The Perioperative Nurse's Role in Table-Enhanced Anterior Total Hip Arthroplasty

Article Outline

• ABSTRACT
• History of Anterior Approach THA
• Patient Selection and Advantages
• Preparation for THA
• Preoperative Assessment
• Intraoperative Care
  • Positioning
  • Surgical skin prep
  • Fluoroscopy
• Surgical Procedure and Table Operation
• Postoperative Care
• Conclusion
• Examination
  • The Perioperative Nurse's Role in Table-Enhanced Anterior Total Hip Arthroplasty
    • Purpose/Goal
    • Behavioral Objectives
    • Questions
• Answer Sheet
  • The Perioperative Nurse's Role in Table-Enhanced Anterior Total Hip Arthroplasty
• Learner Evaluation
  • The Perioperative Nurse's Role in Table-Enhanced Anterior Total Hip Arthroplasty
    • Purpose/Goal
    • Objectives
    • Content
    • Test Questions/Answers
    • Learner Input
• Acknowledgement
• References
• Copyright

ABSTRACT 

The anterior approach to total hip arthroplasty (THA), when performed with the patient in the supine position, is enhanced by the use of a radiolucent, orthopedic table.

This technique has numerous advantages: enhanced intraoperative fluoroscopy because of the patient's supine position on a radiolucent table, improved femoral exposure, and reduced soft tissue trauma. Criteria for patient selection is not limited as it may be for other arthroplasty techniques.

The role of the perioperative nurse during an anterior THA is to ensure optimal function of the orthopedic table and provide safe patient care. A clear understanding of the surgical techniques used and the functions of the table are imperative. AORN J 90 (July 2009) 53–68. © AORN, Inc, 2009.

Key words:  anterior total hip arthroplasty , anterior approach THA , radiolucent orthopedic table-enhanced THA

Nursing care of the patient in surgery has naturally evolved along the same trajectory as the development of the technology used in the OR. Today, most surgical services use computer technology and an increasing amount of specialized equipment, making cross-training of personnel more challenging. With the addition of such technology comes the need for perioperative nurses to be more educated and knowledgeable about new equipment so they can effectively participate in caring for their patients. Orthopedics is no exception as advances in equipment and techniques change rapidly for many types of orthopedic surgical procedures (eg, new approaches for traditional joint replacement procedures).

Performing the anterior approach for total hip arthroplasty (THA) with the patient in a supine position on an orthopedic OR table requires exposure, dislocation, and reduction of the hip joint. As with any surgical procedure, the circulating nurse is directly involved and an integral member of the surgical team. The nurse must have an understanding of the surgical intervention and a willingness to participate in this innovative approach.

There are distinct advantages to the anterior approach. The orthopedic table promotes ease of THA by increasing femoral access with adduction, extension, and proximal femoral hook placement. Improved exposure of the femur limits soft tissue trauma. The supine position and use of a radiolucent orthopedic table facilitates use of fluoroscopy. Patient selection criteria are not limited as they may be with the conventional lateral approach.¹

Back to Article Outline

History of Anterior Approach THA 

Traditionally, most THAs have been performed with the patient in the lateral position and the use of the lateral or posterior approach on a standard OR bed. In 1947, Robert Judet, MD, performed the first anterior-approach THA in France using the Judet-Tasserit orthopedic table.², ³ This table provided unique ways to position a patient for orthopedic procedures rather than having to place the patient in the standard lateral position. During a visit to France in 1981, Joel Matta, MD, of Los Angeles, California, observed this surgical technique as performed by Emil Letournel, MD, a former resident under Dr Judet. Dr Matta began to perform the technique in the United States in 1996 using the Judet-Tasserit orthopedic table. When production of this orthopedic table was discontinued in 2003, Dr Matta began to use the ProFX® and Hana® radiolucent orthopedic tables. With the advent of new, American-made tables, courses teaching the anterior technique for THA began to be offered to orthopedic surgeons in the United States, and interest in the procedure has grown (J. Matta, MD, founder and director, Hip and Pelvis Institute, St John's Health Center; verbal communication; June 9, 2008).

