tokens: 289811204 FIH 2696998 22684/ukjj 819579 4/16/1993 12:00:00 AM RIGHT HIP , OSTEOARTHRITIS . Unsigned DIS Report Status : Unsigned ADMISSION DATE : 4/16/93 DISCHARGE DATE : 4/23/93 PRINCIPAL DIAGNOSIS : Right hip , osteoarthritis . HISTORY OF PRESENT ILLNESS : The patient is a generally healthy 85 year old female , who has had a five year history of right hip pain , worsening over the past several months . Her pain is located in the groin and thigh . It is aggravated by activity and improved by sitting or lying down . It is associated with rest pain as well . She uses a cane or walker for ambulation , and is limited to one to two blocks . She does stairs one at a time and only with help . She has difficulty with shoes and socks and foot care . The patient &apos;s pain has not been relieved by Darvocet and Advil . Radiographs demonstrate right hip osteoarthritis . Having failed conservative management , the patient presented for elective right total hip replacement . PAST MEDICAL HISTORY : Hypertension , possible peptic ulcer disease 1959 , history of left ankle and knee fractures , 1980 . Recent urinary tract infection , E. coli 03/93 . Recent herpes zoster . PAST SURGICAL HISTORY : cholecystectomy , total abdominal hysterectomy , cataract excision . MEDICATIONS ON ADMISSION : hydrochlorothiazide 50 mg. PO qday , KayCiel . ALLERGIES : The patient has no known drug allergies . HABITS : The patient does not smoke or drink . REVIEW OF SYSTEMS : Negative in detail . PHYSICAL EXAMINATION : The patient was an elderly woman in no acute distress . The head and neck exam was within normal limits . The lungs were clear to auscultation . Cardiac : regular rate and rhythm without murmur . The abdomen was soft , nontender , nondistended , with normal active bowel sounds . Extremities : left hip 110 degrees of flexion , 0 degrees of extension , 30 degrees of abduction , 45 degrees of adduction , 10 degrees of internal rotation and flexion , 45 degrees of external rotation and flexion . Right hip 90 degrees of flexion , minus 30 degrees of extension , 20 degrees of abduction , 30 degrees of adduction , less than 5 degrees of internal rotation and flexion and less than 5 degrees of external rotation and flexion . There was no leg length discrepancy . The patient &apos;s gait was halting , stooped and slow . The patient used the cane in her left hand . The patient &apos;s neurovascular examination was intact . LABORATORY DATA : the sodium was 140 , potassium 3.7 , chloride 96 , bicarbonate 30 , BUN and creatinine 14/0.9 , glucose 105 , hematocrit 42 , white blood count 8.6 , platelet count 644,000 , prothrombin time 10.4 , partial thromboplastin time 28.7 , urinalysis trace white blood cells , slight occult red blood cells . The electrocardiogram showed normal sinus rhythm at a rate of 80 with intraventricular conduction delay and poor R wave progression . There were no acute ischemic changes . The chest X-ray showed borderline cardiomegaly but no acute cardiac or pulmonary disease . HOSPITAL COURSE : The patient was admitted to the Orthopedic Service on 4/16/93 . On that day she underwent clearance from the Cardiology Service , Dr. Shuff . It was his impression that the patient &apos;s hypertension was controlled on hydrochlorothiazide . Given the patient &apos;s low potassium level of 2.4 on the day of admission , he suggested supplementation with potassium . The patient was cleared from surgery from a cardiology standpoint . On the following morning 4/17/93 , the patient was taken to the operating room where she underwent a right total hip replacement , using a hybrid S-ROM system . Postoperatively , the patient did extremely well . The patient was seen in consultation with the physical therapy service initially for routine rehabilitation after a total hip replacement . Her hemovac drains were removed on postoperative day # 2 as was her Foley catheter . Her hematocrit remained stable in the low to mid 30 &apos;s and she did not require a transfusion . The patient did have postoperatively hypokalemia to a level of 2.7 and subsequently was corrected with oral and intravenous potassium on 4/22/93 , the patient underwent a duplex ultrasound examination , which showed no evidence of of deep venous thrombosis . The patient &apos;s Coumadin was thus stopped and she was switched to Bufferin . The patient &apos;s hospitalization was uncomplicated . She was discharged to the Encharlea Il Medical Center in New Hampshire . DISCHARGE DIAGNOSIS : Right hip osteoarthritis , status post right total hip replacement on 4/17/93 . Hypertension . Postoperative hypokalemia , resolved . Postoperative confusion , transient and resolved spontaneously . CONDITION ON DISCHARGE : Satisfactory . MEDICATIONS ON DISCHARGE : hydrochlorothiazide 50 mg. PO qday , KayCiel 40 mEq. b.i.d. , Ecotrin 1 tablet qday , Ferrous sulfate 325 mg. PO b.i.d. , Folate 1 mg. PO qday , multivitamins one tablet qday , Tylenol # 3 1 to 2 PO q3hours PRN . DISPOSITION / PLAN ON DISCHARGE : The patient is discharged to the Encharlea Il Medical Center . There she should received physical therapy to consist of a routine post total hip replacement rehabilitation protocol , with emphasis on gait training , partial weight bearing on the right lower extremity , using a walker or crutches . The patient should also have her potassium levels checked two times per week to insure that she is not becoming hypokalemic . The patient should have a follow up appointment arranged with Dr. Level . LAYMIE M HE , M.D. DICTATING FOR : LILLBI SERVICE , M.D. TR : il / bmot DD : 4/22/93 TD : 04/22/93 CC : Dr. Lako Service STAT