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Total Hip Replacement Surgery
HIP REPLACEMENT SURGERY
Total hip replacement surgery treats severe hip pain that has stopped responding to conservative treatments such as, physiotherapy and pain medication. If you experience pain caused by conditions such as osteoarthritis or rheumatoid arthritis, hip replacement may help reduce your pain and restore your mobility. It is one of the most reproducible and effective operations for a reduction in pain and restoration in quality of life. Total hip replacement works by surgically removing a worn and painful joint and replacing it with a man-made joint (known as a prosthesis). Most people can return to normal life within 6 weeks of a modern total hip replacement.
TYPES OF HIP REPLACEMENT SURGERY
There are different ways of performing a hip replacement.
MINIMALLY INVASIVE ANTERIOR TOTAL HIP REPLACEMENT
Anterior minimally invasive surgery (AMIS) is a common technique for performing hip replacements. With AMIS, the surgeon accesses the hip through a more anterior incision towards the front of the hip, and rather than cutting tendons from the femur bone, access to the joint is made between muscles resulting in less tissue injury. The advantage of this surgery is that it avoids cutting through muscles to access your hip. When performed by an experienced anterior approach hip surgeon, research has shown that the Anterior Minimally Invasive Surgery (AMIS) can result in a faster recovery time, less pain post-surgery, and a shorter stay in hospital.
The direct anterior approach is a specialised technique and it is recommended that this procedure only be employed by a suitably trained and experienced surgeon. If your surgeon is not extensively trained in AMIS or experienced (minimum 100 cases) at this technique, it is safer that they perform your operation using a more traditional technique such as the posterior approach.
POSTERIOR TOTAL HIP REPLACEMENT
With posterior hip replacements, the surgeon enters through the back of the hip (though the cut is on the side). Unlike AMIS, posterior hip replacements require a surgeon to take several tendons from the femur bone to access the joint. The scar is often larger than that for Anterior Minimally Invasive Surgery.
The advantage of this surgical approach is that it provides a larger field of surgical view. This makes it useful for revision (“re-do”) surgery where more access is often required in order to remove existing implants and put new ones in, which sometimes cannot be done using the anterior approach. The posterior approach is also the common approach for surgeons who have not been trained in the anterior approach. Posterior hip replacements have a slightly longer recovery time than AMIS, and more initial restrictions on movement, but it is important to note that there is very little evidence of long-term differences between the two approaches.
Most studies demonstrate that although Anterior Approach Hip Replacements recover faster and with less pain than Posterior Approach Hip Replacements on average, by one year postoperatively, there is little if any difference in satisfaction. Both surgical approaches to the hip offer excellent long-term results and most implants last the rest of the patient’s lifetime, regardless of approach.
HIP REPLACEMENT BENEFITS
REDUCTION OF PAIN
With arthritis and other conditions, the cushioning layer of cartilage within the hip joint is worn down, which is one of the causes of pain. Surgery removes and replaces the damaged joint surface with a prosthesis, in many cases allowing pain-free movement. This reduction in pain often lasts for the rest of the patient’s life without further surgery.
RECOVERY OF MOBILITY
With a reduction in pain and an increase in mobility, hip replacement patients are able to return to a relatively normal life, taking part in many pre-arthritic pain activities.
QUALITY OF LIFE
A damaged joint can become stiff, and over time may grow more bone, further restricting movement and preventing actions like tying your shoes and walking long distances. Hip replacement surgery treats the joint and allows you to recover mobility and function.
HIP REPLACEMENT PROCESS
SURGICAL ANAESTHESIA
SURGERY
POST SURGERY
SURGICAL ANAESTHESIA
Anaesthesia for hip replacement surgery usually involves a combination of local anaesthethic, a spinal anaesthetic andor general anaesthetic; and many patients actually have some of each to optimise their pain relief and enhance their post-operative recovery. Consult with your orthopaedic surgeon and their anaesthetist to determine the most appropriate anaesthetic for you.
SURGERY
To begin, your surgeon will make an incision over the hip. The surgeon then removes the damaged bone and cartilage from the hip joint, including the socket and the ball of the femur. A metal stem is placed into the hollow of the femur, onto which a ball is fixed. This element of the prosthesis is the ball which fits with the socket.
The socket is replaced with a cup, which integrates with your natural bone over time. A liner is then added to the cup to provide a smooth surface for the ball to rotate inside.
POST SURGERY
The time spent in hospital following hip replacement surgery varies according to your health, personal needs and circumstances as a patient. To go home, we need to ensure your pain is well controlled, and you are able to safely get around your own home with the use of crutches or another gait aid to assist you as required. The majority of patients spend 2 or 3 days in hospital, but some people are keen and suitable to go home on the day of surgery and some patients can stay for 4 days or more.
It is becoming less and less common for patients to need inpatient rehabilitation after a total hip replacement because various advances in recent years have ensured most patients are able to recover faster with less pain from their surgery and are hence able to safely return directly to their own home. Some patients still require inpatient rehabilitation and this is usually determined based on how the individual progresses with physiotherapy after surgery- we can’t always predict it beforehand.
RECOVERY TIMELINE
DAY OF SURGERY
After your anaesthaetic has worn off, you should be able to place full weight on your hip, with crutches or a frame to aid you and a physiotherapist assisting you. It is preferable that if your operation is done earlier in the day, you stand up on the same day as surgery to get used to being upright again. Sometimes you will even be able to go for a short walk
Nov 09, 20171 DAY AFTER SURGERY
We will try to get you walking, sometimes with a frame, sometimes with only crutches as an aid. Some patients will go home on day one if they are safe and comfortable.