From November 1996 to November 2008, Dr Matta performed 1,723 primary, anterior-approach THAs. According to Dr Matta's patient data, a mean time of 64 minutes and a median time of 85 minutes was required to perform the surgical procedure. Average blood loss has been estimated to be approximately 400 mL. Patients have had an average (ie, mode) length of stay (LOS) in the hospital of three days. The length of the incision is almost always 10 cm (Figure 1). Only three patients have experienced dislocation of their prostheses. The hip prostheses implanted included cemented, uncemented, and surface replacement THA (J. Matta, MD; unpublished data, August 2007).

• 
  • View Large Image
  • Download to PowerPoint

• Figure 1. 

  Typical 10-cm incision for an orthopedic table-enhanced anterior-approach total hip arthroplasty procedure.

Among the 1,723 THAs, 494 consecutive, single-incision, anterior-approach THAs on an orthopedic table were performed by Dr Matta and several surgical fellows from September 1996 to September 2004. The surgical time of these 494 procedures averaged 90 minutes with an average LOS of four days. The majority of these patients were walking postoperatively without external support by 10 days. The postoperative complications reported included one infection, three dislocations, and one temporary nerve palsy.⁴

In general, other surgeons report that the muscle-sparing, anterior approach is versatile and has favorable long-term outcomes with minimal complications.⁵ In a study of 1,037 THAs, there were only 10 hip dislocations. The authors of that study corroborate that the procedure is safe with a low dislocation rate.⁶ Another study of 100 consecutive THAs concluded that this technique was safe and advantageous because of reduced

In a study of 195 THAs, a mini-posterior approach (MPA) performed on 96 patients was compared to a direct, anterior approach (DAA) performed on 99 patients.⁸ The results showed that patients who underwent the DAA had a more rapid recovery of hip function and gait ability. The average surgical time for MPA was 100.4 minutes and for DAA was 104.7 minutes. The LOS was 30.4 days for MPA patients and 22.2 days for DAA patients. Blood loss averaged 426.9 mL during MPA procedures and 526.1 mL during DAA procedures. There was one dislocation experienced by a patient who had undergone MPA and none reported for patients who had undergone DAA. According to the researchers, the blood loss during DAA was greater because of technical difficulty with femoral preparation. A comparison of this study and Matta's statistics is shown in Table 1.

Table 1. Data for Different Approaches to Total Hip Arthroplasty

1 J Matta, MD, Founder and Director, Hip and Pelvis Institute, St John's Health Center, Santa Monica, CA; unpublished data; June 9, 2008.

2 Nakata K, Nishikawa M, Yamamoto K, Hirota S, Yoshikawa H. A clinical comparative study of the direct anterior approach with mini-posterior approach two consecutive series. J Arthroplasty. 2008 Jun 12. [Epub ahead of print].

Back to Article Outline

Patient Selection and Advantages 

The anterior approach is a treatment option for all patients requiring hip arthroplasty including patients suffering from the effects of osteoarthritis, rheumatoid arthritis, traumatic arthritis, and avascular necrosis. Furthermore, there is less subcutaneous and deep fat to dissect over the hip joint using this approach. Patients requiring a revision whose hips were previously replaced using the lateral or posterior approach or who previously had post-traumatic hip or pelvic surgery are not excluded. This technique also is suitable for patients who need bilateral hip replacements.⁴

Patient advantages with the anterior approach include:

The procedure offers better access to the hip because the hip is superficial in the supine position and subcutaneous fat is thinner at the incision site. Placing the patient supine also allows for better control of pelvic position. In addition, the anterior approach preserves pelvic and femoral muscle attachments, thus reducing the risk for dislocation and allowing for a more rapid recovery.⁴

