Caring For A Patient With A Total Hip Replacement

Caring for a patient with a total hip replacement

Nursing, Apr 1998 by Leininger, Susan M

FOLLOW THESE SIX POINTS OF CARE TO HELP PREVENT A DISLOCATION With health care reform reducing the number of specialty units, you can expect to care for more orthopedic patients-including those who've had a total hip replacement. You, like many nurses, may fear caring for these patients because you're afraid you might dislocate their hips. In this article, I'll outline the special care you need to give, including discharge instructions. But first, let's examine why someone may need this procedure.

ORTHOPEDIC OVERVIEW

A patient may need a hip replacement if she's experienced trauma, inflammation, or degeneration of the joint. She may also undergo the procedure to decrease pain and increase mobility. The following terms will help you understand the basics of hip replacement:

total joint arthroplasty. Also called total hip arthroplasty (THA), this procedure involves repairing both sides of the hip joint-the femoral head and the acetabulum. partial joint replacement. This type of arthroplasty involves replacing only one hip component. Hemiarthroplasty (one side only) or bipolar hip arthroplasty (both sides) are variations of partial joint replacement.

revision hip replacement. A hip prosthesis may last 10 to 20 years, depending on the patient's weight and exercise level. Approximately 10% of all patients who've had a THA need to return for a revision because the prosthesis can become worn over time.

MOVING AND TURNING YOUR PATIENT

You may worry that moving your patient after a hip replacement could cause her hip to dislocate. (See

How a Hip Can Dislocate.) But if you remember these six major points, you'll avoid serious problems:

1. Always keep your patient's legs abducted or apart. To maintain this position, use an abductor splint or abductor pillow or place two folded pillows between her legs.

2. Make sure the hip never flexes more than 90 degrees. This is most likely to happen when your patient's in bed, in a chair or a wheelchair, or on a commode. If she needs to attain an 80- or 90-degree hip flexion while she's sitting in bed, adjust the head of the bed to 60 degrees, then place pillows under her shoulders.

3. Always keep the operative leg in the neutral position, toes pointing up. To maintain this position, roll up a towel and place it on the leg's outer side to prevent it from rotating externally. The pillows between the legs will prevent internal rotation.

4. Turn your patient onto the operative side only. In certain institutions, you'll need a physician's order to turn her onto the nonoperative side. When turning her, adjust the head of the bed to the low position, place pillows between her legs to. keep them in the neutral position, and turn her slowly.

5. Favor the unaffected side. When helping your patient out of bed, let her move to the edge of the bed by herself. Then have her step down with the unaffected side to maintain abduction and prevent acute flexion at the hip joint. If she becomes unsteady, the unaffected leg will help provide stability. Always refer to the weight-bearing order from the physician when getting your patient out of bed.

6. Elevate the affected extremity As you transfer your patient to a wheelchair, keep the affected extremity elevated with your hand. If you transfer the patient to a stationary chair, make sure it has arms and is high, firm, and upright.

OUT OF THE HOSPITAL

Once your patient has been discharged, she'll need to remember many instructions. This list can help you give her the best advice following surgery.

In the car. Instruct her to lead with the unaffected leg when getting in and out of a car. That way, the unaffected leg won't push her affected leg into abduction. Reinforce the importance of preventing her legs from coming toward the midline. Once in the car, she should recline the seat to maintain a comfortable angle. If she must sit in a bucket seat, instruct her to use her arm strength to ease herself into and out of the seat.

In the bathroom. Tell your patient to take a shower instead of a bath. That way, she'll have an easier time getting in and out of the tub. Suggest installing rails on the shower walls and nonskid surfaces on the tub or shower floor for safety. For toileting, she should always use an elevated commode seat to prevent posterior hip dislocation. Show her how to use the seat in the hospital and instruct her to continue using it when discharged. Be sure to tell her to wipe from the front after elimination instead of twisting to clean herself.

In general. Tell your patient never to cross her legs, bend over, lift heavy objects, kneel, or sit on low chairs. Any of these movements can cause a dislocation. Instruct her to push herself up out of a chair with her arms instead of her legs.

GAINING CONFIDENCE IN YOUR CARE

These tips can help you provide optimal care for a patient who's had a total hip replacement. With the knowledge you've acquired, you'll no longer need to fear dislocating your patient's hip.