Essay on Enhancing Mobility: Exploring Hip Replacement Surgery in Elderly Patients for Osteoarthritis Relief

Introduction

Elderly patients who suffer from osteoarthritis can now access treatment and bone management as one of the best methods to alleviate pain. The procedure involves surgical replacement of the hip with an artificial hip prosthesis. The operation generally is performed under spinal anesthesia, with the lower half body being immobilized. According to the Centers for Disease Control and Prevention (CDCP), hip replacement surgery is on the rise among elderly patients aged 75 and above. However, it is hypothesized that the procedure may not fully benefit elderly patients in their 90s birthday. In their case, experts believe that total hip replacement is much safer, especially for those in reasonably good health. This paper seeks to examine an array of research concerning the operationalization of hip replacement surgery in elderly patients as a means of restoring mobility otherwise altered due to the encroachment of osteoarthritis conditions.

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Arthritis is a medical condition of the inflamed joint, which causes swelling and pain. Generally, the disease affects bone joints specialty hip and knee joints. According to Guler et al., (2020, P. 44), there are many types of arthritis; however, osteoarthritis is more prevalent. Also referred to as a degenerative joint, osteoarthritis is twice as likely to develop in an older adult as one advance in age. EVANS argues that the condition typically sets when an inflamed and injured joint breaks down to sever the cartilage holding the muscles and the bones to (Guler et al., 2020, P. 44). Muscle breakdown, in turn, causes excruciating pain and swelling and, in extreme cases, deformity of bones. Bone cartilage are firm, rubbery material covering the bones’ terminal ends with the essential function of reducing friction on the joints or, as known, “absorbing shocks.”

Patients suffering from osteoarthritis are affected much because they are unable to walk. According to Okolie et al. (2020, p. 99), diagnosing the condition can sometimes prove difficult because the pain becomes systemic and then localizes in other joints, with many cases reporting stabbing and sharp pain with the stiff hip joint. As a result, there is no single test for the condition, but it is best detected through abnormal X-rays that reveal the bone’s characteristic features, such as spurring joint margins and narrowing.

Literature Review

According to CHAN et al., the main goal of treating and managing osteoarthritis in extreme cases is to improve the individual’s mobility and lifestyle. The condition is medically corrected through surgical hip replacement, among other available treatment methods such as partial hip replacement and hip resurfacing Rolfson, (2009, p. 172)). John Surrey from the Orthopedic Department at Johns Hopkins asserts that hip replacement, also known as total hip arthroplasty is the most convenient means of restoring individuals’ mobility, especially when necrosis begins at the terminal joint bones. However, the procedure remains a complex field with a lot of procedures needed.

He further indicates that the process involves the surgical replacement of old bones with an artificial joint –prosthesis- a better choice for elderly patients. In his research, EVANS intimated that hip arthroplasty involves plastic implants in which the hip sockets are replaced with durable plastic cups, the removal of femoral heads and replaced with ceramic or a metal alloy. The newly acquired femoral ball is then inserted into the hip joint of the femur.

Okolie et al. (2020, p. 122) opines that hip arthroplasty has dramatically evolved in the last century. This is despite the earlier attempts to replace the hip by John Charnley in the 19th century. Today there has been a myriad of advances in carrying out the procedure progressively with effective therapeutic measures. Research indicates total hip arthroplasty as the most effective for his osteoarthritis condition, with much concern being on postoperative outcomes, surgical methods, and materials for use.

As indicated in the photos above, Okolie et al, 2020, argue that total hip arthroplasty is currently the method tested and proved successful in restoring mobility. The method alleviates painful conditions with a high return propensity as far as the patient’s functionality during post-operative is concerned. Nonetheless, some grey areas are always pushed for refinement based on the technique, as CAN puts it.

There are four primary procedural means of approaching the procedure. Räsänen et al. (2017, p. 112) indicate that all of them entail some risks and benefit profiles based on the conditions of the anatomic structures involved. For instance, there are cases of post-operative dislocations, post-operative limps, hip scores, and patient satisfaction, among others. Such are cases and factors that have been used to evaluate the necessity of total arthroplasty on hip joints.

The technique involves an anterior approach to the hip in cases of total arthroplasty. According to Räsänen et al. (2017, p. 116), this approach was practiced in the past decades, but it has become popular with different surgeons for many reasons; 1) it utilizes immediate anterior intramuscular plane and intravenous (described as modified heater approach) as was used by Judet and judet in 1950. The hunter approach has been regarded to result in faster patient recovery to ambulation and strength with a low dislocation rate.