Back to Article Outline

Preparation for THA 

The circulating nurse assesses the function of the orthopedic table (Figure 2) before each procedure to ensure that it is working properly. This includes pressing the “return to level” button, which returns the base of the table to a neutral position and lowers the height of the table when the leveling process is complete. After testing both femoral lifts for function, the circulating nurse lowers the lifts and secures them in a locked position at the base of the lift where it attaches to the table. The nurse checks the femoral lift switch to ensure that the table has been lowered and leveled and confirms that both spars of the table are tightly locked. A spar is a radiolucent extension from the table base. The patient's foot is placed in a secured boot that is locked with a swivel joint to a mount on the spar to allow mobility of the leg. Lowering the table and locking both femoral lifts facilitates safe transfer of the patient to the table.

• 
  • View Large Image
  • Download to PowerPoint

• Figure 2. 

  Orthopedic table used to place patients in the supine position for anterior-approach total hip arthroplasty. The model is seen with the right leg in flexion and external rotation. The purpose of this photograph is to identify the intricate table parts but does not necessarily reflect best practices in patient positioning. Photograph courtesy of Mizuho OSI, Union City, CA.

Other procedure preparation responsibilities of the circulating nurse include ensuring that all necessary equipment is in the room and functioning properly. As with any orthopedic surgical procedure, in addition to the orthopedic table, a mobile x-ray viewing box is used. The nurse places the viewing box on the patient's surgical side. When performing bilateral THAs, the perioperative nurse moves the viewing box to the opposite side after the first hip procedure is complete. The radiology technologist places the fluoroscopy unit (ie, C-arm) on the opposite side of the surgical site and situates the C-arm monitor on the opposite side but distal to the C-arm. The nurse ensures that an upper-body warming blanket, which is used for thermoregulation, is available and functioning, and that the warming unit is near the head of the OR bed. The autotransfusion device, which may be used particularly during bilateral THAs, and the electrosurgery unit (ESU) are also positioned near the head of the bed. The room layout for a left THA is shown in Figure 3.

• 
  • View Large Image
  • Download to PowerPoint

• Figure 3. 

  Setup of the OR for a left anterior approach total hip arthroplasty. Scrubbed personnel are in sterile blue scrub gowns; unscrubbed personnel are in green scrub attire.

Back to Article Outline

Preoperative Assessment 

As part of performing a routine systematic and thorough review of the surgical patient, the perioperative nurse meets the patient and his or her family members in the preoperative holding area, verifies the patient's identity, and performs an assessment. Preoperative assessment and physical findings provide an important baseline with which to compare postoperative assessment data. The nurse's physical assessment of the patient scheduled for anterior THA includes

The perioperative nurse also confirms the availability of blood products (eg, autologous or direct donor blood) and the completion of blood typing and cross-matching. He or she then verifies allergies and NPO status.

To protect the patient during transfer and positioning, the nurse may need additional padding to support the patient's arms. The nurse alerts perioperative team members if the patient has any limited range of motion, previous injuries, mobility issues, or any other restrictions. This information alerts surgical team members to use caution when manipulating the table during the procedure or while rotating the patient's leg. The nurse notes whether the patient has an ankle injury on the surgical side or has any implanted hardware so that he or she knows to take care when placing the ESU grounding pad and avoid placement areas that would allow electrical current to pass through that area. The perioperative nurse notes and documents any altered skin integrity.

The perioperative nurse reviews the medical record for pertinent laboratory values and diagnostic studies (eg, chest x-ray, complete blood count) and ensures the presence of proper documentation. The anesthesia care provider meets the patient and obtains informed consent for anesthesia before transporting the patient to the surgical suite.

After the patient and surgeon have initiated verification of the hip to be replaced, the circulating nurse confirms this information by

After identifying the correct surgical site, the nurse compares that information with the surgical site marking performed by the surgeon. The nurse resolves discrepancies in this information before leaving the preoperative holding area with the patient.

Patient education, which is provided by the perioperative nurses working in the preoperative admissions area and in the OR, includes

The nurse explains the intraoperative and immediate postoperative periods and assesses the patient's level of understanding. The nurse gives the patient and family members an opportunity to ask questions and express fears or concerns before transporting the patient from the preoperative holding area to the OR. The nurse then develops a plan of care specific for this patient and the proposed procedure (Table 2).

