1. 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.comwww.nursingcenter.com © 2008 by Lippincott Williams & Wilkins. All world rights reserved.

2. The Hip

3. 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

4. Causes of Hip Pain & Disability  Most common cause is osteoarthritis  Rheumatoid arthritis  Femoral neck fracture  Failed previous reconstruction surgeries  Congenital hip disease

5. 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

6. Regions of the Proximal Femur

7. 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

8. Examples of Unstable Pelvic Fractures

9. 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

10. 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

11. Treatment for Hip Fracture  Depends on several factors: Patient’s general health Expected quality of life after surgery Stability of the fracture

12. 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

13. Internal Fixation Devices for Stable Hip Fracture

14. 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

15. Picturing Hemiarthroplasty

16. 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

17. Picturing Total Hip Replacement

18. 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

19. 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

20. 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

21. Patient Teaching  Teach the patient about: DVT prevention Pain management Hip precautions Prevention of future fractures Activities of daily living

22. Avoiding Hip Dislocation After Replacement Surgery