Hip Replacement
Total Hip Replacement
If you have severe arthritis of the hip causing pain and limitation of your activities and lifestyle, and have not responded to conservative treatments you may be a candidate for total hip replacement.
Total hip replacement was first performed in 1960. Modern hip replacement is one of the most successful operations in the history of surgery. The prestigious medical journal The Lancet has recently described total hip replacement as “the operation of the century” because of its incredibly high success rate and patient satisfaction rate. Hip replacement replaces a painful arthritic hip with a functional pain free joint that allows patients to resume normal activities.
Causes of damage to the hip.
Oteoarthritis The most common form of damage in the hip is caused by wear on the articular surfaces of the bones causing pain as the bones rub directly on one another.
Trauma as a result of injury or fracture.
Rheumatoid arthritis , chronic inflammation causing damage to the cartilage.
Avascular necrosis which is a loss of blood supply to the femoral head.
Growth abnormalities or childhood disorders causing a predisposition to arthritis.
Family history of arthritis or lifestyle changes such as increased weight.
Disease of the hip joint resulting in a decrease in the cartilage lining causes pain in the hip, buttock, groin and thigh. It also results in stiffness which creates difficulties with daily activities, such as putting on shoes and socks. There may even be pain at rest.
Timing and expectations for Hip Replacement
Total hip replacement surgery uses titanium, ceramic, or polyethylene parts to replace the ball at the upper end of the thighbone (femur) and resurface the hip socket (acetabulum) in the pelvic bone. Total hip replacement surgery replaces damaged cartilage with new material in a step-by-step process.
People with hip arthritis that causes pain that interferes with daily activities, and is no longer controlled using conservative treatment may be candidates for hip replacement surgery.
Hip replacement surgery can be very successful in younger people as well as those over 60. New technology has improved the artificial parts, allowing them to withstand more stress and strain and last longer than previous generations of hip replacement.
Hip replacements are ideally inserted through a minimally invasive muscle splitting, tissue preserving surgical incision. I use all surgical approaches, direct anterior, anterolateral and posterolateral methods. I will discuss with you the most suitable approach for you prior to surgery.
For the majority of people who have hip replacement surgery, the procedure results in:
- a decrease in pain
- increased mobility
- improvements in activities of daily living
- improved quality of life.
Preparing for surgery
Medical evaluation
I will organise routine blood tests, ECG, urine test and occasionally a chest x-ray, prior to your surgery at the Pre-admission Centre in the hospital. The staff in the Pre-admission clinic will also discuss issues related to your hospital stay. Occasionally I will ask you to see a consultant physician to check your medical health prior to surgery. If you are under the care of a cardiologist a consultation to confirm your suitability for surgery is advised.
Dental evaluation
Although the incidence of infection following hip replacement is rare. I recommend treatment of significant dental disease (including tooth extractions and periodontal work) be considered before your hip replacement surgery.
Medications
Anticoagulant medication such as Plavix, Cartia or asprin should be ceased 7 days prior to surgery. Some other anticoagulants including Warfarin medication should be ceased with advice from your treating physician. All vitamins and supplements should be ceased 10 days prior to surgery. All regular prescribed medications should be continued.
Anaesthetic
Hip replacement surgery is performed under general anaesthetic, often in combination with a spinal anaesthetic to assist with post operative pain relief. A decision regarding optiomal anaesthesia will be made by you in consultation with the anaesthetist prior to your operation.
Skin preparation
Your hip and leg should be free of any skin infection or irritation. Contact my nurse of you have any cuts or sores on your hip or leg or anywhere else on your body. Use an antibacterial wash such as Phisohex to wash the body from the waist down to the foot, daily for the week prior to surgery.
Your surgery
The hospital will call you a day prior to your surgery to give you an arrival time and your fasting details.
You will be admitted on the day of your surgery by the nursing staff who will complete your medical records. You will be showered and will change into a hospital gown.
Your anaesthetist will meet you and you will be transferred to the operating theatre.
The operation takes about 2 hours. An incision is made over the hip to expose the joint. The acetabulum is prepared using an instrument called a reamer. The metal acetabular cup is inserted and a liner which can be made of plastic, ceramic or metal or a combination as used in a dual mobility hip prosthesis. The femur is prepared and a press fit femoral component inserted. The femoral head is attached. The hip is tested for stability and leg length. The muscles and tissues are carefully closed. The wound will be covered with a waterproof dressing.
After surgery you will be transferred to the recovery room where you will remain monitored for 1-2 hours before being transferred to the ward.
Your hospital stay
Your hospital stay is usually 3 – 4 days.
You will have some discomfort but medication will be given to you to make you as comfortable as possible. Pain control is very important and you are encouraged to request and take pain medication as often as you need it. Medication to help prevent the formation of blood clots will be given.
