Transcript Get Hip to Hip Replacement

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
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One of the body’s largest weight–bearing joints
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Consists of two main parts:
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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
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Most common cause is osteoarthritis
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Rheumatoid arthritis
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Femoral neck fracture
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Failed previous reconstruction surgeries
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Congenital hip disease
Types of Hip Fractures
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Classified as intracapsular or extracapsular:
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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
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Severity and degree of stability:
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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
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Increasing age
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Chronic medical
conditions, such as
osteoarthritis,
osteoporosis, and cancer
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Female gender
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Decrease bone density
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Family history of
osteoporosis
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Small, slim build
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Decreased bone mass
density
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Asian or Caucasian
ethnicity
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
Signs of Hip Fracture
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Pain in the affected hip
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Vague complaints of pain in the surrounding area:
buttocks, thighs, knees, back, or groin
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Shortening and/or external rotation of the
affected leg
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Swelling or bruising of the hip
Treatment for Hip Fracture
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Depends on several factors:
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Patient’s general health
Expected quality of life after surgery
Stability of the fracture
Treatment for Hip Fracture
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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
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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
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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
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Monitor vital signs
closely
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Monitor level of sedation
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If the patient has a
drain: Expect 200 to 500
mL of drainage during
first 24 hours post-op,
decreasing to 30 mL
after 48 hours
Change the dressing
daily and assess the
wound
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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
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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
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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
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Teach the patient about:
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DVT prevention
Pain management
Hip precautions
Prevention of future fractures
Activities of daily living
Avoiding Hip Dislocation
After Replacement Surgery