Hip Arthoplasty: Post-operative Nursing Management
Transcript of Hip Arthoplasty: Post-operative Nursing Management
![Page 1: Hip Arthoplasty: Post-operative Nursing Management](https://reader031.fdocuments.us/reader031/viewer/2022012011/613d6215736caf36b75cadf9/html5/thumbnails/1.jpg)
Post-operative Nursing Management:
Hip Fracture Surgery
Eva AUAPN, O&T, QEH
8 July, 2007
![Page 2: Hip Arthoplasty: Post-operative Nursing Management](https://reader031.fdocuments.us/reader031/viewer/2022012011/613d6215736caf36b75cadf9/html5/thumbnails/2.jpg)
Epidemiology
• Hip fracture is a major health problem as population ages
• HK (1995): 11/1000 in women, 5/1000 in men >70yrs (Lau et al, 1999)
• 2003: 40,000 elderly fall, 25% fracture• HK (2031): 24.3% population >65yrs• World wide (2050): 6.3 million hip #• ½ women & 1/3 men sustain a fragility
fracture during their life time (Karlsson et al, 2005)
![Page 3: Hip Arthoplasty: Post-operative Nursing Management](https://reader031.fdocuments.us/reader031/viewer/2022012011/613d6215736caf36b75cadf9/html5/thumbnails/3.jpg)
ORIF VS Hemiarthroplasty
• Parker et al 2002 (RCT of 455 patients)
ORIF Hemi- arthroplasty
Shorter length of anaesthesia
√√
Less blood loss √√
Lower blood transfusion requirement
√√
Low risk for 2°
surgery √√
![Page 4: Hip Arthoplasty: Post-operative Nursing Management](https://reader031.fdocuments.us/reader031/viewer/2022012011/613d6215736caf36b75cadf9/html5/thumbnails/4.jpg)
ORIF VS THR
• Tidermark et al, 2003 (RCT of 102 patients)
ORIF THR
Lower failure rate √√Better hip function √√
HRQOL √√
Low revision rate √√
![Page 5: Hip Arthoplasty: Post-operative Nursing Management](https://reader031.fdocuments.us/reader031/viewer/2022012011/613d6215736caf36b75cadf9/html5/thumbnails/5.jpg)
Arthroplasty as 1° surgery
• THR > bipolar hemiarthroplasty > ORIF• #NOF in active, alert, independent elderly• Better function• Minimize 2°
surgery e.g. removal, revision
• Better HRQOL
• (Blomfeldt et al, 2007 RCT of 120 patients)
![Page 6: Hip Arthoplasty: Post-operative Nursing Management](https://reader031.fdocuments.us/reader031/viewer/2022012011/613d6215736caf36b75cadf9/html5/thumbnails/6.jpg)
Post-op
D0↓
D1-3 RV off, X-rayWeight bearing as tolerated
↓D14 off S/S
![Page 7: Hip Arthoplasty: Post-operative Nursing Management](https://reader031.fdocuments.us/reader031/viewer/2022012011/613d6215736caf36b75cadf9/html5/thumbnails/7.jpg)
Immediate Post-op
• Hourly homodynamic status• Monitor blood loss and fluid balance• Observe for wound oozing and signs of
infection• Wound care• Lower limb circulation and sensation• Pain management• Alignment
![Page 8: Hip Arthoplasty: Post-operative Nursing Management](https://reader031.fdocuments.us/reader031/viewer/2022012011/613d6215736caf36b75cadf9/html5/thumbnails/8.jpg)
Early post-op
Back
![Page 9: Hip Arthoplasty: Post-operative Nursing Management](https://reader031.fdocuments.us/reader031/viewer/2022012011/613d6215736caf36b75cadf9/html5/thumbnails/9.jpg)
Out of bed
![Page 10: Hip Arthoplasty: Post-operative Nursing Management](https://reader031.fdocuments.us/reader031/viewer/2022012011/613d6215736caf36b75cadf9/html5/thumbnails/10.jpg)
Muscle training
• Progressive resistance muscle training optimize muscle strength & improve functional capability in elderly after hip fracture surgery
• Knee extension: ↑72%+/-56%• Leg press: ↑37%+/-30%• (Host et al, 2007)
![Page 11: Hip Arthoplasty: Post-operative Nursing Management](https://reader031.fdocuments.us/reader031/viewer/2022012011/613d6215736caf36b75cadf9/html5/thumbnails/11.jpg)
Muscle training
Back
![Page 12: Hip Arthoplasty: Post-operative Nursing Management](https://reader031.fdocuments.us/reader031/viewer/2022012011/613d6215736caf36b75cadf9/html5/thumbnails/12.jpg)
END?
