Total hip replacement involves replacing damaged bone and cartilage in the hip joint with prosthetic components. The procedure involves removing the femoral head and reaming the acetabulum to fit a metal shell. A femoral stem is inserted into the reamed femoral canal and a replacement femoral head is attached. The completed hip replacement provides a new weight-bearing surface for the joint. Post-operative care includes antibiotics, anticoagulants, pain medications, and exercises to restore mobility and prevent complications like blood clots.

1. TOTAL HIP
REPLACEMENT
Presented by Supervisor
Master Student Dr. Shatha Al-Jabari
Haider Mohammed

2. General Anatomical Overview
 The hip is one of your body's largest weight-
bearing joints.
 Consists of two main parts:
 - a ball (femoral head) that fits into a rounded
socket (acetabulum) in your pelvis.
 - Ligaments connect the ball to the socket and
provide stability to the joint
 The bone surfaces of your ball and socket have a
smooth durable cover of articular cartilage that
cushions the ends of the bones and enables them
to move easily.

3. Hip Anatomy

4. More…
 All remaining surfaces of the hip joint are
covered by a thin, smooth tissue called synovial
membrane. In a healthy hip, this membrane
makes a small amount of fluid that lubricates and
almost eliminates friction in your hip joint.
 Normally, all of these parts of your hip work in
harmony, allowing you to move easily and
without pain.

5. Total Hip Replacement
 A prosthetic hip that is implanted in a similar
fashion as is done in people. It replaces the
painful arthritic joint.
 The modular prosthetic hip replacement system
used today has three components – the femoral
stem, the femoral head, and the
acetabulum. Each component has multiple
sizes which allow for a custom fit.
 The components are made of cobalt chrome
stainless steel and ultra high molecular weight
polyethylene. Cement less and cemented
prosthesis systems are available.

7. Statistical Overview
 First performed in 1960.
 Since then, improvements in joint
replacement surgical techniques and
technology have greatly increased the
effectiveness of this surgery.

8. Signs and Symptoms
 Pain localized in hip region
 Exaggerated gait pattern (limp)
 Increase in pain when weight barring
 As the degeneration of the joint worsen,
individual may be awakened at night with
pain.
 Bone spurs may occur

9. Muscle atrophy – Muscles in affected area are not
used as much due to pain, therefore, use-it-or-lose-
it applies.
 Range Of Motion is Limited and stiffness.
X-ray – clear degeneration of the bone
MRI – determines underlying complications
(e.g a vascular necrosis)

10. Causes of Hip Replacement.
 Osteoarthritis.
 Rheumatoid Arthritis.
 Traumatic Arthritis.

12. Common Causes of Hip Pain and Loss
of Hip Mobility
Osteoarthritis
 Usually occurs after
age 50 and often in an
individual with a family
history of arthritis. In
this form of the
disease, the articular
cartilage cushioning
the bones of the hip
wears away. The
bones then rub against
each other, causing
hip pain and stiffness.

13. Causes (cont’d)
Rheumatoid Arthritis
 a disease in which the
synovial membrane
becomes inflamed,
produces excessive
synovial fluid, and
damages the articular
cartilage, leading to pain
and stiffness.

14. Causes (cont’d)
Traumatic Arthritis
 Can leads to a serious
hip injury or fracture. A
hip fracture can cause a
condition known as
avascular necrosis. The
articular cartilage
becomes damaged and,
over time, causes hip
pain and stiffness.

15. Osteoarthritis Fracture

16. Preparation before surgery
 Bath the entire extremity and hip with germicidal solution
twice daily after patients is admitted to the hospital.
 Shave the extremity, perineal area, hemipelvis and
wash with soap as soon before surgery and cover with
sterile towels.
 Prophylactic antibiotics.
 Asess patient’s general condition (thorough medical
examination with laboratory test is must)
 Investigate for any ongoing infection
 Physical examination of spine, both lower limbs, soft
tissue around the hip.

17. Operation
Removing the Femoral Head
 Once the hip joint is
entered, the femoral
head is dislocated
from the acetabulum.
 Then the femoral
head is removed by
cutting through the
femoral neck with a
power saw.

18. Reaming the Acetabulum
 After the femoral head
is removed, the
cartilage is removed
from the acetabulum
using a power drill and
a special reamer.
 The reamer forms the
bone in a hemispherical
shape to exactly fit the
metal shell of the
acetabular component.

19. Inserting the Acetabular Component
 A trial component, which is
an exact duplicate of your
hip prosthesis, is used to
ensure that the joint will be
the right size and fit for the
client.
 Once the right size and
shape is determined for the
acetabulum, the acetabular
component is inserted into
place.

20. Preparing the Femoral Canal
 To begin replacing the
femoral head, special rasps
are used to shape and
scrape out femur to the
exact shape of the metal
stem of the femoral
component.
 Once again, a trial
component is used to
ensure the correct size and
shape. The surgeon will also
test the movement of the hip
joint.

21. Inserting Femoral Stem
 Once the size and
shape of the canal
exactly fit the
femoral component,
the stem is inserted
into the femoral
canal.

22. Attaching the Femoral Head
 The metal ball that
replaces the
femoral head is
attached to the
femoral stem.

23. The Completed Hip Replacement
• Client now has a new
weight bearing surface
to replace the affected
hip.
• Before the incision is
closed, an x-ray is made
to ensure new prosthesis
is in the correct position.

24. Post Operative Treatment
 1- Use antibiotics to prevent any infecion such as
meronem vial 1g or mesporen 1g twice daily and
flagul vial 500 mg in three time per day.
 2- Given anticoagulant drugs such as enoxaparin
4000 units or 6000 units according physician
prescribe.
 3- antiemetic's drugs its given such as
metoclopramide and rentadin.
 4- Analgesic medications must be given.
 5- Blood transfusion if the patient need.

25. Post-Surgery Complications
 Thrombophlebitis
 the blood in the large veins of the leg forms
blood clots within the veins.
 If the blood clots in the veins break apart they
can travel to the lung.
 Infection in the joint
 Dislocation of the joint
 Loosening of the joint

26. Nursing Management
 Instruct the patient To avoid hip dislocation by:
 - Using 2-3 pillows between your legs when
sleeping (roll onto your ‘good side’)
 - Not crossing your legs
 - Use chairs with armrest
 - Using a high-rise toilet seat if necessary
 Encourage to begin regular exercises to restore
your normal hip motion and Increase circulation
for the legs to prevent blood clots
 .


27.  Maintain fluid electrolyte as prescribe.
 Assess the vital signs for patient and record
any abnormal signs.
 Provide quite environment.
 Given analgesic medication as prescribe.
 Observe the dressing of patient
continuously and note any oozing if
present.

28. Exercise Prescription

29. Thank you for listening