Perioperative care of patients undergoing total hip arthroplasty

Question 1

Enhanced Recovery After Surgery for Total Hip Arthroplasty

Answer 1

• Package of measures combining standardised anaesthesia and surgical care
• MDT approach of surgeons, anaesthetists, pharmacists, physios, OT
• Pt education is key so they are prepared of what to expect
• Benefits: reduced LOS, reduced mortality, reduced transfusion rates and complications

Question 2

Pre-operative Interventions for Hip Arthroplasty

Answer 2

• Hip school and prehab
• Reduce pre-op fasting
• Address anaemia

Question 3

Anaesthetic Considerations for Hip Arthroplasty

Answer 3

• GA vs Neuraxial- no clear benefit of one over the other
• Dexamethasone: Single dose of 8-10mg may be of benefit
• LIA by surgeons vs regional- ? PENG is best as motor sparing
• TXA routine recommended
• Typically will need 28-35 days of VTE prophylaxis
• Paracetamol, ibuprofen and opioid