Total Hip Replacement
Total hip replacement is an operation where the damaged parts of the hip (usually from osteoarthritis) are removed and replaced with metal and plastic components. It is a major operation but can be life changing by improving pain and function and allowing you to do normal activities without limitations.
Hip replacement surgery is one of the most successful operations in orthopaedics and most patients have an excellent result, although it is a major operation and comes with the risks and recovery associated with that.
When do you need a hip replacement?
There is no right answer to the question of when is the right time to have a hip replacement. Hip replacement surgery is considered when the pain and limitations of hip arthritis interfere with your daily activities, or disturb your sleep, and when non operative measures such as physiotherapy, anti-inflammatory medications and activity modification don’t work anymore.
Pain and debility from hip arthritis can progress rapidly in some patients, and if the arthritis is severe enough non operative treatments become increasingly ineffective. Thankfully hip replacement surgery is one of the most successful and reliable operations we perform and the results can be life changing for many patients.
The technical aspects
After your anaesthetic, often a spinal anaesthetic (needle in your back to numb your legs), Dr Brooker prepares your hip and leg with a sterile wash and makes a cut on the side of your hip. Dr Brooker uses a piriformis sparing posterior approach, which requires less muscle dissection and soft tissue damage to access the hip joint.
The hip joint is dislocated and the damaged bone from the femoral head and acetabulum (ball and socket) is removed. Dr Brooker then inserts metal and plastic components into your bones to replace the damaged areas, based on a pre operative plan from your x-rays and also the intraoperative state of your hip. The components are generally uncemented with special coatings that allow your body to grow normal bone into the prosthesis and incorporate it into your bones.
After the prosthesis is implanted and the hip is enlocated the wounds are closed with dissolvable sutures and dressings are applied to the skin. You are then moved to the recovery area of the operating theatre before returning to the ward.
Recovery expectations
The recovery from a total hip replacement is different for each patient, but generally not too painful. The first six weeks are your major recovery period and often involve:
- Walking with a walker or crutches begins the day after surgery
- The first night or two can be quite painful but after that pain is generally manageable
- Physiotherapy focuses on practical aspects such as getting out of bed comfortably
- Driving is restricted for at least six weeks
- Dr Brooker does not enforce movement restrictions after hip replacement surgery
- Discomfort for 6 – 10 weeks is expected but usually limited
- Difficulty lying on the operated side is common for 3 months
- Return to normal activities typically occurs within three to six months.
Realistic outcomes
A hip replacement can be a life changing operation for many patients. You should expect to have significant pain relief and most patients would have a pain free hip after recovery. A total hip replacement can feel and function like a normal hip to the point where you may forget which hip you had surgery on.
It is common to be comfortable doing most activities after a total hip replacement, however Dr Brooker recommends avoiding high impact activities, such as running, as it will accelerate wear and may lead to early revision surgery. Activities which are high risk for femoral fracture, such as sky diving and water skiing, are also best avoided.
Modern hip replacement implants typically last 15-20 years or more. Younger, more active patients have a higher probability of requiring revision surgery in the future as they tend to put more pressure through the prosthesis (leading to more wear), but younger patients can still have an excellent result functionally. This is considered when determining surgical timing.
Making the decision
The decision to proceed with hip replacement surgery requires careful consideration. Dr Brooker will provide comprehensive information regarding the likely outcomes and recovery process to assist with decision-making. Dr Brooker recommends talking to people you know who have had hip replacements to get an idea of the likely recovery (remembering that every patient is different) and the long term results. If hip pain significantly limits function despite conservative treatments, consultation regarding possible hip replacement surgery is appropriate.
Before your hip replacement:
Exercises prior to hip replacement surgery may be difficult. By the time your hip pain is causing significant discomfort, the associated stiffness can reduce the effectiveness of physiotherapy or exercises and simply result in pain. Dr Brooker recommends assessing the benefit of pre operative exercises and particularly the amount of pain and inflammation they cause to determine if they are helpful. No impact exercises such as walking in the swimming pool or stationary cycling may be helpful.
Prior to having a hip replacement, maximising your general health is important because it will increase your chance of having a good result. We know from scientific studies that being significantly overweight, having poorly controlled diabetes and cigarette smoking are risk factors for post operative infection after hip replacement surgery. Talk to your local doctor prior to considering joint replacement surgery to make sure your health is maximised with weight loss, tight diabetic control and cessation of cigarette smoking if required.
