Postoperative Care Following Revision Total Hip Arthroplasty

FIGURE 36-1. Hip guide brace.

Hip spica casts very effectively restrict hip motion but are less well tolerated by patients (Fig. 36-2). Most surgeons use these devices selectively for the most difficult instability or abductor mechanism problems.

FIGURE 36-2. Patient in hip spica cast.

The determination of when to use an external orthosis after hip reconstruction is based on a number of factors. These include the operative approach, the magnitude of the hip reconstruction, patient factors of reliability and compliance, and most importantly, the intraoperative stability of the hip. Very high body mass index patients are difficult to brace effectively. Patients who are very thin also can be difficult to brace because of skin breakdown risk. Patients who have a very stable hip intraoperatively and who are likely to be compliant postoperatively may not be selected for treatment with any hip orthosis. This is particularly true for patients treated with an operative approach that keeps the posterior soft tissue envelope intact (such as an anterior approach, an anterolateral approach, or certain transtrochanteric approaches). Patients known to be at high risk for hip instability based on the magnitude of the surgery, type of surgery (e.g., headliner exchange), demonstrated intraoperative hip instability, or compliance concerns probably benefit most from a hip guide brace.

Antibiotic Management Perioperative antibiotics are continued for at least 24 hours postoperatively. Thereafter a decision must be made concerning duration of antibiotic administration. Some surgeons prefer to continue intravenous or oral antibiotics until the final results of intraoperative cultures are available, while others stop all antibiotics at 24 hours. No definitive information on the benefits of either approach are available. The author currently uses 24 hours of intravenous antibiotics followed by an oral antibiotic until intraoperative culture results are available.

Urinary Catheter Protocol

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