Hip Replacement
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What is a Hip Replacement?
A posterior total hip replacement is a procedure which is done to treat hip arthritis. The operation involves taking away the old hip which is worn out and painful due to arthritis, and replacing it with a new prosthetic (artificial) hip.
X Ray with arthritis of the right hip, and after hip replacement
Hip Arthritis
Arthritis of the hip is common in Australia. It is usually as a result of the aging process and ‘wear and tear’. If your hip is causing significant problems in your day-to-day life you may be suffering from a condition which could be helped with hip replacement surgery. Surgeons at Victorian bone and joint are fellowship trained hip replacement specialists in Melbourne who regularly assess patients for hip conditions and can recommend hip surgery when required.
Hip arthritis causes significant problems for many people. Hip joint replacement is a good surgical solution for people who cannot find relief for their arthritis by using other treatments.
Orthopaedic surgeons at Victorian Bone and Joint will look at x-rays of your hips and pelvis to determine the amount and site of arthritis. MRI and CT scan are sometimes used to assess the arthritis in hips to determine if hip surgery is advisable. These scans can also help in the planning of difficult hip replacements.
Most people will try ways to help their arthritic hip ‘get by’. When physiotherapy, pain relief medications, weight loss and other alternative treatments are no longer working, specialist hip replacement may be able to help. It is normally advised that people try ways of dealing with their arthritis before contemplating surgery. Although hip replacement surgery is often used to treat arthritis of the hip, there are other treatments that your specialist can discuss with you.
The posterior approach is a way of performing hip replacements and revision hip replacement surgery in Melbourne.
If you and your specialist decide that surgery is the best option for your arthritic hip, the team at Bone and Joint will organise for a review by a specialist physician to make sure surgery will be as safe as possible. Blood test, a heart trace as well as other investigations maybe organised.
Post-Operative Care For Hip Replacement in Melbourne
Once you have had your hip replacement surgery in Melbourne, you may be able to begin to move the hip, knee and ankle under the instruction of your surgeon. Hospital physiotherapists will aim to safely have you mobilising after your surgery. This is important for your hip and general health.
A dressing will be placed over the hip following surgery. As the tissue and bone heal, a small amount of blood may appear on the dressings. This is normal. Sometimes, replacing the bandage is required to reinforce any areas that continue to bleed.
Elevate the leg for the first few days following surgery. You may be placed on blood thinning medications such as aspirin to help reduce the risk of clots.
Pain relief: After surgery it is normal to have some pain or discomfort. If you had a spinal anaesthetic, your leg may be numb for 3-6 hours, and you may not have any feeling in your legs and be unable to move your feet. The amount of surgery you have had will influence how much pain you can expect and how long you will need pain relief for. You will be given pain relief tablets to take home with you when you leave the hospital. Take these over the next week or so as you need.
You may be prescribed Palexia and Endone (2 weeks) which is a narcotic pain medication for your post-op pain control. You should aim to cease it as soon as possible.
Take the Palexia regularly for the first one-two weeks. Then take the Endone for breakthrough pain as required every 4 hours. It is better to be pain free and be able to do the exercises rather than be in pain and not be able to do any exercise.
Use the medicine as prescribed and do not drive, drink alcohol, or perform duties that require concentration (i.e. school or work) while on the narcotic medication.
Icing
It is recommended that you ice your hip. Ice in a bag with cloth covering can be used fairly consistently for the first 24 to 48 hours to help diminish the swelling. After the 48 hour period, if it is comfortable for you, you may apply ice packs to the hip 3-4 times per day for 30 minutes until swelling is resolved.
Bowel and Bladder Function
It is important that regular medications are given to soften bowel contents and typically coloxyl and senna is given or Movicol daily for the first two weeks, as the pain medications can reduce bowel function post operatively. It is also important to eat a high fibre, high protein diet to assist with bowel function.
Blood Tests and X Rays
You will undergo x-rays after the procedure on the day after surgery to check the alignment of your hip. You may also undergo blood tests depending upon your physician and surgeon.
Discharge home:
After your surgery you will stay in hospital for three to five days. You will be discharged with pain relief tablets. If you need longer to safely walk, rehabilitation can be organised.
Crutches
You can fully weight bear on your new hip as you can tolerate.
