Monday, October 3, 2022

Hip Surgery With Congestive Heart Failure

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How Do I Safely Rest And Sleep After A Hip Replacement

Knee Replacement Surgery

Elevate both of your legs when sitting to minimize swelling. When resting or sleeping in bed, lie on your non-operative side for the first four to six weeks following surgery. Make sure you have a pillow between your legs and a second pillow to support your foot and ankle. When you lie on your back, you must have a pillow between your legs. If you get up in the middle of the night, sit at the side of the bed for a few seconds to avoid dizziness.

How Long Will I Be In The Hospital

You may be in the hospital up to two days after surgery. If it is unsafe for you to return directly home from the hospital, you might have to go to a rehabilitation center prior to discharge home. Talk to your healthcare provider about the best recovery plan.

How long that ends up being in the hospital depends on three things:

  • If your pain is under control: You wont go home if your pain is unbearable.
  • How well you safely move around: You wont go home if it looks like you might be unsafe there.
  • How stable you are, medically: You wont go home if, for example, your blood pressure is too high.

If You’re At Risk For Heart Disease You May Need Additional Testing Before A Hip Replacement Or Other Major Surgery

Image: photodisc/Thinkstock

All surgery, even minor procedures like cataract removal, involves a certain amount of stress. People facing surgery might experience emotional stress related to their illness or condition, often coupled with concerns about their recovery.

Some of the most common noncardiac surgeries done in older people, such as a hip replacement or gallbladder removal, can also put physical stress on the heart. Anesthesia and the operation itself can causes changes in heart rate and blood pressure as well as unmask previously undiagnosed heart disease.

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How Do I Safely Get Dressed After A Hip Replacement

For dressing, to prevent lifting your knee higher than your hip on the surgery side, you may need a long shoehorn and a dressing stick which will help you with your shoes, socks and pants. Remember to always put your operative leg in your pants first. If you wear shoes with shoe ties, try switching to elastic shoelaces.

How Can I Manage At Home During Recovery From Hip Replacement Surgery What Are Hip Replacement Precautions And Restrictions

Failure Mechanisms in Hip Resurfacing Arthroplasty

There are some general safety tips to keep in mind. For example, simplify your surroundings:

  • Remove clutter.
  • Keep stairs free of objects.
  • Keep supplies in the same place.
  • Remove small rugs throughout the house.

Keep walking areas safe:

  • Watch out for your pets when walking.
  • Keep hallways/stairways well lit.
  • Purchase night lights for bedrooms and bathrooms.
  • Stairs should have securely fastened handrails. Non-skid threads on stairs add to safety. If you have problems with your vision, add a contrasting color to mark stair edges.

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Hip Replacement Reduces Heart Failure Depression And Diabetes Risk

by American Academy of Orthopaedic Surgeons

In addition to improving life quality and diminishing pain, total hip replacement is associated with reduced mortality, heart failure, depression and diabetes rates in Medicare patients with osteoarthritis, according to a new study presented today at the 2013 Annual Meeting of the American Academy of Orthopaedic Surgeons . The procedure also is cost effective with the 7-year costs of THR only $6,366 higher than the cost of treating an osteoarthritis patient for hip pain without THR.

“The study has demonstrated that THR confers a potential long-term benefit in terms of prolonged lifespan and reduced burden of disease in Medicare patients with osteoarthritis of the hip,” said lead study author Scott Lovald, PhD, a researcher at Exponent, Inc.

While the short-term benefits of THR are well known and documented, less information exists on the long-term effects, cost and value of the surgery.

Among the results:

  • The THR patients had a consistently lower mortality risk less than 52 percent of that in the non-THR group.
  • Heart failure was similar between groups in the first year, but there was a consistent reduced risk at 3-to-7 years following surgery.
  • THR patients had a reduced risk of diabetes at one and three years.
  • THR patients had a reduced rate of depression starting at three years post THR surgery.

