Postoperative Hip

This patient safety indicator is concerned with postoperative hip fracture and is expressed by... 

The bisphosphonates are used to treat osteoporosis in postmenopausal women, Paget s disease of the bone, and postoperative treatment after total hip replacement (etidronate). 

Without Vascular Insufficiency Adult (greater 50 years) Postoperative (e.g., hip fractures), soft-tissue infections 5. aureus Nafci 11 i n or cefazolin... 

Hip or knee replacement surgery 30 mg every 12 hours by subcutaneous injection, with the initial dose given within 12 to 24 hours postoperatively provided hemostasis has been established. The average duration of administration is 7 to 10 days up to 14 days have been well tolerated. 

Complicating total hip replacement 20 mg/kg/day for 1 month preoperatively, then 20 mg/kg/day for 3 months postoperatively total treatment period is 4 months. 

Small subcutaneous closes of heparin have been found to be effective in high-nsk post-surgical patients and in patients with acute myocardial infarction. The preventive treatment is commenced a few hours before an operative procedure and continued postoperatively for 4 to 5 days. As the result of a study in 1975. low-dose heparin prophylaxis in high-nsk patients who undergo abdomina-thoracic surgery has become a widely accepted practice, However, preventive anticoagulant therapy, to date, has been unsatisfactory and controversial in the instances of hip surgery or prostatectomy. 

Clinical outcomes measures can include morbidity and mortality, event rates, and symptom resolution (Ovretveit, 2001). These measures are a direct measure of quality but may be difficult to assess, especially in pharmacy, where their onset could be years following a treatment or intervention (Chassin and Galvin, 1998 Shane and Gouveia, 2000). In these cases, indicators or markers can be used to assess outcomes. These indicators can be condition-specific (e.g., HgAlc) or procedure-specific (e.g., rate of postoperative infection after hip surgery) or address an important issue of patient care. For example, blood pressure may be used as a marker to assess susceptibility to stroke because it is not practical, safe, or ethical to wait and measure the occurrence of stroke. 

Rofecoxib is approved for the treatment of acute pain and dysmenorrhea at a dose of 50 mg for up to 5 days. The clinical studies indicate that rofecoxib shows efficacy similar to that produced by the maximum analgesic doses of naproxen and ibuprofen (Ehrich et al., 1999). The pain settings in which rofecoxib has been tested include acute postoperative dental pain, the pain of dysmenorrhea for up to 3 days, and postoperative pain for 5 days following surgical replacement of the knee or hip. In contrast, celecoxib is not approved in the United States for the treatment of acute pain, and it appears to be less effective when given acutely than rofecoxib, ibuprofen, or naproxen. The explanation for the differences between rofecoxib and celecoxib in acute pain is not known. 

Elevated levels of chromium in blood, serum, urine, and other tissues and organs have been observed in patients with cobalt-chromium knee and hip arthroplasts (Michel et al. 1987 Sunderman et al. 1989). Whether corrosion or wear of the implant can release chromium (or other metal components) into the systemic circulation depends on the nature of the device. In one study, the mean postoperative blood and urine levels of chromium of nine patients with total hip replacements made from a cast cobalt-chromium-molybdenum alloy were 3.9 and 6.2 pg/F, respectively, compared with preoperative blood and urine levels of 1.4 and 0.4 pg/F, respectively. High blood and urinary levels of chromium persisted when measured at intervals over a year or more after surgery. These data suggest significant wear or corrosion... 

Bonis LCHau(hO,JbigensaiLN, Lassen MR Enoxaparin versus dextran 70 in the prevention of postoperative deep vein thrombosis after total hip replacement. A Danish multicenter shkdy. Proceeding of the Danish Enoxaparin Symposium, Feb 3,1990... 

