Total hip arthroplasty or total hip replacement is a surgical procedure
performed to replace the hip joint. It is performed in patients with severe damage to
the hip joint from injury or disease, resulting in symptoms like pain,
deformity and severe limitation of movement and not responding to other
Medications are required before
and after total hip arthroplasty to prevent complications like infection, pain
and clotting of blood. A brief summary of the medications required, as
explained in an article in the US Pharmacist, is presented below:
Antibiotics should be administered before the surgery to prevent
infection. Cefazolin or cefuroxime are the preferred antibiotics used prior to
case the patient is allergic to these drugs, clindamycin may be used.
Vancomycin should be reserved only for those patients who may have
life-threatening allergy to cefazolin or cefuroxime or those who show the
presence of bacteria resistant to these antibiotics. Antibiotics should be
administered 1 hour prior to commencement of surgery, or 2 hours prior in the
case of vancomycin. The antibiotic should be stopped within 24 hours of the end
Pain following the surgery
is a serious concern and multiple ways have been suggested to tackle it. These include instillation of a local
anesthetic at the surgical site or continuous spinal and epidural anesthesia
with an anesthetic called bupivacaine.
Regular painkillers from the
nonsteroidal anti-inflammatory group of drugs (NSAIDs) are also used in the
post-operative period to control pain.
Pain may also arise due to
abnormal bone formation following total hip arthroplasty. NSAIDs like
indomethacin, naproxen or diclofenac or local radiation given before or after
the operation is useful in preventing this pain.
Another complication of total hip arthroplasty is the formation of
clots in veins.
These could travel to the heart, brain or lungs with serious consequences like
heart attack, stroke and sometimes death. Various methods are used to prevent
this clotting: devices like graduated compression stockings, intermittent
pneumatic compression devices, and venous foot pumps prevent stagnation of
blood in the legs and prevent clot formation in the veins. Low molecular weight heparin
(such as enoxaparin or fondaparinux), a blood thinner, can be used to prevent
clotting when started before or after the surgical procedure and
continued for 10 to 35 days thereafter. Drugs like warfarin, though not
preferred in this situation, may be used as an alternative. Dosage of these
drugs should be reduced in patients with reduced kidney function. It is recommended
that drugs like aspirin, dextran and low dose unfractionated heparin, graduated
compression stockings, and venous foot pumps should never be the sole method to
prevent clot formation.
Thus, antibiotics, painkillers and blood thinners should be carefully
selected to prevent complications of hip replacement surgery and to ensure a
Total Hip Arthroplasty: Presurgical and Postsurgical Drug Therapies;
Tran H. Tran et al; US Pharmacist 2011