Explore further

Risk After Hip Replacement Compared To Other Joint Replacements

In a 2021 study , researchers investigated the rates of heart attack among 322,585 people who received spinal fusion or joint replacements. The researchers found that the risk of heart attack was generally higher in people receiving spinal fusion and lower in people receiving knee or hip replacements.

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The Risk Factors Of Heart Failure In Elderly Patients With Hip Fracture

We included the factors with significant difference in the univariate analysis for further multivariate logistic regression. The variable assignments of multivariate logistic regression were indicated in Table . As presented in Table , logistic regression analyses had found that age70y, hypertension, anemia, hypoalbuminemia, duration of surgery120 min were the risk factors of heart failure in elderly patients with hip fracture.

Table 2 The variable assignment of multivariate logistic regression

How Do I Safely Sit Down And Stand Up After A Hip Replacement

Congenital Heart Disease: Tetralogy of Fallot, Animation

There are three steps to sitting down after a hip replacement:

  • Back up to the bed/chair until the backs of your knees are touching it.
  • Reach your hands back for the armrests. Hold your weight still.
  • Lower your body slowly into a seated position. Avoid bending forward at your trunk.
  • Keep the following tips in mind while youre sitting:

    • Sit on a firm chair with a straight back and armrests. Keep your hips and knees at 90 degrees .
    • Dont sit on low, soft or overstuffed furniture that may cause excessive bending of your hip.
    • Follow the precautions and weight-bearing status as instructed by your healthcare provider or physical therapist.

    To stand, follow these two steps:

  • Scoot to the edge of the bed/chair. Avoid bending forward at your trunk.
  • With your hands on the bed or chair, push up to the standing position. Bring one hand at a time up to your walker.
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    Why Do I Have To See The Dentist Before Surgery

    Have your teeth cleaned and make sure you dont have any cavities that might need to be taken care of during the first few months following surgery. Since the blood supply to your hip is increased during healing time, its better to have any routine dental work done either before surgery or three months after. In addition, any emergencies must be taken care of immediately. Your surgeon may recommend antibiotics prior to any dental procedure once you have a total joint replacement.

    Risk Stratification In The Geriatric Patient

    The preoperative assessment should focus on stabilizing medical conditions that can be corrected, such as dehydration, hypovolemia, anemia, hypoxia, electrolyte disturbances, and arrhythmias. It should aim at recognizing chronic conditions that could modify the postoperative course, such as cognitive disorders and chronic cardiac, respiratory, and renal failure.

    A targeted preoperative evaluation is included in . Some of the major issues of particular significance in the elderly are discussed below.

    Preoperative evaluation of acute hip fracture

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    What Is The Hip

    Your hip is a joint a ball-and-socket joint that connects the thigh bone of your leg to your pelvis. Your femur has a head at its top thats shaped like a ball, and it fits into the acetabulum . Its kept in place by ligaments, tendons and muscles around the joint. Your hip is the most flexible and free-moving joint in your body and can move backwards and forwards, to the side and can perform twisting motions.

    How Common Are Heart Attacks After Surgery

    Periacetabular Osteotomy for Complex Structural Hip Deformity ...

    About 3 percent of people undergoing major surgery experience a heart attack during the procedure. Complications become more common with age and in people with a previous history of cardiovascular disease or other risk factors for heart disease.

    One in 5 people over 65 or over 45 with a history of cardiovascular disease develop one or more MACE within a year of non-cardiac surgery.

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    Evaluating The Risks Of Hip Replacement

    Once the decision has been made that surgery is indicated, it is especially important to evaluate the surgical risks associated with operating on the very elderly. Assessing this risk and comparing it to potential benefits allows the patient and their family to make an informed and intelligent decision. Evaluation of risk is generally conducted in consultation with the patient’s primary care physician, as they have the best perspective and knowledge of the patient’s condition.