After 4 weeks if you feel comfortable you can transition to one crutch and then after review at 6 weeks wean off the one crutch.
Blood Clot Prevention
Blood clots are rare after hip replacement surgery, but they can be serious. You will undergo the following preventative strategies:
Medication – Clexane is normally given in hospital and you may be discharged on Aspirin
Compression stockings – typically for 14 days
Early mobilisation – the quicker patients get up and move, the faster blood gets moving and the lower the risk of blood clots
Remaining hydrated – if you remain well hydrated this can reduce your risk of blood clots
Driving
You may not drive at least until your post-op visit when your surgeon can make a decision regarding this, this is based upon your pain, medications, leg strength and also which leg has been operated on. Typically it takes 4-6 weeks after a right total hip replacement and 2 weeks following a left total hip replacement.
Hip Replacement Surgery Post-Operative Review
You will be reviewed at 2 weeks either by your GP or by your surgeon – please call the rooms on (03) 5752 5020 to arrange an appointment.
You will normally be reviewed at 6 weeks, then 6 months by your surgeon with X rays.
Physiotherapy
You will be seen on the wards twice daily by the physiotherapy team. They will help you with:
Getting in and out of bed
Using crutches
Helping you with walking and gait retraining
You can arrange to be seen by PT within the first week of discharge from surgery. You will continue therapy, with specific therapist instructions, at the first post-operative visit. You may wish to set up an appointment with physiotherapy in advance (2-3 sessions/week).
For the first two weeks until formal physical therapy, you may do the following exercises:
Ankle pumps: Move ankle up and down. 30 reps, 3 times daily.
Hip Pendulum: Stand on step supported by non operative leg, allow operative leg to hang off edge, gently move leg in circular motion clockwise and counter clockwise x 10, 3 times daily.
Precautions:
No weight lifting or water therapy during first two weeks.
Do not flex and internally rotate your hip during the first 6 weeks (do not bend down over the outside of your ankle)
Do not sit in very low, soft chairs
If an exercise is very painful, stop doing it or do it within the limits of motion that is not painful.
Major therapy gains are not made in the first two weeks – this is mainly a recuperative period
Rehabilitation
Most patients do not need to go to an inpatient rehabilitation facility following an anterior hip replacement. Inpatient rehabilitation is reserved for patients who live alone, or those who have complex medical co-morbidities which require monitoring. Rehabilitation physiotherapy services can be arranged at home for you, where a physiotherapist visits your home on a daily basis.
Shower: a plastic shower stool/chair may be useful
Toilet: an over toilet frame may be useful, especially if you have a low toilet
Mats: consider removing rugs/loose floor coverings to prevent tripping hazards
Bed: low mattresses are best avoided as these can be difficult to get off
Kitchen: everyday items should be in easy reach to prevent stretching and reaching overhead
Room: consider moving furniture so that easy access in and out of rooms can be achieved
Grasper: this can be very useful for getting things off the floor
Nutrition for Recovery
Nutrition management is a critical part of your surgical recovery. Protein and essential amino acids are vital to healing your tissues and muscles and expediting your recovery. Protein is mainly found in meat, chicken, fish, eggs, dairy, legumes, and other vegetarian and vegan alternatives. Protein spread throughout the day is best for your hip replacement treatment surgical recovery, and you should aim to consume this 2-3 times per day during your recovery.
Calcium and vitamin D are also recommended to promote bone health and growth following your procedure. Most adults in Australia are vitamin D deficient, and therefore it is recommended to start calcium and vitamin D several weeks prior to your procedure, as this has been shown to be beneficial to your health and recovery. Vitamin D is naturally generated from sunlight exposure, and it is also present in oily fish, fortified foods, mushrooms, and egg yolks.
What to Report Immediately
Signs and symptoms to report
persistent fever
wound redness, drainage, or increased skin temperature around the incision
increasing numbness
sudden increase in pain or swelling
deep calf pain and/or swelling
shortness of breath
If you have any problems please call Victorian Bone and Joint Specialists on 57525020 or 1300 266 366.
You should have a post-op appointment scheduled in 14 days. If you do not, please call 5752 5020 to schedule an appointment.
FAQs On Hip Replacement
Which implants do Victorian Bone and Joint Surgeons use?
