Total Hip Replacement
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Introduction
Total hip replacement, also known as hip arthroplasty, is a surgical procedure to replace a worn-out or damaged hip joint with an artificial joint (prosthesis). This surgery is usually performed to relieve pain and improve function in patients with severe hip arthritis or hip joint damage.
At Victorian Bone and Joint Specialists (VBJS), our highly skilled and experienced surgeons are dedicated to providing exceptional care for patients requiring total hip replacement. Located in Melbourne, our fellowship-trained orthopaedic surgeons utilise the latest techniques and technologies to ensure the best possible outcomes for our patients. With a commitment to personalised care and advanced surgical expertise, VBJS is a leading centre for hip replacement surgery in Melbourne. Our modern facilities and post-operative care services support patients from initial consultation through to recovery, ensuring a smooth and successful surgical experience.
Anatomy
The hip joint consists of the ball (femoral head) and socket (acetabulum). In a hip replacement, the damaged femoral head is replaced with a metal or ceramic ball attached to a metal stem, which is inserted into the femur. The socket is replaced with a metal cup, often lined with plastic or ceramic, to allow smooth movement.
Reasons for Total Hip Replacement
Osteoarthritis: The most common reason, causing wear and tear of the joint.
Rheumatoid Arthritis: An autoimmune disease causing joint inflammation and damage.
Post-Traumatic Arthritis: Arthritis following an injury to the hip joint.
Avascular Necrosis: Loss of bone tissue due to a lack of blood supply.
Hip Fractures: Severe fractures that cannot be repaired with other methods.
Childhood Hip Diseases: Conditions like hip dysplasia leading to joint damage over time.
Different Approaches
Anterior approach: An incision is made at the front of the hip, allowing the surgeon to work between muscles without detaching them.
Posterior approach: An incision is made at the back of the hip, which requires cutting through the gluteus maximus muscle.
Each approach has specific precautions and recovery guidelines, and the choice often depends on the surgeon's experience, the patient's anatomy, and overall health.
Robotic Hip Replacement
Robotic hip replacement is an advanced technique using a robotic arm to assist in precise hip implant placement. The system creates a 3D model of the patient's hip from pre-operative imaging, allowing for accurate surgical planning. The surgeon controls the robotic arm to ensure precision and consistency. This method aims to improve implant alignment and fit, potentially leading to better outcomes. Discuss with your surgeon if robotic hip replacement is suitable for you.
Preparing for Surgery
Medical Evaluation: A thorough evaluation by your surgeon and primary care doctor to assess your overall health and readiness for surgery.
Medications: Inform your doctor about all medications you are taking. Some may need to be stopped before surgery.
Pre-Surgical Tests: Blood tests, X-rays, and other imaging studies.
Home Preparation: Arrange for help at home during your recovery period. Make necessary modifications to make your home safer and more accessible.
Fasting: You may need to fast (not eat or drink) for several hours before the surgery.
The Surgery
Anaesthesia: You will be given general anaesthesia (you will be asleep) or spinal anaesthesia and sedation (you will be sedated but numb from the waist down). This will be discussed with you by our anaesthetist.
Procedure: The surgeon makes an incision over the hip joint, removes the damaged bone and cartilage, and replaces it with the prosthetic joint.
Duration: The surgery usually takes 1-2 hours.
After Surgery
Recovery Room: You will return to the recovery room where your vital signs will be monitored.
Pain Management: Medications will be provided to control pain.
Physical Therapy: You will start physical therapy soon after surgery to help regain movement and strength.
Hospital Stay: Most patients stay in the hospital for 2-3 days.
Recovery and Rehabilitation
Physical Activity: Gradual increase in activity is crucial. Follow your physical therapist's instructions.
Assistive Devices: You may need crutches, a walker, or a cane for a few weeks.
Avoid Certain Movements: Avoid crossing your legs, bending your hip more than 90 degrees, and twisting your leg inward.
Exercise: Regular exercises to strengthen your hip and improve flexibility.