In a double-blind, randomized study of 2309 consecutive patients undergoing elective hip replacement, postoperative subcutaneous fondaparinux 2.5 mg/day was compared with preoperative enoxaparin 40 mg/day (19). By day 11, venous thromboembolism had occurred in 85 (9%) of 919 patients assigned to enoxaparin and in 37 (4%) of 908 patients assigned to fondaparinux, a relative risk reduction of 56% (95% Cl = 33, 73). In a similar comparison of postoperative fondaparinux 2.5 mg/day and enoxaparin 30 mg bd in 2275 consecutive patients undergoing elective hip replacement, by day 11 venous thromboembolism had occurred in 48 (6%) of 787 patients assigned to fondaparinux and in 66 (8%) of 797 patients assigned to enoxaparin, a relative risk reduction of 26% (95% Cl = 11, 53) (20). 

Lassen MR, Bauer KA, Eriksson Bl, Turpie AG European Pentasaccharide Elective Surgery Study (EPHESUS) Steering Committee. Postoperative fondaparinux versus preoperative enoxaparin for prevention of venous thromboembolism in elective hip-replacement surgery a randomised double-bhnd comparison. Lancet 2002 359(9319) 1715-20. 

In a double-blind, placebo-controUed study in 24 elderly patients scheduled for elective total hip replacement who were randomized to either intrathecal morphine 160 pg or nalbuphine 400 pg postoperatively, when the pain score was greater than 3 cm on a visual analogue scale, nalbuphine produced significantly faster onset and shorter duration of analgesia (5). Both opioids produced adequate maximal pain rehef in aU patients. The adverse effects profile was umemarkable in both groups. 

Fournier R, Van Gessel E, Macksay M, Gamulin Z. Onset and offset of intrathecal morphine versus nalbuphine for postoperative pain relief after total hip replacement. Acta Anaesthesiol Scand 2000 44(8) 940-5. 

HPI AF is a 55-year-old woman who is scheduled to undergo left hip replacement surgery. While in the operating room and postanesthesia care unit (PACU), she has on thromboembolic deterrent (TED) stockings and sequential compression devices (SCDs). On postoperative day 1, the SCDs are discontinued, and she is started on enoxaparin for deep vein thrombosis (DVT) prophylaxis. On postoperative day 7, as AF is getting ready for discharge, she becomes acutely short of breath and develops a painful and swollen left leg. 

Hull RD, Brant RF, Pineo GF, et al. Preoperative vs postoperative initiation of low-molecular-weight heparin prophylaxis against venous thromboembolism in patients undergoing elective hip replacement. Arch Intern Med 1999 159 137-141. 

Wade WE, Spruill WJ, Leslie RB. Cost analysis Fondaparinux versus preoperative and postoperative enoxaparin as venous thromboembohc event prophylaxis in elective hip arthroplasty. Am J Orthop 2003 32 201-205. 

Functional incontinence is not caused by bladder- or urethra-specific factors. Rather, in patients with conditions such as dementia or cognitive or mobility deficits, the UI is linked to the primary disease process more than any extrinsic or intrinsic deficit of the lower urinary tract. An example of functional incontinence occurs in the postoperative orthopedic surgery patient. Following extensive orthopedic reconstructions such as total hip arthroplasty, patients are often immobile secondary to pain or traction. Therefore the patient may be unable to access toileting facilities in a reasonable period of time and may become incontinent as a result. The treatment of this type of UI may involve only placing a urinal or commode at the bedside that allows for simplified access to toileting. 

Paget s disease, postoperative treatment after total hip replacement... 

The client diagnosed with Parkinson s disease who is taking selegiline (Eldepryl) has had hip surgery and is being admitted to the orthopedic department. The nurse is transcribing the postoperative orders. Which postoperative order would the nurse question ... 

The client postoperative from hip surgery is scheduled to ambulate with the physical therapist. Which intervention should the nurse implement to assist the client to be able to perform the therapy ... 

The client is 2 days postoperative right total hip replacement and is receiving the low molecular weight heparin (Lovenox) subcutaneously. Which laboratory data should the nurse monitor ... 

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