Hip-O-A Case Study

Katz, J. N., Wright, E. A., Polaris, J. J., Harris, M. B., & Losina, E. (2014, May 22). Prevalence and risk factors for periprosthetic fracture in older recipients of total hip replacement: a cohort study. BMC Musculoskeletal Disorders, 15(1), 1-9. http://dx.doi.org/10.1186/1471-2474-15-168Lewis, S. L., Dirksen, S. R., Heitkemper, M. M., Bucher, L., & Camera, I. M. (2011). Medical-surgical nursing: Assessment and management of clinical problems (8th ed.). St. Louis, MO: else

PROCEDURE IN DETAIL: The patient was brought into the operating room, after satisfactory anesthesia, was placed in the left lateral dicubitis position. The right hip was prepped and draped. A previous made incision was reopened over the greater trochanter and carried down to Illiotibial (IT) band. The IT band was opened in the direction of the skin incision. The anterior 1/3 of the gluteus medius/minimus group was reflected off the trochanter over to the anterior brim of the pelvis. The hip was dislocated. The femoral component was easily removed. It was loose in the cement. The polyethylene was loose and easily removed. There was a lot of cement in and around the acetabulum. We debridement most of this. There was a wired mesh plug that went medially into the pelvis that was left in place. There was also one in the ishium that was quite stable and it was left in place. There was a large defect in the medial wall of the acetabulum about the size of a silver dollar.

Mrs. Pink, aged 75 was admitted to the orthopaedic ward after suffering a fall at home, resulting in an intracapsular fracture of the hip at the femoral neck. Mrs. Pink has a history of cancer and cardiac diseases and has severe rheumatoid arthritis. Due to ageing patients putting a great deal of strain on the health care system, the incidences of hip fractures in the elderly are a major concern and requires careful consideration regarding treatment. Known as a major cause of disability in the elderly, hip fractures and their subsequent need for surgery result in chronic pain and an altered quality of life (Strike, Sieber, Gottschalk & Mears, 2013). Although important to improve a patient’s quality of life and physical independence, pain related to a total hip replacement (THR), also known as hip arthroplasty (HA) can lead to delays in ambulation, longer hospital stays, poor functional outcomes and quality of life. The purpose of this essay is to identify the rationale behind nursing interventions provided to post-operative THR patients as well as the pathology of a femoral neck hip fracture and their procedure for assessment and diagnosis.

These findings could appeal to individuals who might question if they have hip dysplasia. It could also appeal to the individuals that have developed hip dysplasia and are questioning if they could benefit more from a hip replacement or other methods. My interest in this topic began a few years ago during a recreational soccer season. My hips both were not as strong as they were during childhood. Over the course of my high school career, I have spent multiple hours at different specialists for my hips, physical therapy and hydrotherapy. Shortly after my sophomore year of high school, I decided I needed to have periacetabular osteotomy surgery. I know that there are many options to correct a hip, however, I am wondering if a PAO would be better for someone as a young adult.

One afternoon a 67 year-old man presented to the emergency department of a small, rural hospital complaining of severe left leg and hip pain following a fall at home. The patient had no past history of falls. He had a history of impaired glucose intolerance, prostate cancer, hypercholesterolemia and hyperlipidemia. The patient’s current medications were atorvastatin and oxycodone for chronic back pain. The patient stated his pain was ten out of ten on a scale of one to ten with ten being the worst. The left leg appeared shorter than the right, edema was present in the calf, as was ecchymosis and he had limited range of motion. After an evaluation in triage by a registered nurse and a subsequent examination by the emergency department physician, a plan was established to sedate the patient using moderation sedation protocol and perform a manual reduction of the hip.

Indications: The patient is a 69 year old black female who fell landing on her right hip. She was seen in the Emergency Room where physical exam and x-ray revealed an intertrochanteric right femoral fracture. She was admitted to Dr. Loyd’s service .

HIPAA, formally known as the Health Insurance Portability and Accountability act, was signed into legislation back in the 90's. These regulations were enacted as a multi-tiered approach that set out to improve the health insurance system. HIPAA has specifications that ensure the confidentiality and privacy of protected health information. Here are a few Dos and Don’ts of HIPAA:

An incision will be made in your hip. Your surgeon will take out any damaged cartilage and bone.

HPI: S.J. is a 67 y/o Caucasian male with a history of left hip pain for two years. He has difficulty walking due to left hip pain and utilizes a cane, can walk five blocks, climbs stairs leading with the right leg. He denies any surgeries on the left lower extremity. He sought physical therapy, but he does not feel that it is improving his pain but does believe it is improving his strength. He is scheduled for a left total hip arthroplasty due to the progression of severe osteoarthritis of the left hip as confirmed by a pelvic x-ray and MRI of the lower extremity without contrast. S.J. has taken various medications that are listed on the current medication section of this note.

The patient is a 74-year-old female who tells me she did see Dr.[____] and she did get a shot into her hip. She states symptoms are "1000 times better". She does tell me he was done ultrasound and thought she might have a [____] tear, which at this point, if this does not work, she will need likely to have a hip replacement, as he did not think this is fixable at her age.

Slipped capital femoral epiphysis, is a disease that slithers upon you like a snake. The pain begins in your lower leg, usually in the knee or ankle. However, that is not where the pain is truly located, the pain is located at the hip. The pain is caused by the displacement of the proximal femoral epiphysis from the metaphysis. A study of the disease in Germany, “with 411 overweight children in the study, 196 of them being males, the investigation showed 18.2% experienced reduced range of motion for hip flexing” (Wabitsch et al 2-3). The results from the German study showed that “eleven out of 54, showed signs of an abnormal head-neck ratio, this is a sign of prior silent slipped capital femoral epiphysis”

Case Description: The subject of this study is a 78-year-old female with post open-reduction-internal fixation on right hip in June 2014. She typifies an excellent candidate for this study because of a previous right hip fracture due to fall, multiple joint pains due to the diagnosis of osteoarthritis, thoracolumbar dextro-scoliosis, lumbar spinal stenosis, has sleep apnea, hearing and vision deficits. Since May 2016, patient regularly participated in a once a week 45-minute Tai Chi program offered at the local YMCA.

The patient was admitted into the hospital. In the morning after admission was taken to the operating room where she under went open reduction internal fixation of her right ankle fracture. She had an uncomplicated post operative course and gradually returned to assisted ambulation, she was then discharged in good condition.

According to Goodman and Fuller (2009) Osteoarthritis is divided into 2 classifications: Primary and secondary. Primary OA is a disorder of unknown cause which in the cascade of joint degeneration it is believed to be a related defect in the articular cartilage. Secondary OA has a known cause, which may be trauma, infection, hemarthrosis, osteonecrosis, or some condition Primary Osteoarthritis (OA) is the most common joint disorder in the world and often affects the knee and hip joints (Rubak, Svendsen, Soballe, & Frost, 2013). For patients with primary hip OA, pain and disability are the most important indications for total hip replacement (THR) (Rubake et al., 2013, p.486) Primary symptoms of OA include joint pain, stiffness, and limitation of movement. Disease progression is usually slow but can

All of his toes on the right foot cause him a large amount of pain. This is causing his so much pain that he is having trouble standing and walking. He has numbness in his heel and toes.