![Page 13: Hip Arthoplasty: Post-operative Nursing Management](https://reader031.fdocuments.us/reader031/viewer/2022012011/613d6215736caf36b75cadf9/html5/thumbnails/13.jpg)
Complications
• Massive blood loss• Wound infection• Superior gluteal nerve dysfunction• DVT• AROU• Post-op delirium• Dislocation• (Dharmarajan & Prabir, 2006) Fall
![Page 14: Hip Arthoplasty: Post-operative Nursing Management](https://reader031.fdocuments.us/reader031/viewer/2022012011/613d6215736caf36b75cadf9/html5/thumbnails/14.jpg)
DVT
• Risk period: 3 month after hip surgery(Bjornara et al, 2006)
• 35% - 42% in Caucasian hip #(Eriksson et al, 2003)
• 3% in Chinese population with hip #• Not recommended for prophylaxis anti-
coagulation therapy(Chan et al, 2004)
![Page 15: Hip Arthoplasty: Post-operative Nursing Management](https://reader031.fdocuments.us/reader031/viewer/2022012011/613d6215736caf36b75cadf9/html5/thumbnails/15.jpg)
Management of DVT
PreventionPrevention• Ankle pump
exercise• Early ambulation
TreatmentTreatment• Bed rest• LMWH• Warfarin• Monitor clotting• Pressure stocking
Back
![Page 16: Hip Arthoplasty: Post-operative Nursing Management](https://reader031.fdocuments.us/reader031/viewer/2022012011/613d6215736caf36b75cadf9/html5/thumbnails/16.jpg)
AROU
Risk factor• Pain• Position• Anesthesia effect
• AROU ⇒ UTI ⇒ systematic infection
![Page 17: Hip Arthoplasty: Post-operative Nursing Management](https://reader031.fdocuments.us/reader031/viewer/2022012011/613d6215736caf36b75cadf9/html5/thumbnails/17.jpg)
Management of AROU (QEH)
• Multi-disciplinary approach between O&T surgeons, urologist & nurse
• Foley intra-op• Remove Foley within 2 days post-op• Early mobilization & weight bearing• Treat constipation, pain & UTI• To KH after PU without Foley
![Page 18: Hip Arthoplasty: Post-operative Nursing Management](https://reader031.fdocuments.us/reader031/viewer/2022012011/613d6215736caf36b75cadf9/html5/thumbnails/18.jpg)
“Trial without Catheter”
• Re-insert + CSU• R/O bowel/ renal disorder• Consult Surgery/Urology• Treat constipation, pain & UTI• Early mobilization & weight bearing• Try off Foley 2 days after re-insert• To KH after PU without Foley
![Page 19: Hip Arthoplasty: Post-operative Nursing Management](https://reader031.fdocuments.us/reader031/viewer/2022012011/613d6215736caf36b75cadf9/html5/thumbnails/19.jpg)
“Trial without Catheter”
• Foley to BSB• Ix & Tx underlying cause by urologist e.g.