Table 2. Nursing Care Plan for a Patient Undergoing Anterior-Approach Total Hip Arthroplasty

Back to Article Outline

Intraoperative Care 

When the circulating nurse, surgeon, and anesthesia care provider have completed their patient assessments, the circulating nurse transports the patient to the OR and assists the anesthesia care provider in applying monitoring equipment. The anesthesia care provider anesthetizes the patient on the transport cart before the patient is moved to the orthopedic table. Before transfer, the perioperative nurse places the patient's feet into boots that will be fastened to the table spars. The nurse may apply pneumatic compression sleeves to both of the patient's legs to reduce the risk of deep vein thrombosis. All surgical team members actively participate in a surgical time out to verify the correct patient, correct site and laterality, and correct surgery and also ensure that all equipment and supplies, including implants, are immediately available.

Positioning 

Surgical team members (eg, surgeon, fellow, resident, assistant, circulating nurses) help transfer the patient to the orthopedic table and assist with positioning. If the team members are temporarily unavailable, the circulating nurse recruits assistive personnel and, with the help of the anesthesia care provider, transfers the patient to the orthopedic table and positions him or her, assessing for pressure points and body alignment. The surgeon ultimately is responsible for checking the final position and ensuring that it is acceptable.

Team members position the patient close to the perineal post, which is used to accommodate traction on the leg. The nurse places both the patient's arms on arm boards extended at less than 90-degree angles to the bed. After placing a support under the patient's nonsurgical leg, the nurse places both of the patient's legs in slight internal rotation (Figure 4). The nurse then assesses the patient for possible pressure points and places additional padding to support the patient or relieve pressure as needed.

• 
  • View Large Image
  • Download to PowerPoint

• Figure 4. 

  The nurse attaches the boots on the patient's legs in slight internal rotation to the table spar.

Surgical skin prep 

The surgical prep site for a THA spans from the patient's midline abdomen laterally to the level of the bed, distal to the middle of the thigh, and proximal to the navel (Figure 5). The surgeon may want the circulating nurse to expand proximal exposure above the patient's navel to ensure that the anterior superior iliac spine is included in the prep. This surgical approach allows bilateral THA preps to be conveniently performed with a single preparation and draping of both hips. After the prep, the nurse applies a small amount of gross traction, as well as a mild amount of abduction, before locking the table in position. This position enhances the landmarks of the hip for surgical exposure (Figure 6). The nurse positions both of the patient's legs similarly, as the nonsurgical side will be used as a radiographic reference.

• 
  • View Large Image
  • Download to PowerPoint

• Figure 5. 

  Typically, the patient is prepped from the midline abdomen laterally to the level of the bed, distally to the middle of the thigh, and proximally to the navel.

• 
  • View Large Image
  • Download to PowerPoint

• Figure 6. 

  Hip landmarks are identified for surgical exposure.

The circulating nurse confirms correct positioning with the physician before the scrub person applies the surgical drapes because variations of anatomy and physique may require alterations. It is also important that the circulating nurse ensure that each table control has been locked (ie, the boots at the junction of the attachment to the bed, the swivel joint, the rotation of the legs, the gross traction for both spars).

Fluoroscopy 

Anterior to posterior x-rays are hard to obtain when the patient is in the lateral position because hip alignment may not be symmetric. Most traditional THAs are performed in the lateral position; therefore, the surgeon orders x-ray films to be obtained after surgery in the postanesthesia care unit (PACU) to confirm component placement. The patient's supine position on the radiolucent orthopedic table during an anterior approach THA facilitates the use of fluoroscopy during the surgery. Intraoperative use of fluoroscopy not only facilitates accurate component position, but also greatly reduces the risk of a second procedure for exchange of implants when postoperative x-rays are taken after the patient has left the surgical suite. The surgeon compares radiographic landmarks to confirm equal leg length and correct offset during surgery before wound closure.

