Arthroplasty Care: General Guidelines or Key Steps (A-R-T-H-R-O-P-L-A-S-T-Y C-A-R-E)
C – Coach the patient for the use of trapeze and help him or her reposition every 2 hours. Skin care should be provided for the back and buttocks, using warm water and lotion as indicated.
A – Affected and unaffected extremities should be moved by performing muscle strengthening exercises per doctor’s order to help maintain muscle strength and range of motion and to help prevent phlebitis.
R – Relieving pain before an acitivity or exercise should be done by administering pain medication before ambulation as ordered. Movement is very painful, thus, analgesic should be given 30 minutes before mobilization.
E – Encourage the patient during exercises. Help the patient with progressive ambulation, suing adjustable crutches or a walker when needed.
Specific Arthroplasty Care: Care after Hip Arthroplasty
- Affected leg should be maintained in abduction and in neutral position to promote hip stability and keep the cup and femur head in the acetabulum. Pillows should be placed between the legs of the patient to help maintain hip abduction.
- Proper patient positioning after hip arthroplasty depends on the surgical approach used and surgeon’s preferences:
If the surgical approach used is ANTERIOR approach take note of the following guidelines:
- No adduction past midline
- Flexion should NOT be greater than 90 degrees
- External rotation should NOT pass the midline
For POSTERIOR approach, follow the listed guidelines:
- Adduction should NOT pass the midline
- Flexion should NOT be greater than 60 to 90 degrees
- NO internal rotation past midline
- NO extension past neutral
- For 1 hour three times per day and at night make sure to put the patient in the supine position with the affected hip in full extension. Doing so prevents hip flexion contracture.
- Have the patient start plantar flexion and dorsiflexion exercises of the foot on the affected leg on the day after the surgery.
- Instruct the patient to start performing quadriceps exercises if ordered by the physician. In most cases, the patient is allowed to start transfer and progressive ambulation with assistive devices on the first postoperative day.