Arthroplasty is the surgical replacement of all or part of a joint. The most common arthroplastic procedures are cup arthroplasty and total hip replacement. The former involves the insertion for a moveable cup between the hip joint surfaces. Bone ingrowth is promoted as the prosthesis has a porous coating. Usually indicated for young patients, this procedure is done for rheumatoid arthritis, a degenerative joint disease from traumatic injury or an acetabulum fracture.
Total hip replacement, on the other hand, is usually performed to patients over 50 years old and may be used to treat osteoarthritis and a severe crippling rheumatoid arthritis. More commonly this procedure is used to treat severe joint pain, joint contractures, joint surface deterioration and any condition that prohibits full extension or flexion.
Goals of Arthroplasty Care
After the arthroplastic procedure, the following are the goals of patient care:
- Help restore mobility
- Restoration of normal use of the affected extremity
- Aid in preventing complications such as infection, phlebitis and respiratory problems
Nursing Responsibilities in Arthroplasty Care (M-A-P-S)
- M – Maintaining alignment of the affected joint
- A – Assisting with exercises
- P – Providing routine postoperative care
- S – Selecting appropriate home care and exercises for the patient depending on the type of arthroplasty performed and patient’s condition. These exercises and home care should be taught to the patient as these activities may continue for several years.
- Traction frame with trapeze
- Comfort devices such as static air mattress overlay, low-air-loss bed, or sheepskin
- Bed sheets
- Incentive spirometer
- Continuous passive motion machine – for total knee or hip replacement
- Compression stocking
- Sterile pads or dressings
- Hypoallergenic tape
- Ice bag
- Skin lotion
- Warm water
- Crutches or walker
- Pain medications
- Closed-wound drainage system and slings
- Abduction splint
Arthroplasty Care Preparation (P-R-E-P)
- P – Prepare the patient’s bed. After the patient goes to the operating room, a Balkan frame with a trapeze on his bed frame should be made. This will allow the patient to move after the operation.
- R – Rigorously make the bed using a comfort device and clean bed linens.
- E – Enable immediate placement of the patient on his hospital bed after the surgery by having the prepared bed taken to the operating room.
- P – Prevent or eliminate the need for an additional movement of the patient in his bed on the postanesthesia care unit by having the prepared bed transported to the operating room.