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Hip Precautions After Hip Operation Protocol PowerPoint Presentation

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Description : Check out this medical PowerPoint presentation titled "Hip Precautions After Hip Operation Protocol” by Courtney J Lightfoot.

This medical PowerPoint presentation is about total hip replacement (THR) and hip precautions. Total hip replacement (THR) is a surgical procedure that involves the removal of damaged or diseased parts of the hip joint and replacing them with artificial components. This surgery is often recommended for patients with severe hip pain, limited mobility, and joint damage caused by conditions such as osteoarthritis, rheumatoid arthritis, or hip fractures.

After THR surgery, patients are usually advised to follow specific hip precautions to prevent dislocation of the new hip joint and promote healing. These precautions may include the following:

Avoid crossing legs: Crossing legs can cause the new hip joint to become unstable and increase the risk of dislocation. Therefore, patients should avoid crossing their legs and keep their knees slightly apart while sitting.
Use a pillow between the legs: Patients should place a pillow between their legs while sleeping or resting to prevent the new hip joint from rotating inward.
Avoid bending the hip past 90 degrees: Patients should avoid bending the hip beyond 90 degrees, such as when bending forward to tie shoes or picking up objects from the floor. They can use a long-handled reacher or a shoehorn to avoid bending the hip too much.
Avoid twisting the hip: Patients should avoid twisting their hip, such as when getting in and out of a car or turning in bed. Instead, they should pivot on their feet and keep the hip in a neutral position.
Use assistive devices: Patients may need to use crutches, a walker, or a cane for several weeks after surgery to avoid putting too much weight on the new hip joint.

Following these hip precautions can help patients recover faster and reduce the risk of complications after THR surgery. It is important to follow the instructions provided by the surgeon and physical therapist to ensure a successful outcome.

Tags : Hip Precautions, total hip replacement, osteoarthritis, rheumatoid arthritis, hip fractures, Orthopaedic Surgery, Orthopaedic Surgery PowerPoint presentation

Published on : Jun 23, 2023 | Views : 1614 | Downloads : 0

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Slide 1-

HippityHop: Hip Precautions After Hip Operation Protocol Courtney J Lightfoot PhD student, University of Nottingham courtney.lightfoot@nottingham.ac.uk Lightfoot C J, Sehat K R, Drury G, Brewin C, Coole C, and Drummond A
Slide 2-

Surgical treatment considered when the hip joint becomes damaged and causes persistent problems Effective method to relieve pain, improve functional ability, and quality of life (QoL) >83,000 performed in 20151 Dislocation recognised complication with incidence rates 1-15%2 Total Hip Replacement (THR) 1. National Joint Registry, 2016; 2. Resptrepo et al., 2011
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To protect new joint and ↓ risk of dislocation Hip Precautions Avoidance of specific movement 6 weeks Impact on daily life Hip precautions ↓
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Although routinely provided there are large discrepancies in the provision of hip precautions Movements to avoid Length of time to follow Reasons for teaching Equipment provision Hip Precautions Drummond et al., 2012
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Although routinely provided there are large discrepancies in the provision of hip precautions Hip Precautions Drummond et al., 2012 Movements to avoid Flexion Adduction Internal/external rotation
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Although routinely provided there are large discrepancies in the provision of hip precautions Hip Precautions Drummond et al., 2012 Length of time to follow 6 weeks 12 weeks
Slide 7-

Hip Precautions Smith and Sackley, 2016
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Although routinely provided there are large discrepancies in the provision of hip precautions Hip Precautions Drummond et al., 2012 Reasons for teaching OT practice Surgical approach used Surgical opinion Hospital policy Team decision Evidence based length of stay
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Although routinely provided there are large discrepancies in the provision of hip precautions Hip Precautions Drummond et al., 2012 Equipment provision Raised toilet seat Chair / bed raisers Perching stools Long handled reachers Dressing aids
Slide 10-

Hip Precautions Smith and Sackley, 2016
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Literature Review Not needed Long term use Current research is equivocal, with conflicting evidence Counselling patients to avoid bending and to be vigilant during functional transfers2 Dislocations occur due to undesirable movements that cannot be avoided1 1. Gromov et al., 2015. 2. Smith et al., 2012.
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Hip precautions = No additional benefit for ↓ dislocation rates Literature Review ↓ ↓
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No additional benefit for ↓ dislocation rates Literature Review ↓ Barnsley et al., 2015; van der Weegan et al., 2016
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Hip precautions = No additional benefit for ↓ dislocation rates Literature Review ↓ Slower return to ADLs ↓
Slide 15-

Slower return to ADLs Literature Review Ververeli et al., 2009
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Slower return to ADLs Literature Review Peak et al., 2005
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Hip precautions = No additional benefit for ↓ dislocation rates Literature Review ↓ ↓patient satisfaction Slower return to ADLs ↓ ↓
Slide 18-

