Get Hip to Hip Replacement

By Anne Eby, RNNursing made Incredibly Easy! May/June 20082.0 ANCC/AACN contact hoursOnline: 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: 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:

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:

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

Chronic medical conditions, such as osteoarthritis, osteoporosis, and cancer

Female gender

Decrease bone density

Family history of osteoporosis

Small, slim build

Decreased bone mass density

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

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:

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 mL of drainage during first 24 hours post-op, decreasing to 30 mL 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:

DVT prevention Pain management Hip precautions Prevention of future fractures Activities of daily living

Avoiding Hip Dislocation After Replacement Surgery