TOTAL HIP ARTHROPLASTY (THA)

 

Total Hip Arthroplasty (THA), commonly known as total hip replacement, is a surgical procedure to replace a damaged or worn hip joint with an artificial joint (prosthesis). This procedure is typically performed to relieve pain and improve mobility in patients who have not responded well to other treatments. Here's an overview:

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1. Indications for Surgery: THA is commonly indicated for conditions like osteoarthritis, rheumatoid arthritis, avascular necrosis, and fractures or injuries of the hip. It's considered when other treatments, such as medication, physical therapy, or less invasive surgical procedures, have failed to provide adequate pain relief and improved joint function.

2. Surgical Procedure: The surgery involves removing the damaged head of the femur (thighbone) and replacing it with a metal or ceramic ball. The damaged part of the hip socket (acetabulum) is also removed and replaced with a metal socket, and a plastic, ceramic, or metal spacer is placed between the new ball and the socket to allow for smooth movement.

3. Surgical Approaches: There are different surgical approaches for THA, such as the posterior approach, anterior approach, and lateral approach. The choice of approach depends on the surgeon's experience and preference, the patient's anatomy, and specific health conditions.

4. Longevity of the Implants: Modern hip implants are designed to last for many years. Most patients can expect their hip replacement to last for 15 to 20 years or more.

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THA restores movement and relieves pain

                                                                                                 

                                                 Anesthetic Implications for Total Hip Arthroplasty (THA)

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Anesthesia type: General, regional anesthesia

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Airway: ETT

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Preoperative:

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• Osteoarthritis is the most common indication for hip arthroplasty.

• Patients are usually elderly

• Consider preemptive analgesia

• Rheumatoid arthritis: assess for atlanto-occipital instability, valvular pathology, pericardial effusion

• Preoperative hemoglobin and type and screen 

• Tranexamic acid may be administered prior to incision and at closure 

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Intraoperative:

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• Position: Supine for anterior approach, lateral decubitus for lateral or posterior approaches

• In lateral position, patient will be positioned in bean bag and/or kidney rest

• Duration: 2-3 hours

• EBL :250-1000 cc

• Maintain normothermia

• Induced hypotension minimizes blood loss

• Polymethylmethacrylate (PMMA) is used for the cement

• The proximal femur is trimmed and the medullary canal reamed to accept the prosthesis

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Postoperative:

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• PONV prophylaxis

• Multimodal analgesia

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Complications:

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• Fat embolism

• Air embolism

• Thromboembolism

• Pulmonary embolism

• Bone marrow embolism

• Hip dislocation

• Infection

• Deep vein thrombosis

• Femoral/sciatic nerve injury

• Vascular injury to ileac vessels

• Bleeding

• Risk for bone cement implantation syndrome (BCIS)

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Sources:

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Elisha, S. (2010). Case Studies in Nurse Anesthesia.

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Macksey, L. F. (2011). Surgical procedures and anesthetic implications: A handbook for nurse anesthesia practice. 

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Jaffe, R. A. (2020). Anesthesiologist's Manual of Surgical Procedures (6th ed.). 

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Singh-Radcliff, N. (2013). 5-Minute Anesthesia Consult.

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