↓patient satisfaction Literature Review ↓ Peak et al., 2005
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Hip precautions = No additional benefit for ↓ dislocation rates Literature Review ↓ ↓patient satisfaction Sleep deprivation Slower return to ADLs ↓ ↓
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Sleep deprivation Literature Review ‘Sleep deprivation leads to increased anxiety and decreased satisfaction’ 68.4% patients in restricted group and 65.6% patients in unrestricted group rated sleeping fully supine “uncomfortable” Peak et al., 2005 O’Grady et al., 2003
Slide 21-

Sleep deprivation Literature Review Significant differences in side-sleeping were noted at all follow-up time periods Peak et al., 2005 14% patients in unrestricted group began side-sleeping on night of surgery
Slide 22-

Hip precautions = No additional benefit for ↓ dislocation rates Literature Review Significant £ ↓ ↓patient satisfaction Sleep deprivation Slower return to ADLs ↓ ↓
Slide 23-

Significant £ Literature Review Cost savings of $655 … abduction pillow ($120) elevated toilet seat ($65) elevated chair ($955 to purchase, $15/day to rent) Mean (Range) Peak et al., 2005 Drummond et al., 2012
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Hip precautions = No additional benefit for ↓ dislocation rates 1 Literature Review 1. Barnsley et al., 2015; van der Weegan et al., 2016 2. Ververeli et al., 2009; Peak et al., 2005 3. Peak et al., 2005 4. Peak et al., 2005; O’Grady, 2003; 5. Peak et al., 2005; Drummond et al., 2012 Significant £5 ↓ ↓patient satisfaction 3 Sleep deprivation 4 Slower return to ADLs 2 ↓ ↓
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Strong opposing clinical opinions Main difficulties in evaluating key literature: Literature Review 1. 2. 3. Lack of robust methodology Underpowered studies Focus on dislocation
Slide 26-

Research Aims To compare outcomes of hip precautions vs. no hip precautions To explore patients’ experiences of the regimes To explore staff members’ perceptions of the service To assess the costs of providing each regime 1. 2. 3. 4. HippityHop
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Study Design RCT Impractical – service based Unrealistic provision Potential for widespread contamination and protocol infringement Number of participants required to demonstrate a difference would be very large
Slide 28-

Study Design Using a local Trust who are moving to a no precautions model of care as an opportunity to model the study around this service change Before After
Slide 29-

Intervention ‘Routine’ (previous) treatment Hip precautions taught Patients provided with ‘safe height’ Equipment routinely provided ‘New’ treatment strategy Patients encouraged to move as they are able Equipment only provided to those who require it
Slide 30-

Sample Size Treatment regimes Recruit = 342 participants (171 per group/ treatment regime) Pre-defined margin of equivalence = 0.5SD Confounding factors 25% attrition rate Interviews Recruit = 40 participants (20 staff & 20 patients) Sufficient diversity
Slide 31-

Elective THR patients Population and Recruitment Approached at preoperative assessment
Slide 32-

Outcomes Baseline 1 week 6 weeks 3 months Pre-op Surgery Oxford Hip Score (pain and function) ADLs satisfaction QoL mood dislocation sleep equipment time Sample of cohort
Slide 33-

Qualitative Interviews Sample of patients from phase one and two, and orthopaedic staff Selected using maximum variation purposive sampling Interview guidelines developed as study progresses
Slide 34-

Results 182 consented 173 baseline completed 8 withdrawn 162 baseline for analysis 9 non returners 3 late returners 8 cancelled surgery 9 unfit for surgery 302 approached 304 letters sent out To date … Phase One
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Results 27 baselines complete Phase One / Two 118 baselines complete 115 one week complete 3 missed 112 six weeks complete 2 awaiting return 4 non returners 74 three months complete 23 awaiting return 20 to send out Phase One 1 non returner 4 missed 17 one week complete 6 to contact 145 baselines and surgery 8 six weeks complete 10 awaiting return 8 to send out 1 non returner
Slide 36-

Results 42 consented 17 baseline completed 62 approached 84 letters sent out To date … Phase Two
Slide 37-

Next Steps Treatment regimes Recruitment ends = February 2018 Interviews Recruit: 10 clinical staff (November 2017 – January 2018) 10 patients (January 2018 – May 2018) Cost Assess 10 patients
Slide 38-

Thank you Courtney J Lightfoot courtney.lightfoot@nottingham.ac.uk CourtneyJLight
Slide 39-

Literature Review Key reviews Key papers Talbot et al., 2002 Peak et al., 2005 Restrepo et al., 2011 Sharma et al., 2009 Barnsley et al., 2015 van der Weegan et al., 2016 Smith et al., 2016
Slide 40-

Peak et al., 2005
Slide 41-

Drummond et al., 2012