Our surgeons use a variety of implants depending upon the shape of your bones and the type of arthritis you have. Implants with excellent results on the Australian Joint Replacement Registry are used.
Am I too young for hip replacement surgery?
Hip arthritis affects people of many ages, and hip replacement surgery is an effective pain-relieving operation. Hip replacements are done, with excellent results, on both very young (teenagers) and older patients. If hip preservation options have failed, then total hip replacement may be a viable option to discuss with your surgeon.
When can I walk after an posterior total hip replacement?
Full weight-bearing and walking is allowed immediately after a posterior hip replacement. Initially, this will be aided by crutches. We get all patients mobilising Day 1 after their operation on crutches.
When can I work after a posterior total hip replacement?
Your return to work will vary depending on the procedure performed and type of work you are engaged in. Most people can return to office work within 4 weeks. More strenuous manual work may require you to take 12 weeks before returning to full duties.
When can I play sports after a posterior total hip replacement?
Low impact activities, such as cycling and swimming, can be commenced from weeks 6-12. High impact activities, such as running, or excessive twisting such as during tennis or golf, are best avoided for at least 12 weeks after surgery.
How long will I take to heal after a posterior total hip replacement?
The wounds take 7-10 days to heal. Most patients improve dramatically in the first 6 weeks. Occasionally, there are periods where the hip may become sore and then settle again. This is part of the normal healing process. It takes three months for your hip to fully recover from a hip replacement. Continued improvements may be gained up to 1-year post-surgery.
How much pain will I experience after a posterior total hip replacement?
Most patients are surprised at how little pain they have after surgery. A local anaesthetics is injected around the wound during the procedure to minimise any pain you may experience.
Will I beep going through metal detectors at airports?
Maybe. It depends upon the settings of the metal detector in use, some countries have higher sensitivities than others, so whilst you may not set them off in Australia you may do so overseas. Normally it is not an issue if you tell them you have had a hip replacement treatment.
Daily Progress
This is intended as a guide only and it may vary depending upon your circumstances
Day 0: Day of Surgery
If you have surgery in the morning:
Sit out of bed in the afternoon
Mobilise to chair with physiotherapy/nursing assistance
Day 1:
Your pain should be controlled with oral medications
Last dose of intravenous antibiotics and your drip/cannula should be removed
Shower and get dressed in your regular clothes
Sit out of bed all morning and afternoon
X ray
Walk with assistance of physiotherapy and crutches
Day 2:
Mobilising independently with crutches
Step ups/downs
Getting dressed independently
Walking outside your room with crutches
Pain catheter removal
Eating and drinking normally
Days 3-5: Discharge
Physiotherapy review
Discharge paperwork
Medications
Wound/dressing review
Post Op appointment confirmed
Physiotherapy Protocol after Hip Replacement
PHASE I— IMMEDIATE REHABILITATION – Usually 1-2 weeks
Goals
Protect integrity of repaired tissue
Restore independent mobility
Reduce pain and swelling
Precautions
Crutches for first 1-2 weeks – wean to 1 crutch in OPPOSITE HAND
No extension activities beyond neutral extension with extension
No crossed legs
Specific Exercises:
Straight line walking
Clams or Side leg raises (Abductor strengthening)
Supine abduction in bed
Mini Squats
Core stabilisation
Calf pumps
PHASE II— INTERMEDIATE REHABILITATION – 2-6 weeks
Goals
Restore range of motion
Restore hip strength
Normalise gait without aid (crutches)
Precautions
Avoid active hip extension and external rotation
No distance walking – aim 2-4000 steps/day
Specific Exercises
Supine hip abduction
Clam shells
Dynamic gait progression – side stepping, tandem, low hurdles
Forward step ups/downs
Hydrotherapy and upper body exercises with pool buoy between legs
PHASE III— ADVANCED 6 weeks+
Goals
Restoration of muscular endurance/strength
Restoration of cardiovascular endurance
Optimize neuromuscular control/balance/proprioception
Precautions
No precautions
Specific Exercises
Treadmill – inline walking 20mins 2 x per day
Advanced strength training – squats/lunges as tolerated
Side to side lateral agilities
Resume normal sports drills/training at 8-12 weeks
