THA Precautions and Discharge Guidelines

Question 1

Surgical Approaches and Hip Precautions
Q: What factors influence the selection of a surgical approach for total hip arthroplasty?

Answer 1

A: Patient activity level, co-morbidities, life expectancy, anticipated compliance, and surgeon familiarity.

Question 2

Anterolateral Approach
Q: Which muscles are involved in the anterolateral approach?

Answer 2

A: Tensor fasciae latae and gluteus medius.

Question 3

Anterolateral Approach

Q: What are the hip precautions for the anterolateral approach?

Answer 3

A: Avoid:
Hip flexion beyond 90 degrees.
Hip extension.
Lateral rotation.
Adduction.

Question 4

Direct Lateral Approach
Q: What structures are impacted in the direct lateral approach?

Answer 4

Posterior gluteus medius remains intact.
Tensor fasciae latae and vastus lateralis are divided.
Anterior gluteus medius is released.

Question 5

Direct Lateral Approach
Q: Why is the direct lateral approach suitable for noncompliant patients?

Answer 5

A: It minimizes the risk of dislocation.

Question 6

Direct Lateral Approach
Q: What are the hip precautions for the direct lateral approach?

Answer 6

A: Avoid:

Hip flexion beyond 90 degrees.
Hip extension.
Lateral rotation.
Adduction.

Question 7

Posterolateral Approach
Q: What is the main risk of the posterolateral approach?

Answer 7

A: High post-surgical dislocation rate.

Question 8

Posterolateral Approach

Q: What structures are involved in the posterolateral approach?

Answer 8

Gluteus maximus is split.
Short external rotators are released.
Femur is dislocated posteriorly.

Question 9

Posterolateral Approach
Q: What are the hip precautions for the posterolateral approach?

Answer 9

A: Avoid:

Hip flexion beyond 90 degrees.
Adduction.
Medial rotation.

Question 10

General Discharge Guidelines
Q: How long must patients typically follow discharge guidelines after total hip arthroplasty?

Answer 10

A: Up to three months.

Question 11

General Discharge Guidelines
Q: What are key sitting and standing guidelines post-surgery?

Answer 11

Avoid crossing legs while sitting.
Use firm chairs; avoid low or soft furniture.
Limit forward bending when sitting or standing.

Question 12

General Discharge Guidelines

Q: What are key sleeping and bed-related guidelines?

Answer 12

Use a pillow or splint between the legs.
Avoid forward bending to pull blankets.
Place the nightstand on the same side as the uninvolved leg.

Question 13

General Discharge Guidelines

Q: What are safety tips for walking and ascending/descending stairs?

Answer 13

Avoid pivoting on the involved side; turn to the uninvolved side.
Ascend stairs with the uninvolved leg first.
Descend stairs with the involved leg first.

Question 14

General Discharge Guidelines
Q: What home modifications can help prevent falls?

Answer 14

Remove throw rugs.
Use rubber, non-skid bath mats.
Always wear appropriate footwear.

Question 15

General Discharge Guidelines
Q: What guidelines apply to bathing and toileting?

Answer 15

A:

Use a raised toilet seat or portable commode.
Use a long-handled brush to avoid leaning forward.

Question 16

Discharge Guidelines (General)

Seating and Bed Position:
Avoid crossing legs while sitting.
Use firm chairs; avoid low or soft furniture.
Place a pillow or splint between legs in bed.
Avoid pulling blankets up with forward bending.

Posture and Movements:
Stand with feet in a neutral position (no inward turning).
Turn toward the uninvolved side while walking to avoid pivoting on the operated leg.

Assistive Devices:
Use a raised toilet seat or portable commode.
Use a long-handled brush to avoid leaning forward during bathing.

Home Safety:
Remove throw rugs.
Use non-skid bath mats.
Always wear appropriate footwear.

Stairs:
Ascending: Step up with the uninvolved leg first.
Descending: Step down with the involved leg first.

Activity Level:
Walk for short periods, gradually increasing duration to build endurance.

Question 17

Surgical Approaches and Precautions

Anterolateral Approach

Access: Through the interval between the tensor fasciae latae and gluteus medius.
Hip abductors are partially released from the greater trochanter.
Hip is dislocated anteriorly.
Precautions:
Avoid hip flexion beyond 90°.
Avoid hip extension.
Avoid lateral rotation.
Avoid adduction.

Direct Lateral Approach

Access:
Longitudinal division of tensor fasciae latae and vastus lateralis.
Release of the anterior portion of the gluteus medius, with the posterior soft tissues and capsule intact.
Reduces risk of dislocation; ideal for noncompliant patients.
Precautions:
Avoid hip flexion beyond 90°.
Avoid hip extension.
Avoid lateral rotation.
Avoid adduction.

Posterolateral Approach

Access:
Splitting of gluteus maximus along muscle fibers.
Release of short external rotators.
Retraction of hip abductors anteriorly; maintains gluteus medius and vastus lateralis integrity.
Femur dislocated posteriorly.
Commonly used but has a higher dislocation rate.
Precautions:
Avoid hip flexion beyond 90°.
Avoid adduction.
Avoid medial rotation.