The Hip: Preservation, Replacement and Revision

PreOp Planning for THR



- See: Posterolateral Approach to Hip Joint:

- Pre Operative Planning:
    - PreOp X-Rays for THR
    - Template for fracture fragments (opposite extremity)
    - Implant Selection;
    - Bone Graft
    - PreOP Cardiology, Dental, GI, and Urological consults
    - Anesthesia Consult and Posting
    - Autologous Blood / Cell Saver
    - Musculoskeletal Labs:
    - EKG, CXR, UA
- Exam:
    - Previous Incisions
    - Limb Length:
         - note that apparent difference may be due to hip flexion deformity or ankle contracture;
    - ROM:
         - IR lost first - c/w retroversion or anterior osteophytes
         - Flexion Contracture of Hip (look for compensatory lumbar lordosis)
    - Abductor Mechanism:
         - Dysfunction (from abductor muscles, short femoral neck, coxa vara)
         - Trendelenburg Sign:
              - drooping of pelvis on side opposite the involved hip;
         - Trendelenburg Lurch or Duchenne Sign (seen during walking);
              - when pt compensates for dysf(x) by leaning over involved hip which reduces abductor force required to remain standing;
    - Push pull test (revision THR pts)
         - evaluation of loose components, by sudden pulling & pushing on extended hip;
         - sine qua non of loosening, however, is noted when pt lies down on exam table & has to lift leg onto table by using his hand;
         - by this time he is usually unable to perform straight leg raise;
    - Misc: (teeth, prostate, ect...);
- Initial Orders:
    - NPO p Midnight x Meds
    - ATB and PreOp ATB
    - Hiboclens Shower and Bactroban to nares q12 hrs until OR
    - Cleocin solution 300 mg per 100 ml NS q6hr as mouth wash;
    - Foley (w/ Septra) or Void Prior to OR
    - IVF D5W 1/2 NS c 20 KCL at 100 ml/hr to begin at Midnight
    - Cardiovascular System
    - Heparin 5000 units SQ q8 hrs;
    - Diabetes (1/2 NPH dose) + S.S. - Accu Stick in AM and on call
    - Type & Cross 2 units pRBC and/or FFP



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Tuesday, September 6, 2011 2:12 pm