Driving: You can typically resume driving 6 weeks after surgery, depending on your recovery and your doctor's advice.
Post-Operative Care
Pain Relief:
It is normal to have some pain or discomfort after surgery. You will be given pain relief medications such as NSAIDs and opiates.
Avoid driving, drinking alcohol, or performing duties requiring concentration while on opiate pain medications.
Icing:
Some patients find that icing their hip replacement after surgery can improve pain relief and reduce swelling
Use ice packs consistently for the first 24-48 hours to reduce swelling.
After this period, apply ice packs 3-4 times per day for 30 minutes until swelling subsides.
Bowel and Bladder Function:
Pain medications can reduce bowel function, so it is important to take stool softeners like Coloxyl and Senna or Movicol daily while you are taking opiates.
Maintain a high-fiber, high-protein diet to assist with bowel function.
Blood Tests and X-Rays:
X-rays will be taken the day after surgery to check the alignment of your hip.
Blood tests may be conducted as needed based on your physician and surgeon's assessment.
Discharge Home:
Most patients stay in the hospital for 2-3 days after surgery.
You will be discharged with pain relief medications and a rehabilitation plan.
Weight Bearing:
Most patients can full weight bear as tolerated on their hip replacement immediately after surgery. Your surgeon will advise you on your specific weight bearing status.
Blood Clot Prevention:
Medication such as Clexane or Aspirin may be prescribed.
Wear compression stockings for 14 days.
Early mobilization and staying hydrated are essential to prevent blood clots.
Risks and Complications
Infection: Antibiotics are given to prevent infection.
Blood Clots: Blood-thinning medications may be prescribed.
Dislocation: The new joint can dislocate if not careful with certain movements.
Leg Length Inequality: Small differences in leg length can occur.
Nerve and Blood Vessel Injury: Rare but possible.
Wear and Tear: The prosthetic joint may wear out over time, requiring revision surgery.
Long-Term Outcomes
Most patients experience significant pain relief and improved mobility.
The prosthetic joint can last 15-20 years or more with proper care and activity modification.
Regular check-ups with your doctor to monitor the condition of the prosthetic joint.
Frequently Asked Questions (FAQs)
Q: Which implants do surgeons use?
A: Surgeons use a variety of implants depending on the shape of your bones and the type of arthritis you have. Implants with excellent results on the Australian Joint Replacement Registry are used.
Q: Am I too young for hip replacement surgery?
A: Hip arthritis affects people of many ages, and hip replacement surgery is effective for pain relief in both young and older patients. If hip preservation options have failed, then total hip replacement may be a viable option.
Q: When can I walk after a posterior total hip replacement?
A: Full weight-bearing and walking are usually allowed immediately after surgery, typically aided by crutches. Patients usually begin mobilizing on the first day after the operation. Your surgeon will advise what your weight bearing status is.
Q: When can I work after a posterior total hip replacement?
A: Return to work varies depending on the type of work. Most people can return to office work within 4 weeks, while more strenuous manual work may require up to 12 weeks.
Q: When can I play sports after a total hip replacement?
A: Your ability to return to sports will depend on your pre-surgery function, your specific hip replacement, and your progress post operatively. Typically. low-impact activities like cycling and swimming can be started 6-12 weeks after surgery. High-impact activities should be avoided for at least 12 weeks.
Q: How long will it take to heal after a posterior total hip replacement?
A: Wounds typically heal in 14 days, and your hip replacement will have significant improvement within the first 6 weeks. Full recovery can take up to 3 months, with continued improvements up to a year.
Q: How much pain will I experience after a total hip replacement?
A: Most patients experience minimal pain after surgery due to local anaesthetics used during the procedure.
Q: Will I set off metal detectors at airports?
A: It is possible, depending on the sensitivity of the detectors. Inform security personnel if you have had a hip replacement.
Note: This information sheet is for educational purposes and is not a substitute for professional medical advice. Always follow your healthcare provider's instructions and guidance.
