Artificial total hip replacement or artificial femoral head replacement is a common method for treating femoral neck fracture and femoral head necrosis in the elderly, but the long time patients spend in bed after surgery can easily lead to serious complications such as joint stiffness, muscle atrophy and deep vein thrombosis in the lower limbs, and post-operative care is difficult.
What should be noted after artificial total hip replacement or femoral head replacement?
1. Pay attention to the blood flow of the affected limb. Observe the skin temperature, color and swelling of the affected limb, as well as any abnormal sensation and passive pulling toe pain to detect signs of thrombosis in time and prevent venous thrombosis in the lower limb. Maintain correct body position to prevent external rotation and internal rotation and avoid femoral head prolapse. Keep the drainage unobstructed, and also observe the color and amount of drainage fluid.
2. Strengthen basic care. Due to the long time of bed rest after surgery and the limitation of various activities, patients are prone to complications such as pressure sores, pneumonic pneumonia and urinary tract infections, so we should do the following.
① keep the bed dry and flat, massage the pressure area regularly, pad the buttocks with cool liquid, change every 2h, and change the position on time.
② Encourage patients to perform deep whistling and coughing, and give back patting and ultrasonic nebulized inhalation.
③ Instruct patients to drink more water and urinate regularly to avoid urinary retention.
3.Strengthen nutrition. Most patients are old, poor in constitution and have a long operation time, so give high protein, high vitamin and easy to digest food after the operation to improve the body resistance. If necessary, intravenous drip of fat milk, albumin, amino acids, etc.
4.Prevent constipation.
①Ensure sufficient water intake and eat more fruits and vegetables.
② Develop the habit of regular bowel movements.
③ Massage the abdomen several times a day.
③ Massage the abdomen several times a day. ④ Those who have a tendency to constipation can take honey orally, and can be given laxatives or anal injection of corkage when defecation is difficult.
5. Prevention and control of infection. The artificial femoral head replacement surgery site is deep, the exposure area is large, the tissue damage is also large, the postoperative trauma reaction increases, and the chance of infection increases. Preventive measures.
① Strict orthopedic 3-day skin preparation method, absolutely no skin scratches.
②Routine use of antibiotics before and after surgery.
③No intramuscular injection on the affected hip.
④Control potential infection, especially for diabetic patients control blood sugar to normal before surgery.
⑤ Actively treat the primary infection in the body and operate only after the infection is completely controlled.
⑥Pre-operative disinfection of the room should be done to prevent cross-infection.
(7) The continuous negative pressure drainage tube in the trauma cavity should be properly fixed after surgery to prevent slippage, keep the drainage unobstructed, and discharge the blood and exudate in the trauma cavity in time to prevent endogenous infection and retrograde infection.
6, pain and prosthesis loosening. The rate of pain in the affected hip is high after artificial femoral head replacement surgery. Early preventive measures.
①Patients with old fractures should pay attention to functional exercises during the period after the fracture to before surgery to prevent muscle atrophy and ensure muscle strength before surgery.
②Reasonable functional exercise should be performed early after surgery for both fresh and old fractures.
③Guide the patient to leave the bed at an early stage after surgery, and to get out of bed after the joint capsule and surrounding soft tissues have healed and the hip joint has been relatively stable, and the time is appropriate for 3 weeks.
④Guide patients that they should not bear weight too early after surgery, and generally abandon the crutches 4-6 weeks after surgery when the X-ray film is reviewed as per medical advice. Long-term preventive measures: Long-term pain prevention should pay attention to instructing patients to use and strengthen the protection of the replacement joint reasonably after discharge from the hospital.
The following three protective measures can be used.
① Avoid heavy physical work and carrying heavy objects.
② Avoid strenuous exercise and single-leg upright of the affected limb.
Do not do squatting and cross-legged exercise as much as possible.
7. Ensure correct body position to prevent joint dislocation. Postoperatively, the patient should be placed in a flat supine position with the affected limb elevated by 15~20° with a padded pillow. At the same time, keep the patient in a neutral position with 15-30° of abduction, fixed by skin traction or wearing “d” shoes, turn over so that the hip and knee are at the same level, and turn over from the affected side to the healthy side, with a soft pillow between the legs to prevent accidental dislocation of the hip joint.
8.Discharge guidance. The postoperative recovery is long, so the discharge instruction should be actively done, and the patient should be instructed to continue the contraction of the quadriceps muscle of the affected limb, and the functional exercise should be gradual. Do not cross your legs 6 weeks after surgery, and hold a pillow between your legs when lying on the healthy side. Do not sit on sofas and low chairs, do not cross your legs, and do not tilt your body when sitting in a chair. Avoid bending the waist and bending the hip more than 90°. The affected limb can gradually bear weight and get off the crutches appropriately in 1~2 weeks after surgery. 6 months, avoid external rotation of the affected limb and gradually increase the time and intensity of muscle and joint activities, and restore the limb function as soon as possible through accurate and effective functional exercises.
The purpose of artificial femoral head replacement is to relieve the pain of the hip joint and restore the function of the hip joint. During the perioperative period, we should do a good job of education on relevant knowledge, psychological care, and adaptability training, and do a good job of all preoperative preparations; after surgery, we should closely observe the blood flow of the limb, keep the drainage tube unobstructed, maintain the correct position, and strengthen the observation and prevention of postoperative complications, which is the key to ensure the success of surgery.