    Cardiovascular Risk

    Cardiovascular disease can result in serious medical complications after total joint replacement. Myocardial infarction, congestive heart failure and arrhythmia are only a few of the conditions which can be triggered by the stress of surgery, leading to significant medical care needs after surgery. The very elderly patient should be thoroughly screened before surgery for arterial, valvular and electrophysiological disease. Often, surgical or medical interventions can reduce the risks of hip replacement by addressing these diseases preoperatively. In situations where reversal of cardiovascular disease is either impossible or associated with excessive risk, then the patient and their family can be counseled regarding the additional perioperative risks that they must accept if continuing with hip replacement.

    Pulmonary Risks

    Renal Risks

    Comorbid Infection

    Bias Reduction: Stratification By Propensity Score Quintiles

    In view of the fact that this is an observational study and that patients are not randomly assigned to prescription of drugs, there are differences in observed covariates between the treatment and the control groups. In order to balance the covariates and minimize the risk of biased estimates, we stratified for the patients probability or propensity to receive diuretics in the final survival analysis. The propensity score for an individual is defined as the conditional probability of being treated given the individuals covariates . We estimated the PS for diuretic therapy for each patient by multiple logistic regression analysis in which the receipt of diuretics was modeled using all baseline patient characteristics in . We also estimated the PS for statin therapy using the same baseline characteristics.

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    How Do I Safely Walk After A Hip Replacement

    Youll need to use a walker or crutches which your occupational or physical therapist will provide for you. Make sure to stay on your crutches or walker until your healthcare provider or physical therapist advises that you use a cane. Your provider will decide how much weight you can put on your surgery leg. In most cases, you will be able to put 100% of your weight on your surgery leg.

    Your physical therapist will help you learn how to use your walker or crutches correctly and help you get the right equipment. A bag or basket attached to your walker will allow you to carry small items when walking. Keep in mind that walking does take effort following surgery. While physical therapy will help you learn how to correctly use a walker or crutches, your recovery is based on your dedication to therapy and exercises following surgery.

    What Does Recovery Look Like Whats The Rehabilitation After Hip Replacement Surgery

    Orthopaedic Hip Replacement Surgery

    Rehabilitation and physical therapy are started immediately following surgery and continue throughout hospitalization and at home for one year after surgery. Your physical therapist will monitor the strength and flexibility in your leg and hip, as well as your ability to stand and sit. In addition, a physical therapist will provide goals and instructions for you to complete while in the hospital and at home.

    Although discharge home is the goal for the majority of patients, your healthcare provider may determine that its best for your recovery if you go to a rehabilitation center or nursing home after discharge from the hospital. At the rehabilitation center, you will have concentrated time with a physical therapist and occupational therapist and will regain your strength, learn about all your exercises and the precautions that youll need to follow. Your length of stay at this facility is approximately five to 14 days, depending on your recovery progress. Your healthcare providers assistant or nurse will discuss facilities available for your needs, and a case manager specializing in discharge planning will meet with you during your admission. The case manager handles all of the planning for your rehabilitation.

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    What Medications Will I Receive Right Before During And Right After The Hip Replacement

    • Antibiotics: Medication to help prevent infection.
    • Anesthesia: An anesthesiologist will meet with you before your surgery. They will explain the various types of anesthesia available to you and the risks and benefits of each with your health history. The spinal, or regional anesthetic block, is the most common method used for orthopaedic joint replacement procedures. Youll also be asked to complete a health questionnaire from the anesthesia department for surgery clearance to ensure your safety.
    • Thromboprophylaxis: Medication to help prevent blood clots .
    • Pain control: Various medications can help control pain, including NSAIDs, narcotic pain medications and peripheral nerve block.

    What Is The Prosthesis Made Of

    The prosthesis is constructed of metal and plastic. Titanium, stainless steel, cobalt-chromium, ceramic and polyethylene are the most common materials. A prosthesis for a total hip replacement consists of four components:

    • Femoral stem.
    • Acetabular liner.
    • Acetabular shell.

