Total Hip Replacement Surgery Nursing Care Plan Notes



One of the most successful surgeries in orthopedics is the total hip replacement. In this procedure, the acetabulum and the head of the femur is replaced with prostheses. In cases where a severely damaged hip is present, an artificial joint is used to replace the non-functional area.

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Total Hip Replacement surgery is indicated in the following conditions:

  1. Arthritis such as rheumatoid arthritis and degenerative joint diseases
  2. Fractures of the femoral neck
  3. Failure of previous reconstructive surgeries such as failed prostheses, osteotomy and femoral head replacement
  4. Problems that results from congenital hip disease
Nursing Interventions

It is very important that the nurse is aware that complications might harm the client when left unnoticed and no prompt treatment is carried out on time. Potential complications with this procedure should be made known specifically to the nurse. Nursing care plans should be focused on preventing the occurrence of the following complications:

  • Dislocation of the hip prosthesis
  • Excessive wound drainage
  • Thromboembolism
  • Infection
Nursing interventions for possible DISLOCATION OF THE HIP PROSTHESIS

The new hip can be dislocated easily. Thus, the nurse must promote patient teaching on preventing hip prosthesis dislocation which includes the following:

  1. Patient must be cautioned not to sit too low or cross the legs.
  2. The patient’s leg should be positioned in ABDUCTION. This is to prevent dislocation of the prosthesis. It is very crucial that the femoral head component of the acetabular cap is maintained in the correct position. Abduction splints, wedge pillows and two or three pillows between the legs of the patient will keep the hip in abduction.
  3. In cases where the patient needs to be turned, the operative hip must be kept in abduction and the entire length of the leg supported by pillows.
  4. The hip of the patient should NOT be flexed more than 45 to 60 degrees.
  5. To prevent acute hip flexion, the head of the bed should not be elevated more than 45 degrees.
  6. When using the fracture bedpan, the patient is instructed to flex the unoperated hip and use the trapeze to lift the pelvis onto the pan. Instruct the patient not to flex the operated hip.
  7. Limited flexion is maintained during transfers and when sitting. (see section below on interventions when transferring or sitting the patient who underwent total hip replacement)
  8. Remind patient not to sleep on the operated side until this position is cleared with the surgeon.
  9. The nurse should recognize dislocation of the prosthesis which includes:
    • Shortening of the leg
    • Inability to move the leg
    • Malalignment of the leg
    • Abnormal rotation
    • Increased discomfort

When transferring or sitting the patient who underwent total hip replacement:

  • An abduction splint or pillows should be kept between the legs
  • The patient is encouraged to keep the operative hip in extension
  • The patient is instructed to pivot in the unoperated leg while assisted by the nurse, who protects the operative leg from adduction, flexion and excessive weight-bearing.
  • A semi-reclining wheelchair and toilet seat extenders may be used to minimize hip joint flexion.
Nursing Interventions for possible EXCESSIVE WOUND DRAINAGE
  1. To drain the accumulating blood and fluid at the surgical site, a portable suction device should be used. The accumulation of fluid can contribute to patient discomfort and could provide a site for infection.
  2. When drainage volumes are greater than expected, the nurse should notify the physician immediately. Expected drainage is 200 to 500 ml in the first 24 hours and by 48 hours postoperatively the total expected drainage in 8 hours usually decreases to 30 ml or less.
  3. To decrease the homologus blood transfusions, autotransfusion drainage system may be used. This is used when extensive blood loss is anticipated following total hip replacement surgery.
Nursing Interventions for possible Deep Vein Thrombosis

After THR, a thrombus, also known as blood clot, may form in the veins of the client’s thighs, pelvis or leg.  Promoting circulation and decreasing the venous stasis are the priorities the  nurse must keep in mind after a hip reconstruction.The following are important interventions in preventing thrombus formation:

  1. Blood thinning agents may be administered to the client as prescribed by the physician. As prophylaxis for DVT following total hip replacement surgery, low-dose heparin or enoxaparin (Lovenax) may be used. Lovenox is a low-molecular weight heparin that requires no routine monitoring of coagulation times.
  2. Mobilization with ion limits and in proper flexion is encourage.
Nursing Interventions for possible Infection

A small number of people can develop an infection with a total hip replacement. This may require further surgery to remove the prosthetic components and clean out the joint along with a course of antibiotics lasting 6-8 weeks.

  1. Deep infection may require removal of the implant.
  2. Identify patients who are at high risk for infection such as those who have diabetes, elderly, obese and poorly nourished.
  3. Avoid potential sources of infection.
  4. Administer prophylactic antibiotics.
  5. Remove indwelling urinary catheters and portable wound suction as soon as possible to prevent infection.