1.Special attention: prevention of hip dislocation
Avoid sitting on a small stool and squatting; avoid crossing your legs or legs; do not bend sideways or bend forward excessively; avoid poor posture such as inversion and internal rotation of the hip joint on the operation side. The height of the toilet seat should be greater than 40cm.
2, the need for systematic prevention of lower limb venous thrombosis after surgery
The most serious complication of artificial hip and knee joint replacement surgery is the occurrence of lower limb vein embolism, which can lead to all kinds of serious consequences and even death after lower limb vein embolism. Luo Ruiqing, the former Minister of National Defense of China, died of pulmonary embolism after an artificial hip replacement surgery in Germany. Pulmonary embolism is due to the further development of deep vein embolism in the lower extremities. The high-risk factors for lower extremity venous embolism are: hip and knee surgery, old age, trauma, previous history of venous thromboembolism, obesity, paralysis, braking, intraoperative application of tourniquet, general anesthesia, malignancy, central venous cannulation, chronic venous valve insufficiency, etc. The more risk factors there are, the greater the likelihood of occurrence. There is a patient in our department who was able to walk on the ground 4 days after hip replacement and was discharged from the hospital. It was a great pity that he had a cerebral infarction almost one month after the operation and then died from complications.
There are three measures to prevent venous embolism of lower limbs.
First, basic prevention: including encouraging patients to turn over regularly, early functional exercise, get out of bed and do deep breathing and coughing action. Drink more water to avoid dehydration. Improve the lifestyle, such as quit smoking, quit drinking, control blood sugar and blood lipid, etc.
Second, physical prevention: use gradient pressure elastic stockings, etc., using mechanical principles to promote the acceleration of venous blood flow in the lower limbs, reduce blood retention, and reduce the incidence of deep vein thrombosis in the lower limbs after surgery. Our orthopedic center routinely uses 15cm wide elastic straps, which can effectively reduce the risk of DVT.
Third, drug prevention: two methods can be used: oral rivaroxaban tablets or subcutaneous injection of low molecular heparin, oral rivaroxaban will be more convenient and safe, but the cost is a bit higher. Therefore, anticoagulation for 6 weeks after surgery is very important.
1.Take a pelvic plain film once a year
To find out whether the prosthesis has subsided and shifted, and whether there is bone resorption around the prosthesis.
Because the artificial joint has a certain service life, as long as the doctor thinks it needs to be revised again, please do not delay, delayed treatment will cause future treatment difficulties. Early detection and early revision can improve the effectiveness of treatment.
2.The following cases need to use intravenous antibiotics: fever, tooth extraction, wound bleeding
After the installation of the artificial joint prosthesis, as long as the bacteria reached the prosthesis around it will not be killed, resulting in infection can not be controlled. Infection is one of the most common causes of loosening of artificial joints. Dental operations, endoscopy and other minor surgical procedures can produce a transient bacteremia, the prevention of delayed infection around the prosthesis is very important means is to use intravenous antibiotics.
3. Active rehabilitation
Successful artificial hip surgery does not mean good postoperative function. Post-operative rehabilitation is important. Just like a new bearing needs a break-in period, good results can only be obtained after systematic training.
A good joint should be stable, strong and flexible. A joint that has not been rehabilitated tends to have a reduced range of motion and insufficient muscle strength. Insufficient muscle strength tends to make it easier to fall and once a periprosthetic fracture is caused, it will be very tricky to deal with and care should be taken to avoid it. During the post-operative functional recovery period, you can take anti-inflammatory painkillers to reduce the swelling and pain of the joint during functional exercises. Up and down stairs exercises: when going upstairs, the healthy limb is in front, the affected limb follows; when going downstairs, the affected limb is in front, the healthy limb follows.
4, pay attention to the treatment of osteoporosis, hypertensive disease, diabetes and other underlying diseases
Doctors hope that all patients after artificial joint replacement have a good quality of life. Once, I had a patient who lived a wonderful life for 4 years after bilateral knee replacement, but this patient did not pay attention to the treatment of hypertension and later had a cerebral hemorrhage, which caused obvious sequelae and required others to take care of their lives. This is very regrettable.
The prevention and treatment of osteoporosis begins with the recommendation of bone density testing, and the gold standard for bone density testing is the use of dual-energy X-ray equipment. Our hospital’s bone densitometer is one of the most advanced dual-energy X-ray bone densitometers available. Treatment is then based on the bone density report. The first thing to focus on is basic treatment, which includes more exercise, more sunshine, and taking calcium tablets morning and night. If the bone density report T value is less than -2.5, it is recommended to use Calcium D tablets + Fumagal tablets orally, or Zoledronic acid injection is also a good choice. The first treatment phase is recommended to be maintained for one year, and then follow-up treatment will be determined according to the review.
5.After discharge from the hospital, the following conditions need to be reviewed as soon as possible
A. Localized redness, swelling, heat and pain of the joint or the appearance of a small hole with fluid flow.
B. Feel that the joint movement is not normal or limited in the past.
C. Swelling of the whole limb with pain or joint deformity.
D. Deformation and pain in the joint after trauma.