- 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
