Medications Reduce Complications of Total Hip Replacement
Medications used just prior or after a total hip replacement play an important role in reducing complications of the procedure, and thereby the duration of hospitalization, according to a recent review article.
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 treatments.
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 surgery. In 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 of surgery.
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 speedy recovery.
Total Hip Arthroplasty: Presurgical and Postsurgical Drug Therapies; Tran H. Tran et al; US Pharmacist 2011