Data are available from studies that assessed pre-operative analgesia versus pre-operative placebo, as well as those that, to examine the concept of pre-emptive – or preventive – analgesia, assessed pre-operative analgesia versus the same analgesia given postoperatively. However, a previous systematic review of pre-emptive analgesia for acute or chronic postoperative pain relief in a variety of surgical procedures – such as orthopaedic, dental, gynaecological and abdominal – has concluded that there is no benefit of pre-emptive over postoperative administration (Möiniche 2002). Nevertheless, it is considered that analgesic medication needs to be initiated in time to ensure an adequate analgesic effect in the immediate postoperative period. This may necessitate administration prior to the postoperative period.
Well-informed patients can have a direct influence on their surgical outcome, especially in primary total hip arthroplasty where their active participation in rehabilitation and physiotherapy will determine how quickly they mobilise on their new joint.
Patients should be aware of the main surgical complications in total hip arthroplasty, which include: nerve damage (sciatic nerve and/or femoral nerve), differences in leg length following surgery, and dislocation.
Information should be given on the approximate timetable for return to normal physical activities, that is, early weight-bearing mobility with a cemented prosthesis, and no weight- or low weight-bearing on the joint for approximately up to 6 weeks with a non-cemented prosthesis (requiring mobilisation with crutches).
The patient should also understand the importance of complying with programmed mobility and muscle-strengthening exercises
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Patients undergoing primary total hip arthroplasty are usually elderly and may demonstrate significant medical co-morbidity, such as hypertension, diabetes, ischaemic heart disease, renal dysfunction and obesity, all of which can have an effect on patient management before, during and immediately after surgery.
In most patients, hip arthroplasty is carried out as an elective procedure and there should be sufficient time to optimise the patient’s general medical condition prior to surgery. It is also important to evaluate the pre-operative ‘activities of daily living’ and ‘biological age’ of the individual patient, as these can affect the choice of prosthesis (cemented or non-cemented) and will also affect the pattern of rehabilitation, and the need for patient care, in the postoperative period.
In general, it is considered that non-cemented prostheses should be non-weight bearing for approximately 6 weeks (requiring mobilisation with crutches). However, recent studies have shown that there is no difference between immediate full weight-bearing and delayed weight-bearing following non-cemented implantation for functional scores and osteo-integration, and in addition there may be some benefits of immediate weight-bearing for early walking and hospital discharge (Chan 2003, Kishida 2001). Further studies are required to confirm the effects of immediate weight bearing on the postoperative rehabilitation pattern.
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[No data found within the parameters of the systematic review]