According to Rolfson, (2009, p. 188), the approach provides a clear and direct view of the acetabulum point of articulation with much visual acuity on the anterior iliac spine to allow reference for proper cup placement and positioning. However, the femur canal placement and preparation remains a challenge and a complicated approach. Due to the anticipated difficulty, the muscle is dissected from the proximal femur and compromises the intramuscular venous aligned to the femur. In the whole procedure, the use of orthopedic positioning has been an interesting facet to consider. To allow the procedure progression to end, proper positioning is essential to enable the femur’s exposure, allowing accurate femur component positioning.

Lateral positioning of the patient

The objective of positioning during hip arthroplasty is to safeguard the delicate procedure with maximum joint exposure for surgery. According to Okolie et al. (2020, p. 155) total hip arthroplasty is performed many times in a lateral position, also known as lateral decubitus. This position gives a comprehensive view and various degrees of the joint’s tilt to visualize the inner muscles and cartilages properly. Lateral positioning is crucial during the procedure because if any tilt occurs, there is a likelihood of implant apposition, a condition that results in early dislocation during post-operative Okolie et al. (2020, p. 158)

According to JAMES ET, in 96 cases handled, with the primary total hip arthroplasty, three-dimensional pelvic tilts were recommended to impose images needed for reconstruction from the CT data. These data included the position of the posterior radiographs taken when the patient lies laterally and set up after the cap of the femur is replaced. On the same note, Okolie et al. (2020, p. 160) argued that the patient’s lateral positioning during total arthroplasty gives a comprehensive view of pelvis bones; this includes the use of devices that compresses the anterior and superior iliac sacrum and spines. He indicates that exposure is an essential part of the procedure. As such, positioning on the lateral side provides the base from which viewing takes place. A longitudinal incision is made when the patient is on lateral supine on the greater trochanter. The incision of the skin and the underlying subcutaneous layer are exposed, from which point an iliotibial tract can be visualized.

According to Räsänen et al. (2017, p. 211), the patient is positioned supine using a fracture table to allow for some controlled repositioning of the lower extremity. This will include the full freedom to rotate and move the hips during the incision of the skin and the sub-coetaneous layer. The table used (surgical table) requires the support of a perineal post used for the stabilization of the patient. Additionally, the perineal post provides a counterpoint from which gentle traction can be achieved during patients’ hip movement and the limb. Alternatively, a well-padded seat can be used to avoid pudendal nerve development from compression as the patient tilts the sacral bone.

Wyatt, (2015, p. 144) opines that the surgeon prepares the femoral canal in a Trendelenburg position when preparing to conduct the surgery. As indicated earlier, patients undergoing the procedure must be intubated anesthetically to prolong the positioning and avoid stiffing of the muscles around the pelvic girdle. Räsänenet al. (2020, p. 215), in his research, indicates that during lateral positioning, two Hohman retractor gadgets are used. The device exposes the greater trochanter as the patient lies on the supine, and the sacral hip bone is lifted on one side. One gadget is placed just right at the greater trochanter’s terminal end, while the other is placed on the lateral muscles’ gap. According to Wyatt, (2015, p. 148) once the gluteus medius in the inner sacral grove is exposed, it is stripped on the greater trochanter’s terminal side to make the anterior aspect of the capsule more clear in visualization.

JEAN argues the positioning of a patient during the procedure is an important factor worth considering. When poorly positioned, chances of damaging and failing to address the newly made ceramic heads of the femur are heightened Räsänenet al. (2020, p. 217). In doing so, he argues that the current lateral positioning needs to be modified into colorectal. The position has some variations, such as lateral jackknife position. In the lateral position, the patient is placed on either side, as indicated earlier. This entirely depends on which side is to be operated.

Furthermore, a pillow is used and placed under the head while assessing the dependent ear after positioning. The patients’ neck and spinal alignment are considered, as they should be maintained through the operation. Supine lateral positioning ensures hip safety, warding off pressure mounting on the newly reinforced joints.

Lying position, as indicated earlier, is an integral part of total hip replacement. Undoubtedly, the supine lateral positioning has conferred an array of benefits such as a clear view of the internal muscles and cartilage during the operation, among other services. According to Wainwright et al. (2020, p. 44) after the procedure, the patients, especially the elderly, need to heal and take measures that promote quicker healing. Some of the steps with immediate results are the sleeping approach, exercising, and messaging.

Sleep is undoubtedly an essential part of the healing process, especially after any major operation such as a total hip replacement. Wainwright et al. (2020, p. 47) argue that one of the most typical complaints heard after total hip replacement surgery is sleeping difficulty. Many patients report being unable to sleep in the position they used to, and many of them report waking up in great pain. This calls for an extra precaution after surgery by using a 3D table form for lying on the side for comfort while undergoing a hip replacement procedure and after the process.