Hip arthroplasty is the replacement of the hip joint with a prosthesis, and is one of the most common reconstructive operations (Huo et al 2008). Hip arthroplasty may be performed when irreversible damage has occurred to the joint; this damage often causes pain, dysfunction and reduced quality of life. The pre-operative nursing considerations begin with patient education. This should begin at the time the decision is made to have the surgical procedure performed. It is important that the patient understand the preoperative requirements, the surgical procedure, postoperative care and the necessary home/activity modification. The patient should be instructed in self-preparation, including mental and emotion readiness and having a positive attitude about the surgical outcome. There is a great deal of evidence that a patient’s psychological state before the surgery impacts on their recovery afterwards. Studies have shown that patients who report lower levels of general or mental health before surgery have worse physical health outcomes, such as pain levels, after surgery (Long et al, 2005). Like all surgeries, the patient will be assed for their ability to tolerate the procedure and anesthesia. Of particular concern is their cardiovascular and respiratory status, and the presence of any comorbidities. The patient should also be evaluated for the presence of any infection, as it could spread to the hip prosthesis. The teaching of postoperative exercise before surgery allows the patient to become familiar with them and gives them time to ask any pertinent questions. Also, teaching preoperative exercises my help they overall outcome of the surgery. Some studies indicated that preoperative exercise had some postoperative benefit to total hip arthroplasty patients (Barbay, 2009), however more research is needed in this area.
The post-operative nursing considerations begin with routine observations including blood pressure, pulse, respiratory rate, oxygen saturations and temperature to monitor for signs of dehydration, shock or increased levels of pain. The wound should be inspected at regular intervals to check for signs of hemorrhage. The color, sensation, movement and pedal pulses of the operated leg should be assessed regularly to observe for any circulatory or neurological impairment. Pain assessments should be noted at regular intervals, since patients who have their pain well controlled following surgery are able to mobilize more quickly and easily, which helps reduce the risk of post-operative complications such as deep vein thrombosis, pulmonary embolism and respiratory infection. Prolonged and inadequate post-operative pain may result in higher mortality and morbidity rates, increased length of hospital stay and greater healthcare expenses (Eid and Bucknall 2008). The nurse can work closely with the hospital physiotherapists on specific exercises and to assess whether individuals require mobility aides. The patients should be encouraged to participate in foot exercises such as rotation, flexion and extension of the ankle to encourage venous return and to help prevent pooling of blood in the calf muscles (Temple 2004). Since nurses spend more time with patients than other allied health professionals, it is essential that the nursing staff are aware of the nature and benefit of post-operative exercises and are able to instruct and support patients in performing these exercises frequently throughout the day. In conclusion, hip arthroplasty is a common procedure that frequently results in increased levels of independence and reduced pain levels. Knowledge of the relevant anatomy and physiology of the hip helps nurses appreciate why activities of daily living may become painful and difficult for patients with diseases affecting the hip. It is essential that nurses are aware of the importance of effective screening and assessment strategies at pre-operative assessment. They can then identify actual or potential problems either with the intended surgery or with issues regarding discharge arrangements. Understanding the nature of the surgery enables nurses to effectively deliver good pre and post-operative care and anticipate any complications that may ariseReferences

Barbay K Research evidence for the use of preoperative exercise in patients preparing for total hip or total knee arthroplasty. Orthopedic Nursing, 2009 May-Jun; 28(3): 127-33 .

Eid T, Bucknall T (2008) Documenting and implementing evidenced-based post-operative pain management in older adults with hip fractures. Journal of Orthopedic Nursing. 12, 2, 90-98.

Huo MH, Parvizi J, Bal BS, Mont MA; Council of Musculoskeletal Specialty Societies (COMSS) of the American Academy of Orthopaedic Surgeons (2008) What’s new in total hip arthroplasty? The Journal of Bone and Joint Surgery. 91, 10, 2522-2534.

Long M, McQueen D, Bangalore V, Schurman J (2005) Using self-assessed health to predict patient outcomes after total knee replacement. Clin Orthop 434: 189–92

Temple J (2004) Total hip replacement. Nursing Standard. 19, 3, 44-51.