Total Hip Replacement Surgery - Research Paper Example

? Health Sciences and Medicine Total Hip Replacement Surgery The hip joint has primarily been constructed for walking. Its design allows a full range of motion to include flexion, extension, abduction, and adduction and rotation. It is a congruous joint and the acetabulum and femoral head, also called concave and convex joints, are both symmetrical. The femoral head articulates with the acetabulum, with the femoral head fitting inside the acetabulum and held there by a thick capsule, forming ligaments (Marieb). When we are standing our center of gravity passes by the center of rotation on the hip joint. Weight from standing is eventually transferred to the acetabulum and femur. The femur has a thick protective coat of cartilage which acts as a cushion during high impact and lubricates the joint. The Gluteus Maximus is a muscle which acts to extend the hip and also helps to rotate the hip externally. Other muscles that are much smaller also play an important role in the movement of the hip. Because the hip joint is a congruous joint it is able to move in all directions. The hip joint uses flexion and extension when an individual is walking at a normal pace. As an individual ages, a common occurrence known as bone remodeling takes place. Bone reabsorption and growth of new bone occurs. This can cause remodeling of the joint shape and the loss of cartilage can lead to osteoarthritis. Bone remodeling can cause a disruption of the normal balance and result in pain in the joint. The primary cause of hip arthrosis is osteoarthritis (Walker, p51). When arthrosis occurs in an individual it will typically get worse with joint use. Arthrosis is defined as a degenerative disease of the joint or an articulation between bones. Progressive stiffness and fusion in the hip joint may be caused by a chronic inflammatory condition known as ankylosing spondylitis. Though it is associated with the spine it causes difficulties in the hip joint. Necrosis of the femoral head is caused by the disruption of blood flow. This can be as a result of trauma, as evidenced in some fractures, and it can also occur in several diseases’. Caisson disease, Gaucher’s, sickle cell disease and the use of corticosteroids can each be causative factors in avascular femoral necrosis. Obviously of there is necrosis there is the possibility of collapse and pain (Walker, p52). Arthrosis related to a primary cause is bone remodeling, osteoarthritis, avascular femoral necrosis and these related diseases’. Secondary causes can also lead to remodeling of the joint. Hip dysplasia, trauma to the joint, infection, slipped femoral epiphysis, and Legg-Calve-Perthes disease are each secondary causes of hip joint arthrosis. Hip pain itself can be attributed to multiple causes. Osteoporosis causes a loss of bone over time and can weaken bone to a very brittle and fragile condition, unable to bear weight. Sprains and strain can lead to discomfort and pain. Pinched nerves, such as sciatica or a herniated disk can affect the hip joint. Bone cancer, rickets, bursitis, inflammation and leukemia are also conditions that can lead to hip joint pain (Mayo…). To diagnose an individual’s hip pain a physical examination will need to be done. Assessment will be made of range of motion to determine where the pain is coming from originally. The individuals gait will be assessed and hip pain can be associated often with a ‘Trendelenburg gait’, caused by a weakness of muscles (Walker). Leg length differences, muscle strength in the hip and diagnostics of the back will assist a physician in diagnosing hip pain (Diagnosis…). X-rays, cat scans and MRI’s are common tools that may be used to visualize the hip joint and determine the problem. If management of pain is not possible surgery will be done to correct the condition if that is possible. A pre-operative assessment should include blood tests, urine screening, blood pressure, respirations, temperature, and oxygen saturation levels. These base line assessments are especially important to have after surgery in order to compare and contrast and ensure a patient is recovering. Education is also a part of pre-operative care. Both verbal and written education should be provided. Before surgery is the best time to educate the patient on the expected outcome and pain that they may be experiencing. They are alert and oriented and not groggy from anesthesia. Letting the patient know exactly what to expect will reduce anxiety levels that typically patients feel before surgery. Pre=operative there should be discharge planning, taking into consideration the patients home environment and any factors that may relate to or be a hindrance to a full recovery. In preparing for the surgery