BPH• Treat constipation, pain & UTI• CIC/CISC with RU monitoring in KH till
problem solved• FU by urologist for further Ix e.g. CMG
Back
![Page 20: Hip Arthoplasty: Post-operative Nursing Management](https://reader031.fdocuments.us/reader031/viewer/2022012011/613d6215736caf36b75cadf9/html5/thumbnails/20.jpg)
Delirium
• 41% after hip surgery(Brauer et al, 2000)
• Electrolyte imbalance, metabolic abnormalities
• Infection, hypoxia • Pain, medications• Altered environment, dementia
(Dharmarajan & Prabir, 2006)
![Page 21: Hip Arthoplasty: Post-operative Nursing Management](https://reader031.fdocuments.us/reader031/viewer/2022012011/613d6215736caf36b75cadf9/html5/thumbnails/21.jpg)
Management of Delirium (QEH)
• S – Stress reduction• M – keep Memory• A – Ask question• R – Recall events• T – Time and date orientation and pain
control
![Page 22: Hip Arthoplasty: Post-operative Nursing Management](https://reader031.fdocuments.us/reader031/viewer/2022012011/613d6215736caf36b75cadf9/html5/thumbnails/22.jpg)
SMART
Target patientsTarget patients• > 65 years• MMSE > 20• No communication problem
![Page 23: Hip Arthoplasty: Post-operative Nursing Management](https://reader031.fdocuments.us/reader031/viewer/2022012011/613d6215736caf36b75cadf9/html5/thumbnails/23.jpg)
SMART
• Orientate nursing interventione.g. environment, reason for hospitalization, peri- operative managements
• Show equipment• Maintain memory ability
e.g. call by name, refer to calander
• Provide functional visual or hearing aids• Provide visual and verbal orientation to
date & time• Adequate pain control
![Page 24: Hip Arthoplasty: Post-operative Nursing Management](https://reader031.fdocuments.us/reader031/viewer/2022012011/613d6215736caf36b75cadf9/html5/thumbnails/24.jpg)
SMART
Consequent AssessmentsConsequent Assessments• On admission• The day before OT• Post-op D1
ResultsResults• experimental group: control group⇒19.4% : 60%
Back
![Page 25: Hip Arthoplasty: Post-operative Nursing Management](https://reader031.fdocuments.us/reader031/viewer/2022012011/613d6215736caf36b75cadf9/html5/thumbnails/25.jpg)
Dislocation
• Anterior VS Posterior approach
• Higher rate of dislocation in posterior capsular approach (Bush & Wilson, 2007)
• Treatment: CR +/- OR +/- Revision
![Page 26: Hip Arthoplasty: Post-operative Nursing Management](https://reader031.fdocuments.us/reader031/viewer/2022012011/613d6215736caf36b75cadf9/html5/thumbnails/26.jpg)
Posterior Approach
![Page 27: Hip Arthoplasty: Post-operative Nursing Management](https://reader031.fdocuments.us/reader031/viewer/2022012011/613d6215736caf36b75cadf9/html5/thumbnails/27.jpg)
Anterior Approach
![Page 28: Hip Arthoplasty: Post-operative Nursing Management](https://reader031.fdocuments.us/reader031/viewer/2022012011/613d6215736caf36b75cadf9/html5/thumbnails/28.jpg)
ADL aids
![Page 29: Hip Arthoplasty: Post-operative Nursing Management](https://reader031.fdocuments.us/reader031/viewer/2022012011/613d6215736caf36b75cadf9/html5/thumbnails/29.jpg)
Home Modification
Back
![Page 30: Hip Arthoplasty: Post-operative Nursing Management](https://reader031.fdocuments.us/reader031/viewer/2022012011/613d6215736caf36b75cadf9/html5/thumbnails/30.jpg)
END?
![Page 31: Hip Arthoplasty: Post-operative Nursing Management](https://reader031.fdocuments.us/reader031/viewer/2022012011/613d6215736caf36b75cadf9/html5/thumbnails/31.jpg)
Subsequent Fall
• Management of hip # does not end with surgery
• Prevention of fall• Screen for osteoporposis and risk of fall• Prevent and treat osteoporosis• (Dharmarajan & Banik, 2006)
![Page 32: Hip Arthoplasty: Post-operative Nursing Management](https://reader031.fdocuments.us/reader031/viewer/2022012011/613d6215736caf36b75cadf9/html5/thumbnails/32.jpg)
Prevent Subsequent #
• Community fall prevention campaign
• Fall assessment
• Hip Protector
![Page 33: Hip Arthoplasty: Post-operative Nursing Management](https://reader031.fdocuments.us/reader031/viewer/2022012011/613d6215736caf36b75cadf9/html5/thumbnails/33.jpg)
Thank You!
