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Discussion

Question - Total Hip Replacement

I had a patient who had a total hip replacement performed in 2001. According to the patient the operation was a success. Well, someone told me that this patient should ALWAYS keep a pillow between her legs when she repositions herself in bed (i.e., turns left to right) to prevent possible dislocation. Is this information accurate?

Thanks!

Nursing Student.

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There are a lot of different things to consider. Height, weight, body type when encouraging a patient to use support. Hip prostetics do dislocate but unless there is something specific with this person like muscular deficiencies or nerve damage i dont think that just turning in bed would cause a problem. The patient sometimes feel more comfortable with leg support, but if it is healed and strengthening excersises and physical therapy was followed i dont know that it is ALWAYS necessary.

I doubt a patient would conciously wake at night, place a pillow between their legs before they turned over in bed. Was this a LTC patient who is relying on others to turn them?

I'm always dealing with residents with total hip replacement everyday. (Convalescing Home)....I've always wondered what type of tools do they use...I hear saws, hammer......who knows...anyone?

  • Experts
I'm always dealing with residents with total hip replacement everyday. (Convalescing Home)....I've always wondered what type of tools do they use...I hear saws, hammer......who knows...anyone?
It has been a lot of years since I was in an OR (other than as a patient) but one memory that has stuck with me from my rotations in nursing school was the amount of tools used in ortho surgeries. I am talking REAL tools (both hand & power)...Ryobie, Craftsman, Makita, Black & Decker, I assume they are still in use today.
I'm always dealing with residents with total hip replacement everyday. (Convalescing Home)....I've always wondered what type of tools do they use...I hear saws, hammer......who knows...anyone?

Had a chance to watch a total hip recently. Saw for removal of head of femur. Drill for attaching prosthesis to acetabalem (sp? neuro flatulence tonight) Glue gun for cement. Hammer for seating and fit. I forget what else he used. Was interesting. Lots of equipment used and a whole set of different sized prothestics, different types and sizes of screws, etc. available for the doc to choose from. Seeing a total knee later that day was even more awesome. Helped me understand so much more what patients go through and why knee patients seem to have more pain generally than hip patients. Doc added even more equipment for knees, including chisels and different types of saws. Lots of hammering, chiseling, sawing and shaping of the bone for knees.

I work in the OR, we do total joints, heres some imagery you can do

close your eyes imagine your husband/fathers dream toolbox

makita cordless drill and saw.

hammers

chisels

screws, nails

screwdrivers

and all of it in beautiful stainless steel

my dad's an orthopedic surgeon, and he builds the most beautiful furniture :)

marci

  • Experts

I have seen hips dislocate when the patient sat down.....years after the surgery. I've seen another play tennis about 3 weeks out, fall on the court and the prosthesis stayed seated. How far out is the patient. It's usually 6-8 weeks for the muscles and tendons to reform the joint capsule. If an anterior incision was used the precautions are a bit different. What you want to do is avoid whatever position was used in the OR to disarticulate the original hip.

Usually it depends on a few common things. How well was the fit to begin with? Does the patient have sufficient healing of the joint capsule. Has it ever dislocated before? What size ball was used on the hip component. Small balls will dislocate more easily. Was it cemented or was it press fitted?

Most of the doctors will tell the patient to never sit in a low chair, never sit with the knees higher than the hips. The max flexion should be no more than 110-120 degrees....and not to cross their legs at the knee. Further out they may let them cross their legs in a figure 4. That is putting the ankle over the other knee. Not all docs agree on this though.

Using a pillow only because of this probably won't do anything one way or the other. But we've all been taught to position patients comfortably and that would be my reason for saying yes use the pillow.

Also if you can, find out what their orthopod told them to do. My MIL had a total knee in the early 90s. The doctor told her to keep it elevated to ease edema. 10 years later she was still elevating...."because that's what the doctor said do."

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It brought back memories of a female orthopod that I used to work with,

who was about 5'2" and 110#. You can imagine her with all of those drills and toys.

:balloons:

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