Process of Total Hip Replacement Surgery

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Process of Total Hip Replacement Surgery Essay

Hip fractures remains to be the most horrendous complications that occur as a result of osteoporosis among older adults. In recent years, the rate of hip fractures seems to be constant or declined. Perhaps the decline results from a combination of enhanced treatment and management of obesity and osteoporosis epidemic. Hip fracture is associated with adverse effects which are generally classified into long-term and short-time complications. The short-term effects are early complications occurring within the first 30-90 and are potentially preventable (Florschutz et al., 2015). Process of Total Hip Replacement Surgery Essay. Common short-term complications include delirium, cardiovascular infections, pressure ulcers, and venous thromboembolism. On the other hand, long-term effects include mortality, secondary fractures, and functional disabilities.

A fractured neck of femur is a common manifestation of most hip fractures. It is a condition that occurs in increasing frequency due to the increase of aging population. Its morbidity and mortality rate is high partly because of frail nature of the population at risk. The common treatment for hip fracture is a total hip replacement surgery (Kremers et al., 2015). In this procedure, the affected surfaces are replaced with artificial prosthetic joints. This essay will elaborate on the process of total hip replacement surgery. It will provide a comprehensive discussion on pre-operative and post-operative management requirements associated with hip replacement surgery.Process of Total Hip Replacement Surgery Essay.



Total hip replacement procedure is frequently done electively. However, it is a process used to manage pathological conditions, traumatic events like fall, and hip fractures resulting from displaced neck of femur. High rates of hip fractures in the aging population are believed to be due to osteomalacia and osteoporosis. Although many instances of total hip replacement originates from the pathophysiological aspect where the degenerative process of osteoarthritis plays a significant role, this essay will focus on hip replacement due to trauma (Basu et al., 2016). During hip replacement, a prosthetic head replaces the natural head of femur along the shaft. The surface of the acetabulum joint is aligned with a synthetic joint surface in the shape of a bowl. Regarding the neck of femur fractures, the procedure aims to replace only the femoral part. Advance in medical technology may deem the procedure simple and successful (Basu et al., 2016). However, the aspects of age, activity status, hip disease, possible features of the structure, and medical problems can influence the surgical procedure, hence must be considered.

Classification and Preoperative Management Procedure.

Femoral neck fractures are common among elderly patients after slipping on ice or falling from a chair.Process of Total Hip Replacement Surgery Essay. Hipfractures are classified into impacted or nondisplaced femoral neck fractures, displaced neck fractures of the femur, stress fractures, sub-trochanteric hip fractures, and inter-trochanteric hip fractures. Nondisplaced femoral neck fractures have good prognosis and can be repaired by percutaneous pining and limited incision (Swart et al., 2016). In displaced femoral neck fractures, total hip replacement is required. Before conducting a surgical procedure for total hip replacement, the medical practitioners in charge should assess potential risks. Perioperative risks generally depends on the extent of invasiveness of the surgical process, patient’s medical status, and the amount of damage caused by the injury (Florschutz et al., 2015). Since replacement surgery is the only way to relieve pain in this case, the patient is expected to prepare for the surgery. For instance, the patient should ensure that the surgeon is notified of any present medications because some of them may be stopped before the procedure. The orthopaedic surgeon is required to discuss possible complications and risks and assess is there is any health condition that may be risky for the surgery. Process of Total Hip Replacement Surgery Essay.

During pre-operative management, each case is handled individually. There are no specific guidelines for total hip replacement because an individual may present with a health condition that is different from others (Park, Koehle, and Deveza, 2016). For instance, is a patient presents with an unstable angina pectoris, he or she should be stabilized first before proceeding with the surgery. However, if the unstable angina is revealed as the patient’s long history of health condition which after treatment, is refractory, total hip replacement should be conducted despite the risk. Teamwork is a fundamental factor in this procedure as it improves the outcome (Grant, Cooper and Conroy, 2017). The surgical team consists of a medical consultant, orthopaedic surgeon, and the anaesthesiologist. The role of the medical consultant is to evaluate medical conditions such as delirium, diabetes, hyponatremia, and malnutrition, and stabilizes the patient before surgery. The orthopaedic surgeon conducts assessment of the extent and type of surgery, whereas the anaesthesiologist manages hematologic conditions, plans for the need of advanced intraoperative management, and preoperative risks (Mclsaac et al., 2018).

