Nursing Care During Total Hip Replacement

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Nursing Care During Total Hip Replacement
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Introduction
Total hip replacement is a medical process by which entails the replacement of the
damaged surfaces of the hip joint and the neck of the femur region. During the process, femur
head is replaced with a shaft on the prosthetic head and the joint surface situated at the
acetabulum which is located on the bowl-shaped synthetic surface joint. Further, a practical
replacement can be done on the femur neck where the femoral sections are replaced.
The hip reflects a ball and socket joint which the femur head fits into the pelvic
acetabulum. The femoral head represents the ball which fits itself on the socket on the
acetabulum regions of the pelvis. Femur head and the inside of acetabulum are shielded with
a thin layer of hyaline cartilage. More often the cartilage is worn out leaving the bone
underlying it exposed leading to pain, stiffness, and shortening of the leg (Park, Koehle &
Deveza, 2016).
Total hip replacements are frequently undertaken procedures. It is initiated to
selectively manage fractures of the hip especially displaced neck femur fractures occasioned
by trauma such as fall as the case for the patient.
Preoperative care
The neck of femur fractures is often as a result of trauma or falls. It leads to the
inability to walk and leads to pain complain on the knee, groin, and thigh or at the back and
difficulty in weight-bearing. Key indicators for surgery entail loss of mobility and pain which
are common preoperative complains before total hip replacement. In more advanced and
severe cases, despite full management care, there still persistent pain, reducing mobility.
Studies have shown that existence of complications on the fracture fixation on the femoral
neck especially articular cartilage loss or failure of the endoprosthesis in acute fractures can
be managed through total hip replacement (Le Manach et al., 2015).
More often nursing care considerations before undertaking total hip replacement are
activity status, age, expectations of the patients and underlying medical diseases if present.
Undertaking patient prioritization is essential in determining the urgency of hip replacement.
Common indicators for undertaking total hip replacement entails osteoarthritis state, post-

traumatic arthritis, avascular necrosis, failure of the hardware and congenital hip dislocations
(Affatato, 2014).
Occurrences of contraindications which are key during surgery entail active
infection, sepsis, neuropathic joint, and malignant tumors. Other relative procedures entail
localized infection, insufficiency of abductor musculature, neurologic deficit and destruction
bone (Perez et al., 2016).
Common diagnostic procedures to be undertaken entail assessment with current
symptoms. Loss of motion, pain and functional impairments are important to consider.
Consultation with orthopedic surgeon often entails observation, subjective interview to
review pain complaints, previous history, and physical examination, such as standing.
Trendenberg tests, gait, supine, objective observation and motion ranges. Other special
investigations entail x-rays on the hip and CT scans (Iamthanaporn, Chareancholvanich &
Pornrattanamaneewong, 2015).
The pre-surgery review is undertaken to assess and determine the approach for
surgery. Surgical approaches can be anterior, anterior lateral, direct lateral, lateral trans
trochanteric approach, lateral approach, posterolateral and posterior approach. Various
approach can be applied as they determine soft tissue damage and key precautions for total
hip replacement (Lamo-Espinosa et al., 2015).
During pre-operative care, prescription of preoperative exercise is essential for the
improvement of hip surgery and is essential in improving the quality of life during the
preoperative phase. Studies and evidence have shown that educational and physiotherapy is
essential for patients with end-stage osteoarthritis (Gill & McBurney, 2013). A six-week
study on exercise and education indicated significant and improved pain and disability for
patients waiting for joint replacement care. Moreover, there were marked improvement on
knowledge, functional and social aspects (Saw, Kruger-Jakins, Edries & Parker 2015).
Assessment and treatment session during this phase is essential in the planning of
post-operative care after total hip replacement. Key beneficial effects entail declined length
of stay, lowered anxiety levels, increased levels of confidence and establishment of trusts
between the patient and physiotherapist early enough (Robertson, Warganich, Ghazarossian
& Khatod 2015). Further, it is essential in developing a patient-specific rehabilitation process
thereafter. Research studies have demonstrated that a mix of verbal explanation and written