[Medical environment of total hip prosthesis]

Total hip replacement is an extremely frequent operation for the treatment of degenerative joint disease. Indication for surgery must take into account the patient's general status, associated diseases, multiple joint involvement, and the efficacy and tolerance to medical treatments. The decision to operate is taken together by the physician and the patient. The degree of functional impairment and the patient's age are important factors. The patient must be informed that the period of hospitalization will be approximately 15 days and that good results are obtained in approximately 98% of the cases. Preoperative consultation with the anesthesist will focus on associated diseases with special attention to possible infectious foyers. Early post operative care includes a 48 hour antibiotic reginien, thromboprophylaxy with low molecular weight heparin for 3 days followed by anti-vitamin K for 6 weeks, and non-steroid antiinflammatory drugs for 5 days of up to 6 weeks in case of suspected risk of ossification. At mid-term, complications may include hematomas, infection and luxation. The fixation may also fail in certain cases where transtrochanter access was used. Long-term follow-up monitors for possible late onset infection and late luxations which usually result from prosthesis wear and more rarely from muscular causes.