the surgeon will meet with the patient and mark the correct leg or area to be operated on with a marker to ensure there are no mistakes. Total hip replacement has been shown to effectively reduce hip and joint pain and the entire procedure and what to expect will be explained to the patient several times. Some risks that will be described are thromboembolisms, or blood clots, and post-operative infections. The main post-operative concern is usually the belief that surgery will not reduce the pain (Gustafsson, p664). Other common concerns are body image, anesthesia, negative perceptions of the future and discontinuity in relationships. One type of possible anesthesia is hypotensive epidural anesthesia. A large dose of anesthesia is injected into the lumbar causing a sensory block at T4 and above. Heart rate and blood pressure will be maintained, with epinephrine given as needed to maintain the rate from going to low. Sedation such as midazolam or something similar is then given to the patient (Hypotensive…). Benefits of this type of anesthesia include reduced blood loss, improved bone cement interface, low rate of deep vein thrombosis, and the technique is cost effective. The surgical procedure will involve removing the femoral head and resurfacing the acetabulum with a concave lining (Gustafsson…). The lining is placed so that the joint can move about smoothly when a prosthetic is placed. A type of cement will be used to allow placement and holding of the prosthesis. It is possible to use an un-cemented prosthetic allowing for bone growth which causes fixation. It will be the surgeon’s choice according to the situation what type of prosthesis is used. Around 10% of surgeries will need a revision in about ten years; this would include removing the original cement and is much more extensive with more recovery time and effort involved. Post-operative care will be monitoring vital signs; blood pressure, respirations, heart rate, O2 saturation, and wound observation. The patient should be assessed for pain, movement, fluid balance, urine output and surgical drainage. It is expected that the patient will be able to stand within one day. It is likely that the patient will have a pain pump, allowing them to control their own pain management. Deep breathing exercises and frequent turning will ensure the patient’s lungs remain free of fluid. Pedal pulses will be assessed and the patient will be encouraged to do foot exercises as soon as they are able to prevent DVT’s. Special socks may be worn to help prevent this also. It is likely that the surgery will be done using a small scope, leaving a very small incision. A drain is inserted so that there is no fluid buildup. The drain usually works with suction, keeping a constant pressure therefore removing the fluid. The appearance of the drainage is important in assessment. Consistency and amount will also be assessed. If the patient is experiencing adequate pain relief they are likely to begin movement much quicker. Physical therapy will begin as soon as the patient is able with the therapist assessing movement soon after surgery. Any complications will be treated and explained though the patient will be aware of their possibility before surgery. Once the patient has healed and become functional it is likely they will gain a new sense of independence. Reduced or absent pain will allow them to participate in the activities of daily living and to resume many activities they may have quit due to pain. They will participate in physical therapy until they learn what needs to be completed and are able to continue on their own until they make a complete recovery. References Diagnosis of Hip Pain - HSS.edu - HSS. (n.d.). Hospital for Special Surgery : Top Ranked Hospital for Orthopedics and Rheumatology. Retrieved December 21, 2011, from http://www.hss.edu/hip-pain-center-diagnosis.asp Gustafsson, B., Ekman, S., Ponzer, S., & Heikkila, K. (2010). The hip and knee replacement operation: an extensive life event B. A. Gustafsson et al. Joint replacements - an extensive life event. Scandinavian Journal Of Caring Sciences, 24(4), 663-670. doi:10.1111/j.1471-6712.2009.00759.x Hypotensive Epidural Anesthesia for Total Hip Replacement. (1999). Acta Anaesthesiologica Scandinavica, 4339. Marieb Human Anatomy Powerpoint 8th Edition Chapter 7 .pdf Full Version. (n.d.). Fast PDF Database Search. Retrieved December 20, 2011, from http://www.ufgop.org/pdf/marieb-human-anatomy-powerpoint-8th-edition-chapter-7/ Mayo Foundation. (2011). Hip Pain Causes. Mayo Clinic. Retrieved December 21, 2011, from http://www.mayoclinic.com/health/hip-pain/MY00257/DSECTION=causes Walker, J. (2010). Total hip replacement: improving patients' quality of life. Nursing Standard, 24(23), 51-58. Read More