    They are linked, but flexible, so that the surgeon can adjust for anything unexpected. The prosthetic is then fixed to the remaining bone using either:

    • Fixation to the host bone by relying on a bony ingrowth onto or into the porous surface of the bone that has either been interference-fit or press-fit into the surrounding bone.
    • Medical cement , if the original bones quality is low.

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    Total Hip Replacement Surgery Risks And Complications

    The most concerning complications related to hip replacement are those that threaten the overall health and life of the patient, such as complications involving anesthesia. Other complications, such as differences in leg length, are not medically serious but can affect comfort and quality of life.

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    Do I Still Take My Normal Medications Before Surgery

    8 Reasons for Hip Replacement Failure

    Inform your surgeon about all of your medications, both over-the-counter and prescription. Some medications dont react well with anesthesia, and others such as aspirin, ibuprofen and blood thinners increase bleeding. For these reasons, you may need to stop taking certain medications before your hip replacement. If youre taking aspirin or aspirin-based medication for arthritis, you must stop taking these two weeks before your surgery. If youre taking medications for other medical problems, dont discontinue taking these without checking with your primary healthcare provider. Make sure to bring a list of all medications, the dosages and how often you take them. This includes all herbal supplements and vitamins. This is important information that will be documented in your hospital records.

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    Impact Of Heart Failure On Patients Undergoing Major Noncardiac Surgery

    Bradley G. Hammill, Lesley H. Curtis, Elliott Bennett-Guerrero, Christopher M. O’Connor, James G. Jollis, Kevin A. Schulman, Adrian F. Hernandez Impact of Heart Failure on Patients Undergoing Major Noncardiac Surgery. Anesthesiology 2008 108:559567 doi:

    Changes in the demographics and epidemiology of patients with cardiovascular comorbidities who undergo major noncardiac surgery require an updated assessment of which patients are at greater risk of mortality or readmission. The authors evaluated short-term outcomes among patients with heart failure, coronary artery disease , or neither who underwent major noncardiac surgery.

    Patients were aged 65 and older, had Medicare fee-for-service coverage, and underwent 1 of 13 major noncardiac procedures from 2000 through 2004, excluding patients with end-stage renal disease and patients who did not have at least 1 yr of Medicare fee-for-service eligibility before surgery. Main outcome measures were operative mortality and 30-day all-cause readmission.

    Elderly patients with heart failure who undergo major surgical procedures have substantially higher risks of operative mortality and hospital readmission than other patients, including those with coronary disease, admitted for the same procedures. Improvements in perioperative care are needed for the growing population of patients with heart failure undergoing major noncardiac surgery.

    What Causes Congestive Heart Failure In Cats

    A variety of factors can cause congestive heart failure in cats. It is most commonly caused by a condition in which the walls of the heart thicken , but it can also be caused by thyroid disease, high blood pressure, or birth defects, among other things. Congestive heart failure can occur in cats of any age, breed , or gender, but it is most common in middle-aged to older cats.

    CHF can also develop in a heart that’s been weakened by other heart conditions, so it’s essential to do what you can to prevent heart disease from occurring in your pet, including preventing obesity and providing heartworm prevention.

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    Study Design And Cohort Definition

    This was an observational cohort study intended to examine the association between pre-existing CVD and the risk of post-operative cardiovascular events among patients who received hip fracture surgery. Each patient with pre-existing CVD was matched for age , gender, fracture type, and year of admission to a hip fracture patient without pre-existing CVD.

    Pre-existing CVD was defined as having one of the following diagnosis at admission: coronary heart disease , cerebrovascular events , peripheral artery disease and heart failure, and other cardiovascular diseases . The diagnosis of the above conditions was undertaken by medical specialists based on patient history and medical records or admission results based on electrocardiogram, coronary computed tomography , echocardiogram, and cranial CT/magnetic resonance imaging .

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