Beruflich Dokumente
Kultur Dokumente
- Medical Assesment:
- see Anesthesia, Medical Consderations, and Timing for Femoral Neck Frx
- preop cardiology, dental, GI, and urological considerations;
- with history of prostatic hypertrophy or surgery be prepared to have urologist available for foley placement;
- anesthesia consult and posting
- vitamin D:
- Vitamin D deficiency in patients with osteoarthritis undergoing total hip replacement: a cause for concern?
- transfusion considerations:
- preoperative hemoglobin is main indicator for need of postoperative transfusion;
- Hgb less than 11 g/dl is a strong indicator for need for transfusion;
- autologous blood: (see pRBC transfusion)
- 2 units for primary hips) or cell saver;
- disadvantages: time consuming, expense, significant decrease in preop Hbg level (which actually
increases likelihood of transfusion), possibility of clerical
error, possibility of transfusion reaction;
- in the study by Sculco TP and Gallina J (1999), 82% of these patients (autologous or PAD patients)
required transfusion of their own blood (vs 50% in patients that
did not donate autologous blood), but only 8% of PAD patients required allogenic transfusion;
- 34 to 45% of autologous blood was discarded;
- w/ preop Hgb level of less than 11 g/dl about 93-96% of pts required a transfusion vs. only 52-59% of pts
w/ preop Hgb of greater than 14 g/dl;
- w/ THR, expected transfusion requirements are 0.8 units when the Hgb level is more than 14 g/dl vs 1.6
units when Hgb level is less than 11 g/dl;
- erythropoitin
- references:
- Blood management experience: relationship between autologous blood donatoin and transfusion in
orthopaedic surgery.
- Efficacy of Intraoperative Blood Collection and Reinfusion in Revision Total Hip Arthroplasty.
- Exam:
- previous incisions:
- limb length: most common cause of apparent limb length inequality is hip flexion contracture;
- vascular status;
- delay surgery if any "minor" infections are present (such as infected ingrown toenail, prostatitis, ect);
- flexion contracture:
- not caused by the weakness of the hip extensors;
- result of contractures of the flexor muscles and the joint capsule
- to compensate for reduced hip extension in terminal stance phase & to obtain step length, there is
development of increased anterior pelvic tilt in sagittal plane;
- obesity:
- Obesity is a major risk factor for prosthetic infection after primary hip arthroplasty
- Factors associated with prolonged wound drainage after primary total hip and knee arthroplasty
- Periprosthetic joint infection: the incidence, timing, and predisposing factors.
- Surgical Alternatives:
- hip arthrodesis:
- girdlestone resection arthroplasty
- references:
- Osteoarthritis of the hip treated by intertrochanteric osteotomy. A long-term follow-up.
- Medial-displacement intertrochanteric osteotomy in the treatment of osteoarthritis of the hip. A long-term
follow-up study.
- Osteotomy for osteoarthritis of the hip. A survivorship analysis.
- References:
Comparison of preoperative templating with postoperative assessment in cementless total hip arthroplasty.
Back Pain and Total Hip Arthroplasty: A Prospective Natural History Study