Nov 09, 20172-5 DAYS
When you are comfortable and once you are able to walk independently and climb stairs, that’s generally when you are safe to head home. Everybody is a little different and this timeframe is tailored to you as an individual.
Nov 09, 20172-3 WEEKS
After 2-3 weeks, your wound will be checked (usually by a specialist wound nurse). Your surgeon will probably use dissolving suture and glue so no suture removal is likely to be required. After your wound review you should arrange to see your physiotherapist to begin post-operative exercises. We recommend against seeing your physio before the wound review to allow the wound to settle first.
Nov 09, 2017BETWEEN 2-6 WEEKS
By two weeks you are probably down to using a single crutch in the opposite hand to your hip replacement. You will use this for longer walks and balance but can actually often get short distances around home without a gait aid. A lot of people do not require any assistance at all. You will gradually disband this remaining crutch over the next few weeks depending on your stability.
Nov 09, 2017AFTER 6 WEEKS
From 6 weeks post-surgery, you should be able to return to normal activities as. Some patients may be able to drive earlier, notably following a left hip replacement if you have an automatic car.
Nov 09, 2017SURGICAL RISKS
Every surgery carries risk. Whilst the probability of these risks has been shown to be lower in the hands of experienced specialist hip surgeons they are nevertheless a possibility.
Your physician and surgeon will discuss these with you and inform you of the most common risks prior to the operation, to allow you to make a well informed decision. Your surgeon will always put your health first, and will consult with you on any potential risks. Before surgery, your physician and surgeon will assess any risks involved with your current medications, medical history, and will require your skin to be healthy without any cuts or scrapes over the surgical site or on the same limb as the operation to be performed.
Some risks present themselves only after surgery, such as infection and DVT. Ongoing medical check-ups with your physician will help identify and prevent any complications.
Common risks and side effects associated with total hip replacement surgery include:
- Infection
- Dislocation of the hip prosthesis
- Leg length inequality
- Fracture of the pelvis or femur
- Wear and loosening of the implants
- Audible ‘squeaking’ of the articulating ceramic components
- Blood vessel injury or bleeding from bone, sometimes requiring transfusion
- Nerve injury
RECOVERY AND EXERCISE
Most patients feel better than they were preoperatively within a few weeks of surgery. You should be able to do most normal activities after 6 weeks, if not before. Please note that time frames differ for each patient.
Physiotherapy is important to your recovery but you should avoid strenuous physio exercises for the first 2-4 weeks and stick mainly to gentle walking to allow the wound to settle first. You can then progress to more strenuous physiotherapy exercises to build your strength.
If you have further questions or to find out about how a total hip replacement can benefit you, please get in touch today.
FAQS
How long does a hip replacement last?
Advances in surgical techniques and prosthetics mean that you can expect hip replacement surgery to last for much longer today than previously. Australian data shows that almost 90% of hip replacements last for 20 years or more. The majority of patients therefore only need their hip replacement done once.
How long does a hip replacement take?
From being admitted to hospital to returning to the ward, the entire process of hip replacement surgery will take several hours. This includes preparation for surgery and recovering (waking up) afterwards. The surgery itself usually takes approximately one hour when performed by an experienced surgeon but is dependent on how complex your anatomy is.
How long does it take to recover from hip replacement?
While every individual is different, and recovery can be affected by many factors, you should expect to resume normal life by or before 6 weeks of surgery.
Are hip replacements covered by my health insurance?
The majority of the cost of your hip replacement will be covered by your health insurance. Sunshine Coast Orthopaedic Group will advise you of any remaining likely out-of-pocket costs for after your consultation. These vary based on your fund and type of cover, but will be itemised for you in detail after your pre-operative consultation.
What if I don’t have health insurance?
Sunshine Coast Orthopaedic Group are very experienced at treating patients seeking to “self-fund” their hip replacement. Broadly speaking, rough total costs are generally around $25,000 but can be lower for patients who are safely able to have their hip replacement on a “short-stay” basis (either as day surgery or one night admission only). One of the main costs in a hip replacement is the cost of the hospital stay and the total cost can therefore be lowered by shortening your hospital stay where it is safe to do so. Sunshine Coast Orthopaedic Group will never agree to lower the cost of your operation by using substandard implants or compromising on safety.
How long after hip replacement can I tie my shoes/cross my legs/bend forward to pick something up off the floor?
If you have had a Direct Anterior Approach (AMIS) Hip Replacement, you can do all these movements straight away.
After a posterior approach hip replacement, it is generally necessary to avoid bending your hip past 90 degrees/crossing your legs for the first 6 weeks in order to reduce your risk of dislocation. This means you may need a special toilet seat and a grasping device to pick up objects from the floor.
Can you overdo exercise after hip replacement?
For the first few weeks after your operation we recommend gentle walking only in order to allow the wound the opportunity to heal.
After this period, you can resume most normal activities.
How do I know if my hip replacement is failing?
If you had your hip replacement many years ago, may experience some wear in your hip replacement. This is because the materials used in those days often didn’t last as long as the materials now used. The time frame for this is generally years, but this may include a ‘loosening’ of the joint accompanied by pain. Occasionally, dislocation can occur. If you have these symptoms, we recommend consulting your orthopaedic surgeon.
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- Phone: 07 5493 8038
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Sunshine Coast University Private Hospital
Suite 12, 3 Doherty Street, Birtinya, QLD, 4575
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