Dr Matta calculated an average fluoroscopy time of 24.9 seconds on 102 of his most recent arthroplasties (J. Matta, MD; unpublished data, August 2007).⁵ Published reports of fluoroscopy time for these procedures are not available currently, and not all surgeons use fluoroscopy during these procedures. Annual radiation exposure limits established by the Nuclear Regulatory Commission are set at a total effective dose equivalent of 5 roentgen equivalent units (REMs) for radiation workers and 0.1 REMs for members of the public.⁹

As with any procedure in which fluoroscopy is used, the surgical team should adhere to recommended safety measures to reduce their exposure to ionizing radiation. AORN's “Recommended practices for reducing radiologic exposure in the perioperative practice setting,” states, “The greater the distance an individual or target is from the source of radiation, the less the amount of radiation exposure.”^10(p1000) Radiation exposure can be reduced by one-quarter when the distance from the source is doubled.¹⁰ Radiation exposure time is minimal but the use of distance and shielding and the consistent use of dosimeters can reduce radiation risks.

The radiology technologist positions the fluoroscopy unit on the opposite side of the surgical team next to the nonsurgical hip and perpendicular to the patient. The circulating nurse also places a thyroid shield on the patient's neck for radiation exposure protection. According to Dr Matta's data, the ionizing radiation exposure for both the patient and surgical team during the procedure is minimal (J. Matta, MD; unpublished data, August 2007).

Use of the fluoroscopy unit and the orthopedic table are based on the surgeon's preference. The surgeon may choose not to use fluoroscopy or may limit its use throughout the procedure. The surgeon may also decide to perform the surgery without the use of the orthopedic table. The anterior approach to THA performed without the use of the orthopedic table increases the difficulty of access to the femur, and patient selection is more limited because surgeons must avoid operating on heavy and/or muscular patients because of the difficulty of accessing the femur.

Back to Article Outline

Surgical Procedure and Table Operation 

To better anticipate the circulating role during an orthopedic table-enhanced procedure, the nurse must have a thorough understanding of what occurs (Table 3). Understanding and using proper body mechanics during table manipulation is essential to prevent injury to both the patient and the circulating nurse. More than one circulating nurse is required during this procedure. One nurse stands at the foot of the orthopedic table throughout the procedure to perform needed table operations, always giving direct attention to the surgeon and to the progress of the procedure. Another circulating nurse is required to provide direct patient care and meet all additional circulating responsibilities during the procedure.

Table 3. Surgeon Preference Card for Orthopedic Table-Enhanced Total Hip Arthroplasty

The circulating nurse operating the table provides individualized care to ensure safety of the patient during orthopedic table-enhanced THA. For instance, osteopenic bone is at higher risk of fracture and the force of external rotation may lead to a tibial or ankle fracture. The force used on a patient with osteopenia, therefore, is more gentle. The nurse assigned to assist the surgical team performs all table operations under the direction of the surgeon throughout the procedure using the table controls (eg, fine traction, gross traction, rotation) on the foot of the orthopedic table, which are not within the sterile field (Figure 7). The nurse does not rotate the patient's leg to the extent of his or her range of motion, but rather stops rotation when resistance is met. The surgeon directs the circulating nurse regarding the amount of rotation to apply based on the amount of resistance met and will direct the nurse if further rotation is indicated. This rotation can be applied safely with clear communication and direction from the surgeon combined with careful consideration of the patient's physical status. The nurse's preoperative assessment plays a large role in this aspect of the procedure. Before the beginning of the procedure, the surgeon and the circulating nurse who performed the preoperative physical assessment on the patient discuss the patient's condition and the individualized plan of care, including the degree of rotation anticipated. As table movements are being performed, the nurse communicates with the surgeon regarding the extent of force being used and, if additional exposure is requested, the nurse describes the force being used and resistance, if any, that he or she feels.

• 
  • View Large Image
  • Download to PowerPoint

• Figure 7. 

