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
• 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
  Avoid Low chairs
 Avoid sitting longer than 45 minutes
 Avoid tub baths
 Avoid overexertion
PREVENTION OF DVT
o Perform ankle / foot exercises
o TED hose
o Plexi Pulses
o Lovenox – 30mg “side effects”
 PT (Platelets should not be below 100)
o If they have a DVT they are at risk for Pulmonary Emboli
 Assess pulmonary function
PREVENTION OF INFECTION
o Elderly
o Obese
o Poorly nourished
o Diabetes
o Look for elevated WBC – above 5-10,000 indicates infection
o Rheumatoid arthritis
o Concurrent infection
 UTI’s
 Dental - Abscesses
o Large hematoma
o Hand washing
Watch for dehydration

Prophylactic antibiotics now with future surgical instrumentation

HOME CARE AFTER HIP REPLACEMENT
• Considerations
o Pain Management
 Periodic rest
 Distraction / relaxation
 Meds (NSAID’s, Opioids)
o Wound care
 Sutures / Staples are removed 10-14 days post op
o Mobility
o Self-Care (ADL’s)
o Potential Problems
• Instructions
o Keep incision clean and dry
o Taking care of wound and change dressing
o Recognize signs of wound infection
 Pain, Swelling, drainage, fever
• Complications
o If they get home and are on pain meds and they do not relieve pain CALL MD
o Dislocation
 Increased pain Shortening of leg Inability to move leg
o Popping sensation in hip
o Abnormal rotation
o DVT – Calf pain, swelling
o Wound Infection
 Swelling, purulent drainage, pain, fever