How soon post op do you turn your total hip replacement pattients? - page 2

Just curious what the rest of you ortho nurses do? Do you reposition and then let them go back to the back or do you turn them and leave them on the unop side for a period of time? Is it... Read More

  1. by   P_RN
    Quote from jax
    I haven't seen THR done via laproscope - sounds great.
    Quote from TNNnurse
    Our facility now does most of their total hips via lap.a very small incision,
    Do you mean the minimally invasive (4") incision? I don't think a laparoscope access would be large enough to fit the stem, acet. component and the ball.
  2. by   jax
    I have only seen the old fashioned BIG incisions - PRN, it is interesting to think how the hardware might squeeze in! I am open to all education , I presume the "minimally invasive" total hips are up and about earlier?

    jax
  3. by   P_RN
    http://www.medscape.com/viewarticle/458346_29

    An Innovative Surgical Technique: Mini-incision Total Hip Replacement
    Richard A. Berger, MD

    Abstract

    Minimally invasive surgery (MIS) has the potential for minimizing surgical trauma, pain, and recovery time in many surgical and orthopaedic procedures. Some surgeons have been using minimally invasive approaches for total hip replacement surgery. These approaches include single incision and 2-incision techniques. This presentation will discuss the methodology and early results of the novel 2-incision technique.

    The first MIS 2-incision total hip arthroplasty (THA) procedure was performed at Rush-Presbyterian-St Luke's Hospitals 2 years ago. Since then, more than 300 of these operations have been performed in 18 centers nationally and internationally, including over 100 at Rush-Presbyterian-St Luke's Hospital in Chicago.

    The procedure of minimally invasive hip replacement involves a 2-incision technique; one incision is for the acetabular component and the other is for the femoral component. Unique instruments have been developed to aid in this challenging approach. Fluoroscopy aids in many steps in the process to ensure the proper starting points for the incisions and accurate component positioning and alignment.

    To date, over 100 patients have been enrolled in an IRB-approved study at Rush-Presbyterian-St Luke's Hospitals. While the first cases had long operative times, the operative times for the last 80 cases was between 80 and 120 minutes (the average age of these patients was 55 years old). Complication rates at our institution were very low, at 1% (one femoral fracture that occurred during insertion of a taper stem. The stem was removed and replaced with a stem with a distal fixation. The stem has ingrown and the fracture has healed). No other complications have occurred at our institution. There have been no failures of ingrowth, no dislocations, and no other complications.

    This minimally invasive THA technique has enabled a shorter length of stay in hospital for the patient. In our last 80 cases, 80% of the patients elected to go home the same day, with the remaining patients leaving the hospital the next day. The patients, not the surgeon, determined the length of stay. No patient has remained in the hospital for longer than 23 hours and no patients were transferred to any other care facility.

    Since fluoroscopy is used during insertion, the overall alignment and fit of the components have been excellent. In the first 70 cases, 94% of the femoral stems have been in neutral alignment, with all stems between 2 of varus and 3 of valgus. In this same cohort, the abduction angle for these acetabular components has been 35 and 55, with an average of 45. All components with a follow-up period of greater than 3 months have shown ingrowth without migration.

    This 2-incision, minimally invasive THA technique continues to show great promise; however, it must be emphasized that this technique is still investigational and continues to be refined. Moreover, this procedure is technically extremely challenging and is very different from a standard total hip replacement. The technique should be tried only with specially designed instruments and proper hands-on training.
    You will have to register (free) if you haven't already. Medscape is a vast source of education. Get on their ortho and other spx mailing lists and you will get all sorts of info.
  4. by   TillyC
    We will turn them as soon as necessary if their skin condition etc requires strict PAC. Remember that a cemented hip is as secure as it ever will be so careful turning within the limits imposed by pain is OK. As they are out of bed on day 1 or 2 post op it does not pose too much of a problem.

    I have been playing this game for too long and have never seen a sciatic nerve palsy from positioning in a THR patient.

    Did you know that in some places the patient will be rolled onto the operative side - the theory is that the limb is splinted by the mattress

    Hooroo for mow.
    Quote from brinasmommy27
    Just curious what the rest of you ortho nurses do? Do you reposition and then let them go back to the back or do you turn them and leave them on the unop side for a period of time?

    Is it possible by not turing them you could cause a nerve injury?

    Thanks
  5. by   bedwards
    Man am impressed, how do they do THJR via laproscopy? What about the implants, are they just jammed down the small incision.? sounds impressive..
  6. by   TillyC
    With the minimally invasive method there are 2 inscisions - one in the groin for the femoral component and the other is in a more traditional position over the hip for the acetabular bit. For all the info on this put "NILNAV Hip System" into google.
    All the best from Australia,
    Tillyc
    Quote from bedwards
    Man am impressed, how do they do THJR via laproscopy? What about the implants, are they just jammed down the small incision.? sounds impressive..
  7. by   lcbaird
    We turn them Q 2 after they come to the floor from recovery with an abductor pillow.
  8. by   Philo
    Quote from jax
    I haven't seen THR done via laproscope - sounds great. Curious as to what is the average length of stay? Are hemi-arthroplastys open or done via laproscope?

    Thanks for any replies. Jax
    That I would like to see, a THR replaces the head, neck and sometimes a good portion of the shaft of the femur. The incisions are usually any where from 12cm to 24cm long the only time in my ortho hx that I've see a lap sx was for pinning a break.
  9. by   Thunderwolf
    I agree with the general concensus. Once pain is in control and an abductor pillow is in place, turn them q2hrs. When on their backs, provide elevation of the heels off the bed to prevent heel breakdown and irritation to them. Turning is good in order to prevent skin breakdown, to prevent atelectasis, and to promote bowel functioning. Typically, the next day, they are up either up sitting in a chair for a meal and/or began ambulating with walker.

close