Total Hip Replacement

TOTAL HIP REPLACEMENT TOTAL HIP REPLACEMENT • • • • • •

Dislocation of hip prosthesis Excessive wound drainage Hemorrhage Biggest concern other than hemorrhage is DVT Infection Associated with immobility Heterotrophic association – formation in periprosthetic space Neurovascular deficit - Avascular necrosis Loosening prosthesis Pneumonia

MANAGEMENT •

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Pain o Assess it o Give Pain meds or monitor PCA o Positioning, making sure comfortable in bed o Modify environment Hemorrhage o Post op H&H will begin to drop within the next 2 or 3 days (normal H&H – 36) o Check VS o LOC o Look at dressing – and look under incision – pull back the cover o Hemovac will be in place: Look at amount, it bright red you know it is active bleeding  Put in place to drain the fluids  Make sure the Hemovac is compressed real tight  May have an Orthopedic drainage system (suction); for the purpose of draining the fluid and when you get to a certain amount the patient can be auto infused with there own blood. Done no more than 8 hours post op. AUTOTRANSFUSSION DRAINAGE SYSTEM o 200-500cc for 1st 24hours o No more than 250cc in the first 8 hours o Within 48 hours want the drainage to be no more than 30cc or less during an 8 hour period o Usually DC Hemovac on Post op Day 2 Neuro Vascular Compromise o Neuro assessment Dislocation o Keep knees apart at all times o Abductor Pillow o Avoid Adduction o Avoid Hip flexion greater than 90o o MORE AT RISK AFTER THEY GO HOME; because immediate post op they are in to much pain to be moving around o Home Teaching  Put pillow between leg when sleeping  Never cross leg when sitting  Avoid bending over when seated in chair  Avoid bending over pick up object on floor  Use raised toilet seat  Sit in a good firm straight back chair; No recliners or sofa  When sitting down be sure to keep a 3” to 6” space between the legs  DO NOT flex hip to put on clothing

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Avoid Low chairs Avoid sitting longer than 45 minutes Avoid tub baths Avoid overexertion

PREVENTION OF DVT o o o o o

Perform ankle / foot exercises TED hose Plexi Pulses Lovenox – 30mg “side effects”  PT (Platelets should not be below 100) If they have a DVT they are at risk for Pulmonary Emboli  Assess pulmonary function

PREVENTION OF INFECTION o o o o o o o

o o

Elderly Obese Poorly nourished Diabetes Look for elevated WBC – above 5-10,000 indicates infection Rheumatoid arthritis Concurrent infection  UTI’s  Dental - Abscesses Large hematoma Hand washing

Watch for dehydration

Prophylactic antibiotics now with future surgical instrumentation

HOME CARE AFTER HIP REPLACEMENT •

Considerations o

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Instructions o o o

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Pain Management  Periodic rest  Distraction / relaxation  Meds (NSAID’s, Opioids) Wound care  Sutures / Staples are removed 10-14 days post op Mobility Self-Care (ADL’s) Potential Problems Keep incision clean and dry Taking care of wound and change dressing Recognize signs of wound infection  Pain, Swelling, drainage, fever

Complications o o o o o o

If they get home and are on pain meds and they do not relieve pain CALL MD Dislocation  Increased pain Shortening of leg Inability to move leg Popping sensation in hip Abnormal rotation DVT – Calf pain, swelling Wound Infection

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Swelling, purulent drainage, pain, fever