Optimizing Hip Replacement in Elderly Patients: Exploring Lateral Positions for Enhanced Mobility

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 as well as the use of current lateral positions in use that minimize pain in adult patients.

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Arthritis is a medical condition of the inflamed joint, which causes swelling and pain. Generally, the disease affects bone joints with 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 elderly persons as one advance in age. Guler et al. argue that the condition typically sets when an inflamed and injured joint breaks down to sever the cartilage holding the muscles and the articulating bones (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, “absorbs 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 Okolie 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 total hip replacement (THR) , 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 argues 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, Rolfson 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. 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.

Existing Lateral Positions during Hip Replacement

Treatment of an osteoarthritis patient requires the total observance of procedures, including positioning. Indeed positioning during total hip replacement is one of the new paradigms associated with smooth operation. Among the many positioning methods, the Lateral position has been researched due to its benefits and affectivity during the procedure. According to Ghostine et al (2012, p. 461), the lateral position is when the patient's non-operative side is placed on a surgical surface during the operative season. Surgeons have widely adopted the position due to t several advantages. It confers the procedure, such as proper body alignment and stabilization of the patient, critical during the procedure.

In the same breath, the use of lateral position does not, however, make the procedure problem-free. Sometimes during the procedure, issues such as tissue damage, shoulder pain, and numbness resulting from lying on one side for a long time are encountered. Such problems can be explained based on the various types of equipment used during the procedure (Ghostine et al 2012, p. 463).

Prepping during surgery

At the onset of the procedure, anesthesia (general or spinal) will be administered. The table is tilted in a reverse Trendelenburg so that high spinal is prevented. In cases where this is not achieved, there are issues concerning vertical cup position resulting in pain. During this time, the leg-lengthening position is made more common with the spinal. The anterior and posterior are generally observed and placed in a lateral position. Besides, the surgeon ensures that the anterior Montreal post is curved above that ASIS (Ghostine et al 2012, p. 466). At the moment, the patient should be able to move and flex slightly more than 90 degrees.

In cases where the patient’s post is placed below the ASIS, there will be an impinge on the patient’s thigh, and the hip should move slightly while flexed. This is made so because during the actual operation, the hip flections will not allow for optimal clearance, and femoral broaching may be difficult.

In this position, the body is allowed to rest supinely with the base on the table. The pelvis is flexed while it is adducted in comparison with the standing posture. During the pelvis’s flexion, the acetabular components can be placed in less anteversion with more adduction than desired (Ghostine et al 2012, p. 468). Based on research, the surgeon is advised to insist on a true lateral position to make it easy to reaming the acetabular bone. One of the undoing of this position is the swayback due to an increment in the cup anteversion as insertion takes place.

Superior-inferior tilt

Another position is the superior-inferior tilting, in which case the spinal anesthesia during admission will keep the table tilted in a lateral position. However, he should ensure an average spinal. Superior-inferior tilting generally is used to induce the error of the vertical cup as reaming ad insertion is done (Ghostine et al 2012, p. 472). Before this is completed, prepping is done to ensure the table remains tilted downwards to expose the inferior trochanter head. Sometimes, the patient’s position may be as in a bean bag with the torso tilted in an inferior position to the arm.

Antero-posterior tilt

This refers to the tilting of the pelvis during total hip replacement. Generally, the operative side remains flexed in from of the non-operated one. This position has been found effective, especially in the reaming pelvis in a retroverted angle line. When the anterior-posterior tilt of the lateral position is done, the surgeon must ensure the patient’s back is moved towards the working table's posterior edge for the operative leg to lay and rest on the table.

Advantages of lateral positioning

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)

Painless Lateral Positions in Total Hip Replacement (THR)

Compared to superior-inferior tilt, the lateral approach position approach during hip replacement presents a minimally invasive method that results in less pain during and after the surgery. According to Goebel et al., the method decreases post-operative pain levels during the first three days after surgery. Goebel et al. (2012, p. 492) argue that the consumption of pain reduction medicines on the day of surgery as it used to be initially had significantly reduced when the lateral position was first used in elderly patients.

As opposed to the prepping position, which is a delicate procedure yet post-operative is marred with pain, the lateral position confers a minimally invasive approach that leads to a reduced hospital stays with an array of earlier achievements of defined motions. This is why prepping has become a more preferred method of lateral approach used currently in elderly patients.

Several studies have indicated that the minimally invasive approach based on prepping depends on skin incision. The majority of the studies examined different approaches for pain alleviation during and after the operation. In a meta-analysis that included randomized and non-randomized trials, Goebel et al. (2012, p. 450) found a lower level of pain in an elderly patient. The finding was clinically relevant when lateral positioning was adopted in elderly patients.

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.

Lateral Position as a Method to Ease Pain

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.

According to Okolie et al. (2020, p. 159), 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.