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
Total Hip Replacement surgery is indicated in the following
- Arthritis such as rheumatoid arthritis and degenerative joint
- Fractures of the femoral neck
- Failure of previous reconstructive surgeries such as failed
prostheses, osteotomy and femoral head replacement
- Problems that results from congenital hip disease
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
- Dislocation of the hip prosthesis
- Excessive wound drainage
Nursing interventions for possible DISLOCATION OF THE HIP
- The new hip can be dislocated easily. Thus, the nurse must
promote patient teaching on preventing hip prosthesis dislocation
which includes the following:
- Patient must be cautioned not to sit too low or cross the
- 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
- 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.
- The hip of the patient should NOT be flexed more than 45 to 60
- To prevent acute hip flexion, the head of the bed should not be
elevated more than 45 degrees.
- 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.
- 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)
- Remind patient not to sleep on the operated side until this
position is cleared with the surgeon.
- The nurse should recognize dislocation of the prosthesis which
- 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
- An abduction splint or pillows should be kept between the
- The patient is encouraged to keep the operative hip in
- 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
- 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
- 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
- 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:
- 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.
- Mobilization with ion limits and in proper flexion is
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.
- Deep infection may require removal of the implant.
- Identify patients who are at high risk for infection such as
those who have diabetes, elderly, obese and poorly nourished.
- Avoid potential sources of infection.
- Administer prophylactic antibiotics.
- Remove indwelling urinary catheters and portable wound suction
as soon as possible to prevent infection.