  Table controls on the foot of the orthopedic table are not within the sterile field.

The surgeon removes the femoral head with assistance from the nurse, who uses the table controls at the foot of the table to manipulate the degree of fine traction and external rotation. Several turns of fine traction control while the gross traction mechanism is still locked creates a space between the femoral head and the acetabulum where the surgeon inserts a bone skid (ie, flat instrument with a dip/scoop on the distal ends in which to distract the femoral head from the acetabulum). The circulating nurse then releases the fine traction almost entirely by reversing the turns. For example, if three turns of traction were initially applied, then two turns in reverse may be sufficient. The circulating nurse then externally rotates the hip approximately 20 degrees to allow the surgeon to insert a corkscrew, after which both the surgeon and circulating nurse apply further external rotation to dislocate the hip.

The circulating nurse may apply fine traction to distract the neck osteotomy and facilitate the surgeon's extraction of the femoral head. The surgeon may cut the femoral head in situ without dislocation, but this may make extraction more difficult. While the surgeon prepares the acetabulum, the circulating nurse externally rotates the leg approximately 45 degrees and maintains a slight amount (ie, one turn) of fine traction to provide better exposure. The surgeon may initiate fluoroscopy at this point to confirm depth of reaming and prosthesis insertion.

After the acetabular components have been inserted, the circulating nurse must position the patient for femoral preparation. After unlocking the gross traction on the spar, the circulating nurse applies some internal rotation to assist the surgeon in posterior placement of the femoral hook. The circulating nurse then externally rotates the patient's leg approximately 90 degrees, to the extent of the patient's maximum range of motion as directed by the surgeon. The circulating nurse then extends the patient's hip with the table spar positioned to the floor and adducted so the patient's leg is crossed under the other spar. The circulating nurse must ensure that the gross traction mechanism is unlocked before extending the hip to prevent stretching of the femoral nerve. To further expose the femur, the surgeon raises the femoral lift after he or she has placed the femoral hook into position.

After the surgeon inserts the trial components and removes the femoral hook, the circulating nurse flexes the hip and returns it to its original neutral position. The circulating nurse reduces the hip with simultaneous application of internal rotation and gross traction by manually pulling and rotating the gross traction handle of the table. The amount of pulling should be just enough to accommodate reducing the hip. A gentle push of the gross traction handle after reduction is achieved ensures that no traction tension remains.

The surgeon obtains fluoroscopic views of both hips and compares them with printed images on transparency film (Figure 8). If needed, the surgeon may request abduction and adduction of the spars to match the alignment of both hips. The circulating nurse should identify the last position of the spars placement so he or she can readjust the spars to this position when the hip is returned to a neutral position.

• 
  • View Large Image
  • Download to PowerPoint

• Figure 8. 

  The surgeon compares fluoroscopic views of both hips and with printed images on transparency film of the replaced total hip.

To dislocate the hip for removal of the trial components, the circulating nurse externally rotates the hip and applies gross traction. This is done simultaneously and similarly to the reduction of the hip. The surgeon reinserts the femoral hook, after which the circulating nurse externally rotates the leg and extends and adducts the patient's hip. Reduction and dislocation occurs as often as is necessary for the surgeon to insert trial components and determine the best component sizes for the patient. After the surgeon inserts the components (Figure 9), the circulating nurse performs a reduction of the hip (ie, adjusts the spars to the desired position) and ensures that flexion and rotation are the same for both of the patient's hips. The radiology technologist takes and prints final views via fluoroscopy.

• 
  • View Large Image
  • Download to PowerPoint

• Figure 9. 

  The surgeon inserts the femoral hook and retractors to insert the components during a resurfacing total hip arthroplasty (ie, surface replacement). The femoral head shown is larger than the implant for a total hip replacement.

