Capacity

Scenario

You are the ST3 in Trauma and Orthopaedics. A 90 year old lady has been admitted with a Right sided neck of femur fracture. She normally mobilises with a Zimmer frame. A decision has been made to perform a hemiarthroplasty.

For a patient to have capacity they must:

  • Understand information relevant to the decision
  • Retain the information
  • Use the information to make/weigh up their decision
  • Communicate their decision

 

You must also explain the procedure and the alternatives to the procedure.

 

The procedure:

The hip joint is a ball and socket joint. It allows movement of the leg and carries the weight of the body. In this operation we replace the ball with a metallic one.

  • Before the operation: you will be visited by your surgeon and the anaesthetists. They will mark your leg. The nurses will change you into a gown.
  • During the operation: On the day of the operation you will first be taken into the anaesthetic room, you will be greeted by the anaesthetist. You may be given either a general anaesthetic or a regional block (where they numb the area to be operated on). After this you will be taken into the operating theatre. You will lie on the opposite side to the leg being operated on. Your skin will be cleaned and you will be wrapped in drapes. The surgeon will make an incision over the affected hip. The top of the thigh bone (femur) will be cut away. A metal replacement will be fitted and secured with cement. The wound will be closed with dissolvable stitches.
  • After the operation: You will be seen by the physiotherapists who will help you/encourage you to walk.

 

Risks for hemiarthroplasty include:

  • Generic risks: Infection, bleeding, pain
  • Specific risks: blood clots (DVT/PE), altered leg length, joint dislocation, altered wound healing, COVID, Fracture, cement reaction, nerve damage resulting in weakness or loss of sensation.