![Page 34: Hip Arthoplasty: Post-operative Nursing Management](https://reader031.fdocuments.us/reader031/viewer/2022012011/613d6215736caf36b75cadf9/html5/thumbnails/34.jpg)
References• Bjornara BT, Gudmundsen TE, Dahl OE; 2006; Frequency and
timing of clinical venous thromboembolism after major joint surgery: The Journal of Bone & Joint Surgery (Br), Mar 2006, 88,3; pp 386 – 391
• Blomfeldt R, Tornkvist H, Eriksson K, Soderqvist A, Ponzer S, Tidermark J; 2007; A randomized controlled tril comparing bipolar hemiarthroplasty with total hip replacement for displaced intracapsular fractures of the femoral neck in elderly patients; The Journal of Bone & Joint Surgery (Br), Feb 2007, 89, 2; pp 160 – 165
• Brauer C, Morrison RS, Silberzweig SB; 2000; The cause of delirium in patients with hip fracture; Arch Intern Med 2000, 160(12), pp 1856 – 1860
• Bush JB, & Wilson MR; 2007; Dislocation after hip hemiarthroplasty: anterior versus posterior capsular approach; Orthopedics Feb 2007, Vol 30, No.2; pp 138 - 144
![Page 35: Hip Arthoplasty: Post-operative Nursing Management](https://reader031.fdocuments.us/reader031/viewer/2022012011/613d6215736caf36b75cadf9/html5/thumbnails/35.jpg)
• Chan YK, Chiu KY, Cheung SWK, Ho P; 2004; The incidence of deep vein thrombosis in elderly Chinese suffering hip fracture is low without prophylaxis: a prospective study using serial duplex ultrasound; Journal of Orthopaedic Surgery, 2004, 12(2), pp. 178 – 183
• Dharmarajan TS, Prabir B; 2006; Hip fracture: risk factors, preoperative assessment , and postoperative management; Postgraduate Medicine, Jun/Jul 2006, 119,1; pp 31 - 38
• Eriksson BI, Lassen MR; 2003; Duration of prophylaxis against venous thromboembolism with fondaparinus after hip fracture surgery: a multicenter, randomized, placebo-controlled, double-blind study; Arch Intern Med 2003, 163; pp 1337 – 1342
• Host HH, Sinacore DR, Bohnert KL, Steger-May K, Brown M, Binder EF; 2007; Training-induced strength and functional adaptations after hip fracture; Physical Therapy, Mar 2007, 87,3, pp 292 – 303
![Page 36: Hip Arthoplasty: Post-operative Nursing Management](https://reader031.fdocuments.us/reader031/viewer/2022012011/613d6215736caf36b75cadf9/html5/thumbnails/36.jpg)
• Karlsson MK, Gerdhem P, Ahlborg HG; 2005; The prevention of osteoporotic fractures; The Journal of Bone & Joint Surgery (Br), Oct 2005, 87, 10; pp.1320 -1327
• Lau EMC, Cooper C, Fung H, Lam KK, Tsang KK; 1999; Hip fracture in Hong Kong over the last decade – a comparison with the UK; Journal of Public Health Medicine, Vol. 21, No.3, pp.249 -250; Faculty of Public Health Medicine
• Parker MJ, Khan RJK, Crawford GAP; 2002; Hemiarthroplasty versus internal fixation for displaced intracapsular hip fractures in the elderly; The Journal of Bone & Joint Surgery (Br); Nov 2002, 84,8; pp 1150 -1155
• Tidermark J, Ponzer S, Svensson O. Soderqvist A, Tornkvist H; 2003; Internal fixation compared with total hip replacement for displaced femoral nect fractures in the elderly; The Journal of Bone & Joint Surgery (Br); Apr 2003, 85, 3; pp 380 – 388