Arthritis is the most common reason for hip replacement surgery. However any activity or condition causing the gradual wearing of the labrum in the hip can create a need for a hip replacement.
These causes include:
- Repetitive jumping or running.
- Previous hip trauma that affects the stability of the joint.
- Hip dysplasia.
A hip replacement involves the removal of the hip joint and the insertion of an artificial (prosthetic) device, generally made of metal and/or plastic.
A replaced hip can last for as long as twenty years. Hip replacement surgery usually alleviates pain, reduces inflammation, and improves the range of motion of the hip.
By restoring relatively normal function, hip replacement surgery dramatically improves quality of life.
Total Hip Replacement – Anterior Approach
When the surgeon replaces the hip by approaching through the front of the joint, it’s called the direct anterior approach. Total recovery takes at least 12 months, however most patients can walk without a stick by 4-6 weeks.
It has been well promoted that anterior hip replacement surgery can lead to quicker recovery, but this is not the case in all patients. The risk of some complications that can seriously slow recovery time may be higher in the anterior approach. Like with most new surgical procedures, selecting the right operation for each patient is paramount, and a well-selected anterior hip replacement can offer significant benefits.
Total hip replacement surgery is rarely an emergency, and optimal results are achieved with proper preparation, known as prehabilitation. It is vital that you work with your physiotherapist or exercise physiologist to maximise your range of motion and hip strength to be prepared for the rehab and recovery. Our prehabilitation programs, devised by our rehabilitation physician to suit your particular needs, can help with this.
We recommend 4-6 weeks of prehabilitation to ensure that you get the best outcome. At Precision Integrated Orthopaedics, we place great emphasis on prehabilitation involving physical preconditioning (coordinated by our rehabilitation physician, in conjunction with your physiotherapist and/or exercise physiologist), psychologically preparation (with our psychologists, where necessary), and safe management of your medications and pain (with the help of our pain specialists) to get you into the optimal shape for surgery.
Pre-operative tests may include a CT scan and functional x-rays as Dr Shah uses patient specific technology for joint replacement surgery, routine blood tests, and swabs for MRSA (“golden staph”). If there are any specific concerns or medical issues, we will ensure that they are managed prior to the surgery, and to do this we will also organise for you to be seen by our Cardiologist to ensure there are no issues with your heart during the anaesthetic, and bariatric surgeon to ensure optimal weight. Other physicians may also be engaged eg. for your diabetes or lung conditions
If you are a smoker, you should refrain from smoking for as long as possible prior to and after surgery to ensure the best outcome.
Take caution to ensure that your hip remains free from scratches or grazes in the weeks before surgery, so avoid gardening during that period. If you do sustain trauma to the skin around the hip, or an obvious infection, please notify your surgeon immediately, as surgery may need to be delayed to reduce the risk of a post-operative infection
You will arrive at the hospital 1-2 hours before your surgery, and will have fasted prior to that according to our instructions.
The most common anaesthetic for hip replacement surgery is a spinal block with a general anaesthetic. A urinary catheter is placed before the operation but this will be removed in recovery in most cases.
Your waterproof dressing should be left intact until you have your wound check at around 2 weeks. A small amount of ooze is common over the first 24-48 hours. You can shower with the dressing, however avoid soaking in the bath or pool. If the dressing becomes loose or gets soaked, please replace it. We do not advise hydrotherapy within the first 3 weeks of joint replacement surgery, preferring to wait until the wound is healed.
It is usually safe for patients to go home on the same day of surgery but some stay overnight in hospital.
A walking aide such as a frame or crutches, will be arranged for you to use in the early post-operative period. During the first 2 weeks following surgery, you will need to take the painkillers so that you can do the exercises needed to regain flexibility back into the knee and strengthen your muscles.
A few patients require inpatient rehabilitation services, but most can be rehabilitated post-operatively with a customised post-operative rehabilitation program designed by our rehabilitation physician, in conjunction with your physiotherapist and exercise physiologist.
Your first post-operative visit will be with your orthopaedic surgeon at around 2 weeks. This appointment is critical for checking your wound healing. Further follow up with your surgeon with x-rays at each visit will be undertaken until the full healing has occurred.
At Precision Integrated Orthopaedics, we recommend that you book your first post operative appointment with your physiotherapist as soon as you have a confirmed surgical date. This should be between 2 and 5 days from the surgery. We will have communicate the rehab plan with your treating physiotherapist and/or exercise physiologist, and you will also see our rehabilitation physician pre-and post-operatively. The goals of rehabilitation are to manage swelling and stiffness, and then to concentrate on leg strength and function.
Further follow up with your surgeon with x-rays at some visits to check the prosthesis –
- 6 weeks after surgery + XR
- 12 weeks after surgery
- 6 months after surgery
- 1 year after surgery and annually ongoing + XR
Returning to work and sport depends on your type of work, speed of recovery, and reliance on transport and medications.
After surgery you should avoid bending, twisting, or turning the repaired hip too much for at least a few months, as these movements can dislocated the hip hip. Walk up stairs as little as possible, and minimise sitting on upright chairs if you can. Use of an elevated toilet seat can also protect the operated hip, promoting a faster recovery.
Total Hip Replacement – Posterior approach
When your orthopaedic surgeon approaches the hip through the back of the joint it is called the posterior approach.
Recovery after a Hip Replacement Surgery
Returning to work after a hip replacement
Office jobs can resume as soon as you are comfortable and are no longer taking strong painkillers, although sitting for long periods may be uncomfortable. To return to more physically demanding jobs takes longer, and activities such as climbing ladders and carrying heavy loads are to be avoided for 12 weeks.
Return to sport after hip replacement
Return to sport is a gradual process guided by your recovery, pain levels, and the activity you wish to return to. For example, swimming can restart when your incision has healed, and you are comfortable (usually around 3 weeks). Return to more intensive sports, including golf, is more gradual and may take up to 6 weeks. Do not run on a hip replacement unless approved by your orthopaedic surgeon.
Returning to driving after hip replacement
You should not recommence driving until you can safely perform an “emergency stop” and are no longer using strong painkillers, and no earlier than 6 weeks after a hip replacement.
Risks of Hip Replacement Surgery
Hip replacement is a generally safe procedure, however there are always some risks with joint replacement surgery.
Surgical complications include general risks of:
- Blood clots in the legs and lungs (DVT/PE)
- Wound or joint infection
- Injury to blood vessels
- Nerve injury
- Sciatic nerve damage, which can cause ‘foot drop’ and numbness.
- Femoral nerve damage, which can cause thigh weakness and numbness.
- Damage to the adjacent bones, including fractures.
- Leg length discrepancy, where the operated leg is made longer or shorter. This is generally less than 5-10mm and this is well tolerated by most and may need just a small insole in the shoe to manage.
Specific complications of the anterior approach to the hip:
- The most common risk is bruising or stretching of a nerve that supplies the sensation in the outer part of your upper thigh, which can cause numbness over that region. This usually improves with time, but in some cases is permanent. It does not cause any muscle weakness.
- The femoral nerve can be damaged by the retractors, which can lead to weakness in the quadriceps muscles (which straighten the knee). The risk of this is less than 1%.
Anaesthetic risks include allergic reactions, heart attack, stroke and death.