescribed antibiotics and other drugs are administered. Reports of laboratory and radiological studies are reviewed, and the physician is notified of any abnormal findings. The patient is informed about pain evaluation techniques and the availability of analgesics. Epidural or intravenous PCA may be employed. Preoperative preparations are carried out (skin, gastrointestinal tract, urinary bladder, and premedication), and their significance is explained to the patient. The patient should be encouraged to verbalize feelings and concerns.

Postoperative: Dressings and drainage devices are monitored for excessive bleeding, and the area beneath the buttocks is inspected for gravity pooling of drainage. Dressings are replaced or reinforced according to the surgeon's protocol. Vital signs are monitored, and neurovascular status of the affected extremity is checked frequently, comparing it to the unaffected limb. Analgesics are administered as prescribed and required, and the patient is evaluated for response. The patient is repositioned frequently in prescribed positions, and the integrity of all supportive equipment (splints, pillows, traction devices) is maintained during repositioning. The patient should avoid crossing his legs and internal rotation, which enhance the potential for dislocation of the prosthesis and interfere with venous return. Respiratory status is assessed, and incentive spirometry and deep breathing and coughing are encouraged to prevent pulmonary complications. An exercise program and early ambulation (often on the day after the operation) should begin as prescribed by the surgeon (type and extent of weight bearing on affected limb) and in collaboration with the physical therapist. Raised toilet seats and reclining chairs are used to prevent hip flexion. A diet high in protein and vitamin C is provided, wound healing assessed, and skin breakdown prevented. Antithrombotic devices and anticoagulant drugs are given if prescribed, and the patient is assessed for complications like thrombophlebitis, embolism, and dislocation. The patient will usually be transferred to a rehabilitation center or may rehabilitate at home. Teaching on discharge focuses on the exercise regimen and limitations of the patient's activity and the importance of swimming and walking. Outpatient orthopedic follow-up and therapy are arranged as required. The patient should participate in a weight reduction program if necessary.