Advice on hip surgery

meownsmile, BSN, RN · Jul 4, 2005

The doctor will probly have her discontinue her heparin or coumadin a couple days prior to surgery. She may want to go donate a couple units of her own blood for transfusion post op, joint patients routinely need a couple units 2-3 days post op.

Make sure she is clear from the anethesiologist if she is to take her blood pressure medications and which ones the morning of surgery. They will restart them following surgery but the nurses should know and she should be able to tell them which ones she has already taken that morning. She should also know that depending on her blood pressures following surgery they may delay starting the BP meds a day or so. If not sure about that ask!!!!!

Your mom has the right idea about a transitional care unit or rehab unit to help with her physical therapy following surgery.

They will use the SCD hose post op while/when she is in bed and most likely TED or support hose of some kind and she needs to be encouraged to do the ankle pump excersises as she recovers(think old tredle sewing machine, same action).

Make sure she is clear that she needs to follow instructions of the nurses and doctor immediately post op and during recovery. No laying in bed feeling sorry because it is hurting, that wont do her any good at all. Not that she will, but you wouldnt believe the people who come in and think they can just lay around in bed "recovering" and dont want to get up and get moving. Sometimes the nurses have to get a little harsh about getting the patients moving, its not being mean, its just fact and has to be done to get people up on their feet again. The more she lays the more likely she is to get a clot, so cooperation with staff and physical therapy is crucial.

Also make sure your mother askes to be turned if the nurses arent as attentive to that as they should be. She should be getting turned to her unaffected side at least every 2 hours while she is in bed. If not to prevent pneumonia as much to prevent pressure areas.

Never be afraid to ask, anything. If the nurse cant answer it, the doctor should.

PeachyOrthoRN, RN · Jul 4, 2005

Most surgeons will put pt's on some sort of prophylaxis, coumadin, lovenox. Make sure to do your foot, ankle, toe movements. Pump those ankles. The nurses will be getting you out of bed the first evening if early morning surgery and the next morning if later evening surgery. This is the way it is in my hospital. SCD's and ted's are always on. Make sure you do deep breathing and coughing and turning this will also help get moving faster. Hope this helps.

kae rn · Jul 5, 2005

Hope your mother does well. As for the diabetes, and high blood pressure--both are pretty common and should be handled fairly well. My biggest concern is regarding blood clots. Take leg measurements fairly post-op, on both legs. Make lines with permanent markers on thighs, and calves. Compare measurements to previous ones. Any major increase on either side could be related to a clot. Also make sure she is on some kind of prophalyxis--heparin, coumadin, lovenox. Rehab is a great idea!! Just make sure there have been dopplers done to the legs (an ultrasound) prior to transfer to the rehab facility. Where I work, we won't get a patient out of bed until we know they are clot free. That can be bad news if your mother transfers there on a Friday late afternoon, and vasc lab (where dopplers are done) is only open Monday through Friday.

GrnHonu99, RN · Jul 5, 2005

thanks so much guys! I was wondering about the heprin, as soon as she stops taking the heprin her blood should not be as thin? She has been on it for so long that I figured it would take longer than a few days for her blood to thicken...I was wondering since she was on the heprin so long that when they made the incision if she would bleed a lot? I appreciate the replies...I am going to try to be with her on TR and Sat and Sun and my sister is going to be there MWF. How long do you think it will take before she is almost back to normal? I think it will take her longer bc she has needed this surgery for sooo long, the MD says she has complete bone rubbing bone...

One more Q. what is the risk of anasthesia in her conditions?

again thanks so much for taking time to answer my questions...I know I will definetly get her moving after the surgery...i am so glad that I am in nursing school and atleast know what to expect!

meownsmile, BSN, RN · Jul 5, 2005

Most all orthos will stop the blood thinner products a couple days prior to surgery then restart either coumadin or lovenox the evening of or next morning after surgery. I'm sure they will do the PT/INR prior to surgery and postpone if she isnt back to within their required values. Coughing deep breathing and incentive spirometers are used to prevent pneumonia not to assist in helping the patient move, however preventing post op pneumonia is ultimately important.

I dont think she would require any more recouperation time than anyone else actually. If she is in fairly good shape, she will actually feel better following the surgery. Bone on bone wont increase her recoup time unless she has been sedintary and has a lot of muscle weakness. The important thing is not to let her start refusing to get up to the commode, walk to the bathroom when she is able and those things. That is where we see the biggest problems, when the patient refuses and families insist on not supporting the staff regarding their activities.

I think the MOST important thing it to make sure the excersises, physical therapy, TEDS, SCD's are used and that she get up and move with assistance AS MUCH AS POSSIBLE following surgery.