Back to Article Outline

Postoperative Care 

The circulating nurse reassesses the circulation of both of the patient's feet and the condition of the skin around the perineal area after the procedure to ensure that no injury has occurred before helping to transport the patient to the PACU. If the patient has not been given a regional anesthetic and is able to obey commands, the nurse assesses the mobility of the patient's lower extremities through passive range of motion. The circulating nurse's hand-off communication includes the surgery performed, outcomes related to the procedure, the patient's allergies, and the patient's current condition. The PACU receiving nurse verifies the information received and asks the circulating nurse questions as needed.

The location of the incision and lack of muscle dissection in a patient who has undergone anterior THA decrease the patient's postoperative pain, allow for early ambulation, and reduce the risk of dislocation. Proper postoperative wound care reduces the risk of infection. Physical therapy begins within hours after surgery. Activity is not restricted because the patient can bear weight immediately, and activity is increased according to the patient's tolerance level. Many patients use a walker to begin ambulating with assistance on the same day of their surgical procedure or the following day, depending on the time of day that the surgery was performed, and most patients can walk with a cane by the time they are discharged. Some patients may use an assistive device, such as a walker or crutches, while others do not require any assistance at discharge. Generally, most patients are walking without aids within seven to 10 days after surgery. For those patients who continue to use aids beyond the seven- to 10-day period, use of these aids is usually discontinued after two to three weeks (J. Matta, MD, e-mail communication, June 10, 2008).

There are no dislocation precautions for the patient who has undergone an anterior THA. This eliminates the postoperative need for an abduction pillow, a traction sling, a raised toilet seat, or a hip cushion. The use of sequential compression devices on both legs during the postoperative period helps prevent deep vein thrombosis. Typically, a patient is discharged home from one to three days after undergoing a unilateral anterior THA and two to five days after a bilateral procedure.

Back to Article Outline

Conclusion 

The use of an orthopedic table enhances the surgeon's ability to perform an anterior approach for THA. The supine position of the patient and the radiolucency of the orthopedic table create ideal conditions for the use of fluoroscopy, which increases accuracy of component placement and ensures matching leg length.

The perioperative nurse plays a vital role in the successful execution of the orthopedic table-enhanced, anterior-approach THA in the supine position. Under the direction of the surgeon, the circulating nurse is responsible for maneuvering the orthopedic table to provide acetabular and femoral exposure to accommodate hip replacement. These table functions have multiple benefits that appeal to surgeons and patients, including decreased soft tissue trauma; less pain after surgery; shorter hospitalization; a single, smaller incision; and a very low risk of postoperative hip dislocation.

An understanding of the complete anterior approach procedure, proper technique while operating the orthopedic table, and clear communication between members of the surgical team help minimize complications. Coordination between the surgeon and perioperative nurse, as always, is imperative.

Back to Article Outline

Examination 

The Perioperative Nurse's Role in Table-Enhanced Anterior Total Hip Arthroplasty 

Purpose/Goal 

To educate perioperative nurses about caring for patients undergoing orthopedic table-enhanced anterior-approach total hip arthroplasty (THA).

Behavioral Objectives 

After reading and studying the article on anterior-approach THA, nurses will be able to

Questions 

Back to Article Outline

Answer Sheet 

The Perioperative Nurse's Role in Table-Enhanced Anterior Total Hip Arthroplasty 

Event #09112

Session #1087

• 
  • View Large Image
  • Download to PowerPoint

Please fill out the application and answer form on this page and the evaluation form on the back of this page. Tear the page out of the Journal or make photocopies and mail with appropriate fee to:

AORN Customer Service

c/o AORN Journal Continuing Education

2170 S Parker Rd, Suite 300

Denver, CO 80231-5711

or fax with credit card information to (303) 750-3212.

Additionally, please verify by signature that you

have reviewed the objectives and read the article, or you will not receive credit.

Signature ______________________________________

AORN (ID) # ____________________________________________

Name __________________________________________________

Address ________________________________________________

City ___________________________________________________ State __________ Zip __________

Phone number __________________________________________

RN license # ____________________________________________ State __________

Fee enclosed ___________________________________________

or bill the credit card indicated MC Visa American Express Discover

Card # ___________________________________ Expiration date _____________________

Signature _______________________________________________________________ (for credit card authorization)

Fee: Members $23.50 (includes $5 processing fee);

Nonmembers $42 (includes $5 processing fee)

New! Save time and money by completing this CE activity online.