Timing for total hip replacement is crucial. Studies reveal that the surgical procedure for total hip replacement should be conducted within 48 hours of stabilization and medical evaluation. Procedures that were undertaken within this period were associated with reduced mortality and declined perioperative complications (Basu et al., 2016). Process of Total Hip Replacement Surgery Essay. Generally, delay of surgical procedure affects overall recovery of the hip-joint functionality. Besides, failure to manage and stabilize health issues elevates the risk of perioperative abnormalities.

Post-Operative Management.

Post-operative complications of total hip replacement are bound to occur even if the patient is under the best nursing care. In this section, overview of complications that the patient can encounter after the surgical procedure for hip fracture will be provided. The potential complications are divided into two categories namely immediate and long-term post-operative complications based on the time of their occurrence after surgery. In addition, the essay will provide appropriate strategies that medical professionals and patients can use to prevent the occurrence of these complications.

Immediate Post-operative Complications.

Immediate post-operative complications occurs within the first few days of the surgical procedure. They include pain, delirium, venous thromboembolism, and Anaemia.


All hip fractures cause severe pain during both pre and post-operative procedures. Pain contributes to development of delirium and poor quality of life. To manage pain experienced by the patient after total hip replacement, regional nerve blocks and opiate medications are often administered. Patients with a history of dementia are cumulatively administered with smaller doses of opiates. According to Cook and his colleagues (2017), control of aggressive pain among patients with hip fractures is a crucial step in its management. They encourage that patient with dementia should be frequently administered with oral or parenteral opiates medication to assess aggressive pain. Process of Total Hip Replacement Surgery Essay.

Delirium and its Management.

Delirium is a post-operative complication that occurs among almost 25% of patients with underlying dementia. Consequently, about 50% of dementia patients with the condition of hip fracture develop delirium (Florschutz et al., 2015). The conditions that facilitate development of this complication include old age, male gender, reduced body mass index, delay in the patient’s operative repair, more comorbidities, and longer time taken during surgery. Application of regional anaesthesia seems to significantly reduce the risk of developing delirium (Colón-Emeric, 2012). Therefore, regional, rather than general anaesthesia is recommended where feasible. Other management strategies include proactive geriatrics, early mobilization, psychoactive medication, ensuring faecal and urinary elimination, oxygenation, electrolyte and fluid normalization, and pain control. These strategies have proven to reduce the incidence of delirium significantly.

Venous Thromboembolism.

Colón-Emeric (2012) asserts that the rate of proximal and all-site deep vein thrombosis is higher in hip fracture patients who undergoes total hip replacement without prophylaxis. Process of Total Hip Replacement Surgery Essay.Hence, it is crucial for medical practitioners to pay close attention and uphold prevention measures against this complication. Similar to the case of delirium, regional anaesthesia is preferred as it reduces the risk of developing venous thromboembolism (Colón-Emeric, 2012). Several medications such as fondaparinux, warfarin, and unfractionated heparins are effective in the prevention of deep vein thrombosis.

Long-term Post-operative Complications and Management

Long-term complications begins after total replacement of hip fracture and result in secondary fracture, mortality, and functional disability. Commonly occurring functional disability is gait impairment. After one year of post-operation, less than 50% of hip fracture patients obtain their normal ambulation level. On the other hand, almost 20% of this population becomes completely immobile (Colón-Emeric, 2012). More than half the number of patients who can move around independently develop functional disabilities which require assistance. Under certain circumstances, these disabilities may worsen and leading to a series of hip fractures. Process of Total Hip Replacement Surgery Essay. Management of long-term complications involves rehabilitation, prevention of secondary fracture, nutritional supplements, and anabolic steroids.


Rehabilitation is considered as a fundamental aspect aimed at reducing the rates of functional and ambulatory impairments. A meta-analysis of randomized studies on geriatric rehabilitation interventions among inpatients in Canada and Europe shows remarkable outcomes (Colón-Emeric, 2012). These studies reveals that there is substantial enhancement of functional abilities compared to the outpatient rehabilitation intervention. Hence, rehabilitation process should be facilitated within healthcare institutions to improve outcomes.


In summary, femoral neck fracture that require total hip replacement is a delicate condition which should be handled with care. Such patients benefits a lot from an appropriate approach of a multi-disciplinary team for their preoperative and postoperative management and care. Process of Total Hip Replacement Surgery Essay.