On the day following surgery the physiotherapist will give you some breathing exercises, leg exercises and sit you out of bed and encourage you to weightbear and walk with a frame support.
Your dressing and sutures remain intact for 14 days post operation. The sutures will dissolve. The dressing will be removed at rehab or in my office at around 14 days post-operation.
Arrangements for a follow up appointment should be made with my staff.
If you opt for inpatient rehabilitation it will be arranged by the hospital and you will be transferred directly from the hospital to the rehab facility. You do not need to arrange your own rehab or transport to rehab. We will do it for you. We would prefer that you concentrate on your ow recovery and leave the practical details relating to discharge, rehab transfer and wound dressing to us.
Risks and complications
Complications following hip replacement surgery are unusual, but surgical and medical complications can occur and may prolong or limit your recovery. The decision to proceed with surgery is made because the advantages outweigh the disadvantages.
Complications can include
- Allergic reactions to medications
- Blood loss requiring transfusion with its low risk of disease transmission. I routinely use Tranexamic acid TXA which significantly reduces bleeding so the need for transfusions is very rare.
- Infection superficial or deep requiring antibiotics. I use prophylactic antibiotics so infection is very rare. I try to keep hospital stays to a minimum.
- Blood Clots (DVT) My blood clot prevention program includes early mobilisation, anticoagulant medication and TED stockings. Doppler ultrasound may be done if required.
- Damage to nerves. Most common in direct anterior hip replacement and can lead to loss of sensation and neurogenic pain in the groin and thigh.
- Damage to the sciatic nerve is more common with posterior approach hip replacement and can lead to leg weakness and 'foot-drop'
- Damage to blood vessels is rare but can occur.
- Wound or scar irritation. Some sensitivity or small areas of numbness may occur at the wound site. This usually decreases over time and should not affect the function of your new hip.
- Leg length inequality. In some cases it can be difficult to make the leg length equal to the other one. I make every effort to equalise leg lengths at the time of surgery. There are times when it may be necessary to lengthen your leg slightly to make the hip stable. All leg length inequalities can be treated with a simple shoe raise.
- Limp due to muscle weakness. This is usually addressed over time with physiotherapy and exercise.
Please feel free to discuss any queries with me or my staff.
Advice following hip replacement surgery
Stay mobile. Use aids and rails until you feel strong and your balance and strength has returned. You may sleep in any position you find comfortable including on your side and sit in any chair you find suitable.
Preventing infection. If you have surgery, invasive dental procedures or large skin cuts temporary antibiotic cover is recommended.
Diet. A balanced diet is important following your surgery. Occasionally an iron supplement will be required.
Driving. You may drive when you are walking comfortably and not taking strong analgesics for pain.
Activity. Enjoy your new hip and stay active. Return to sport and activities as you feel comfortable.
Frequently asked questions
How long will my new hip last? The type of hips I use have excellent survival rates. The quality of materials has improved with the expectation many hip replacements will never need revision. However in younger patients (under 50) future revision may be required.
Will I have pain after my hip replacement?
You can expect to take analgesics for up to 6 weeks (occasional simple analgesics) following surgery.
How long will I be “out of action” following hip replacement
You will be in hospital approximately 3-4 days and then rehab (if you choose) for approx. 10 days. You may require a stick for a couple of weeks. Depending on your type of work you may return in 3-4 weeks. Light duties may be undertaken sooner as comfort allows. Heavier work may mean a delay in return for up to 3 months.
What about exercise?
Daily activities as tolerated and return to active pursuits as comfort allows. Walking, pool based exercises and cycling are acceptable. You may return to sport as advised by me. Golf usually at 6 weeks.
Sex?
Whenever you are ready. No restrictions.
In summary modern total hip replacement is an extremely successful procedure that allows patients to resume an active lifestyle in comfort.
The ideal approach to the hip depends on the individual patient’s anatomy. Surgical approaches can include:
- Anterior hip Replacement
- Anteriolateral hip replacement
- Posterolateral hip replacement
I like to use the dual mobility hip replacement in suitable patients.
Following successful dual mobility hip replacement many patients can return to a high level of physical activity.
Dual mobility hip replacements can be safely implanted using either the direct anterior or posterior methods. Both approaches are highly effective and very likely to lead to a successful outcome.
Dual mobility hip replacements are more stable than conventional hip replacements with a much lower risk of dislocation.
Surgical Methods
Minimally Invasive Surgery
Minimally invasive technique can be used with all surgical approaches to the hip including the:
- Direct anterior
- Anterolateral
- Posterolateral
In summary modern total hip replacement is an extremely successful procedure that allows patients to resume an active lifestyle in comfort.
Computer Assisted Orthopaedic Surgery
Accurate alignment of the hip components is critical to the overall function and improved outcomes after Hip surgery.
This system can also help navigate through different bone cuts and implant alignment.