No processing fees at aorn.org/CE.

Program offered July 2009; The deadline for this program is July 31, 2012.

A score of 70% correct on the examination is required for credit. Participants receive feedback on incorrect answers. Each applicant who successfully completes this program will receive a certificate of completion.

Back to Article Outline

Learner Evaluation 

The Perioperative Nurse's Role in Table-Enhanced Anterior Total Hip Arthroplasty 

• 
  • View Large Image
  • Download to PowerPoint

This evaluation is used to determine the extent to which this continuing education program met your learning needs. Rate these items on a scale of 1 to 5.

Purpose/Goal 

To educate perioperative nurses about caring for patients undergoing orthopedic table-enhanced anterior-approach total hip arthroplasty (THA).

Objectives 

To what extent were the following objectives of this continuing education program achieved?

Content 

To what extent

Test Questions/Answers 

To what extent

Learner Input 

What other topics would you like to see addressed in a future continuing education article? Would you be interested or do you know someone who would be interested in writing an article on this topic?

Topic(s): _______________________________________________________________________________________

Author names and addresses: ____________________________________________________________________________________________________________________________________________

Back to Article Outline

Acknowledgement 

The author thanks Joel Matta, MD; Founder and Director, Hip and Pelvis Institute, Saint John's Health Center, Santa Monica, CA, for allowing use of his data and consulting on the article.

Back to Article Outline

References 

1. Matta JM , Ferguson TA . The anterior approach for hip replacement . Orthop . 2005;28(9):927–928
   • View In Article
2. Matta JM . The anterior approach for total hip arthroplasty: background and operative technique. August 2005. Hip and Pelvis Institute . http://www.hipandpelvis.com/patient_education/totalhip/index.html Accessed April 28, 2008.
   • View In Article
3. Matta JM . The anterior approach for total hip arthro plasty: background and operative technique . In:  Scuderi GR ,  Tria AJ ,  Berger RA editor. MIS Techniques in Orthopedics . New York, NY: Springer; 2007;p. 121–140
   • View In Article
4. Matta JM , Shahrdar C , Ferguson TA . Single-incision anterior approach for total hip arthroplasty on an orthopaedic table . Clin Orthop Relat Res . December 2005;441:115–124
   • View In Article
   • MEDLINE
   • CrossRef
5. Kennon RE , Keggie JM , Wetmore RS , Zatorski LE , Huo MH , Keggi KJ . Total hip arthroplasty through a minimally invasive anterior surgical approach . J Bone Joint Surg Am . 2003;85-A(Suppl 4):39–48
   • View In Article
6. Siguier T , Siguier M , Brumpt B . Mini-incision anterior approach does not increase dislocation rate: a study of 1037 total hip replacements . Clin Orthop Relat Res . September 2004;426:164–173
   • View In Article
   • CrossRef
7. Rachbauer F . Minimally invasive total hip arthroplasty via direct anterior approach [In German] . Orthopade . 2005;34(11):1103–1110
   • View In Article
   • MEDLINE
   • CrossRef
8. Nakata K , Nishikawa M , Yamamoto K , Hirota S , Yoshikawa H . A clinical comparative study of the direct anterior approach with mini-posterior approach two consecutive series . J Arthroplasty . 2008 Jun 12; [Epub ahead of print].
   • View In Article
9. Part 20—standards for protection against radiation. United States Nuclear Regulatory Commission . http://www.nrc.gov/reading-rm/doc-collections/cfr/part020/ Accessed May 19, 2009.
   • View In Article
10. Recommended practices for reducing radiological exposure in the perioperative practice setting . In: Perioperative Standards and Recommended Practices . Denver, CO: AORN, Inc; 2009;p. 455–466
    • View In Article