P_RN, ADN, RN · Jul 7, 2005

When you speak with her surgeon take a list of questions with you. The surgeon will most likely want a preoperative clearance by her primary HCP for advice on the medications etc.

There are probably as many different total hip protocals as there are total hip surgeons, and many tasks will depend on what hip system is used and what type of incision is done. Does your Mom still walk alone or does she require a cane, crutch or walker? She may have to relearn her gait when she gets the new hip because after all these years of degeneration that leg is probably shorter, and certianly more painful than it will be post-op.

I like this site for general information.

http://www.emedicine.com/pmr/topic221.htm#section~continuous_passive_motion_after_total_knee_replacement

(just the hip section obviously).

As far as heparin, it has a short half life and can be reversed with medication if her PTT is too long. Ask the surgeon what and when the post op anticoagulant will be started. Ask the anesthesia provider what type she will have. I favor the epidural, but then there are certainly other options.

Find out ahead of time if her insurance covers rehab facilities.

Ask for a social work consult to help with discharge planning....that's what they're there for.

Good luck to Mom she certainly is lucky to have a wonderful daughter.

GrnHonu99, RN · Jul 7, 2005

When you speak with her surgeon take a list of questions with you. The surgeon will most likely want a preoperative clearance by her primary HCP for advice on the medications etc.
There are probably as many different total hip protocals as there are total hip surgeons, and many tasks will depend on what hip system is used and what type of incision is done. Does your Mom still walk alone or does she require a cane, crutch or walker? She may have to relearn her gait when she gets the new hip because after all these years of degeneration that leg is probably shorter, and certianly more painful than it will be post-op.
I like this site for general information.
http://www.emedicine.com/pmr/topic221.htm#section~continuous_passive_motion_after_total_knee_replacement
(just the hip section obviously).
As far as heparin, it has a short half life and can be reversed with medication if her PTT is too long. Ask the surgeon what and when the post op anticoagulant will be started. Ask the anesthesia provider what type she will have. I favor the epidural, but then there are certainly other options.
Find out ahead of time if her insurance covers rehab facilities.
Ask for a social work consult to help with discharge planning....that's what they're there for.
Good luck to Mom she certainly is lucky to have a wonderful daughter.

thanks sooo much! I am going to forward this link to her. I think that she is waiting on her insurance co to call her to let her know about rehab. I really hope that it is covered. My mom walks with a cane sometimes but if she is just going short distances she will walk alone but with a definite limp. Again thianks for the link:)

heartICU · Jul 7, 2005

One more Q. what is the risk of anasthesia in her conditions?

I am in anesthesia school right now, and can answer some of your questions, if you want:-) I'm currently in my ortho rotation, so I can shed a little light on your situation. Regional anesthesia is much preferred to general anesthesia. A lot of places still do all knees and hips under general, but research has shown that patients have less bleeding, fewer incidences of DVTs, and less pain after they have had regional anesthesia when compared to general anesthesia.

We typically do most hips under spinal anesthesia, occasionally epidural if it is going to be long or if they are doing both hips. Even when patients have been on blood thinners (heparin, coumadin, etc) our orthopods typically transition them to lovenox during the perioperative period, and they usually do very well.

I see that you are from Ohio - me too!

GrnHonu99, RN · Jul 7, 2005

I am in anesthesia school right now, and can answer some of your questions, if you want:-) I'm currently in my ortho rotation, so I can shed a little light on your situation. Regional anesthesia is much preferred to general anesthesia. A lot of places still do all knees and hips under general, but research has shown that patients have less bleeding, fewer incidences of DVTs, and less pain after they have had regional anesthesia when compared to general anesthesia.
We typically do most hips under spinal anesthesia, occasionally epidural if it is going to be long or if they are doing both hips. Even when patients have been on blood thinners (heparin, coumadin, etc) our orthopods typically transition them to lovenox during the perioperative period, and they usually do very well.
I see that you are from Ohio - me too!

thanks for the advice. I am definetly adding that to the list of questions that I have for the MD. What part of Ohio are you in? I am in Cincinnati, I have been thinking about CRNA school, does your school also require the one year of practice before applying? Thanks:)

heartICU · Jul 7, 2005

thanks for the advice. I am definetly adding that to the list of questions that I have for the MD. What part of Ohio are you in? I am in Cincinnati, I have been thinking about CRNA school, does your school also require the one year of practice before applying? Thanks:)

I am in Cleveland, and I go to Case Western. It requires one year of experience - every school requires one year (minimum). It is a requirement from the American Association of Nurse Anesthetists.

GrnHonu99, RN · Jul 7, 2005

I am in Cleveland, and I go to Case Western. It requires one year of experience - every school requires one year (minimum). It is a requirement from the American Association of Nurse Anesthetists.

That is what I thought. I looked into Case for their direct entry MSN program, how do you like it?