Total Hip Replacement

Arthritis is a general term covering numerous conditions where the joint surface (cartilage) wears out. The joint is covered by a smooth articular surface that allows pain free movement in the joint. This surface can wear out for a number of reasons; often the definite cause is not known. When the articular cartilage wears out, the bone ends rub on one another and cause pain. There are numerous conditions that can cause arthritis and often the exact cause is never known. In general, but not always, it affects people as they get older (osteoarthritis).

Other causes include

• Childhood disorders such as dislocated hip, Perthes’ disease and slipped epiphysis
• Growth abnormalities of the hip, such as a shallow socket, may lead to premature arthritis
• Trauma (fracture)
• Increased stress caused by intensity training or overuse
• Avascular necrosis (loss of blood supply)
• Infection
• Connective tissue disorders
• Inactive lifestyle and obesity, as additional weight puts extra force through your joints which can lead to arthritis over a period of time and result in the requirement of hip replacement surgery
• Inflammation

In an Arthritic Hip

• The cartilage lining is either thinner than normal or completely absent
• The degree of cartilage damage and inflammation varies with the type and stage of arthritis
• The capsule of the arthritic hip is swollen
• The joint space is narrowed and irregular in outline; this can be seen in an X-ray image
• Bone spurs or excessive bone can also build up around the edges of the joint
• The combinations of these factors make the arthritic hip stiff and limit activities due to pain and fatigue

Diagnosis

The accurate diagnosis of osteoarthritis is made with a comprehensive physical examination, patient history and the support of X-ray and MRI imagery. Hip replacement recommendations will be made once your surgeon has a clear idea of your specific problem area.

THR is indicated for arthritis of the hip that has failed to respond to conservative (non-operative) treatments. You should consider a THR when you have:

• Arthritis confirmed by X-ray
• Pain not responding to analgesics or anti-inflammatories
• Limitations of activities of daily living including your leisure activities, sport or work
• Pain keeping you awake at night
• Stiffness in the hip, reducing flexibility and making mobility difficult

Prior to hip replacement surgery you will usually have tried treatments such as simple analgesics, weight loss, anti-inflammatory medications, modification of your activities, walking sticks and physiotherapy.

The decision to proceed with total hip replacement surgery is a cooperative one between you, your surgeon, family and your local Doctor. Benefits of surgery include:

• Reduced hip pain
• Increased mobility and movement
• Correction of deformity
• Equalization of leg length (not guaranteed)
• Increased leg strength
• Improved quality of life, ability to return to normal activities
• Enables you to sleep without pain

• Your surgeon will send you for routine blood tests and any other investigations required
• You will be asked to undertake a general medical check-up with a physician
• You should have any other medical, surgical or dental problems attended to before total hip replacement surgery
• Make arrangements around the house
• Cease aspirin , anti-inflammatory and any naturopathic or herbal medications 10 days prior to surgery as they can cause bleeding
• Stop smoking for as long as possible prior to treatment

• You will be admitted to hospital
• Further tests may be required on admission
• You will meet the nurses and answer questions for the hospital records
• You anaesthetist will talk you through the procedure
• You will be able to shower and be given hospitalclothes to change into
• The operation site will be shaved and cleaned
• Approximately 30 mins prior to surgery, you will be transferred to the operating theatre

An incision is made over the hip to expose the hip joint. The acetabulum (socket) is prepared using a special instrument called a reamer. The acetabular component is then inserted into the socket. This is sometimes reinforced with screws or occasionally cemented. A liner – which can be made of plastic, metal or ceramic material – is then placed inside the acetabular component.

The femur (thigh bone) is then prepared. The arthritic femoral head is cut off and the bone prepared using special instruments. This will precisely fit the new metal femoral component. The femoral component is then inserted into the femur. This may be press-fit, relying on bone to grow into it or cemented depending on a number of factors such as patient bone quality and the surgeon’s preference.

The real femoral head component is then placed on the femoral stem. This can be made of metal or ceramic. The hip is then reduced again, for the last time. The muscles and soft tissues are then closed carefully, completing the hip replacement procedure.

You will wake up in the recovery room with a number of monitors to record your vitals and will have a dressing on your hip and drains coming out of your wound. Post-operative X-rays will be performed in recovery to monitor the success of your hip replacement surgery. Once you are stable and awake you will be taken back to the ward, where you will have one or two drips in your arm for fluid and pain relief. This entire process will be explained to you by your anaesthetist.

Your drains will usually be removed one day after surgery and you will be allowed to sit out of bed or walk depending on your condition and your surgeon’s preference. Discomfort is normal but if you are experiencing a great deal of pain you should inform your nurse.

You will be able to put all your weight on your hip and your physiotherapist will help you with the post-op hip replacement exercises. You will be discharged to either go home or to a rehabilitation hospital approximately 5-7 days after total hip replacement surgery depending on your pain and help at home.

A post-operative visit will be arranged prior to your discharge. You will be advised about how to walk with crutches for two weeks following surgery and then using walking aids for another four to six weeks.

Remember this is an artificial hip and must be treated with care.

AVOID THE COMBINED MOVEMENT OF BENDING YOUR HIP AND TURNING YOUR FOOT IN. This can cause DISLOCATION. Other precautions to avoid dislocation are:

• You should sleep with a pillow between your legs for 6 weeks. Avoid crossing your legs and bending your hip past a right angle
• Avoid low chairs
• Avoid bending over to pick things up. Grabbers are helpful as are shoe horns or slip on shoes
• An elevated toilet seat can be helpful
• You can shower once the wound has healed
• You can apply Vitamin E or moisturizing cream into the wound once the wound has healed
• If you have increasing redness or swelling or temperatures over 100.5° you should call your Doctor immediately
• If you are having any procedures such as dental work or any other surgery you should take antibiotics before and after to prevent infection in your new prosthesis. Consult your surgeon for details
• Your hip replacement may go off in a metal detector at the airport

As with any major operation, total hip replacement surgery carries potential risks. The decision to proceed with the surgery is made because the advantages outweigh the disadvantages.

It is important that you are informed of these risks before the surgery takes place.

Complications can be medical (general) or specific to the hip

Medical Complications include those of the anaesthetic and your general well being. Almost any medical condition can occur so this list is not complete.

Complications include:

• Allergic reactions to medications
• Blood loss requiring transfusion with its low risk of disease transmission
• Heart attacks, strokes, kidney failure, pneumonia, bladder infections
• Complications from nerve blocks such as infection or nerve damage
• Serious medical problems can lead to ongoing health concerns, prolonged hospitalisation, and even death

Specific hip replacement surgery complications include

Infection

Infection can occur with any operation. In the hip this can be superficial or deep. Infection rates are approximately 1%; if it occurs it can be treated with antibiotics but may require further surgery. Very rarely your hip may need to be removed to eradicate infection.

Dislocation

This means the hip comes out of its socket. Precautions need to be taken with your new hip forever. If a dislocation occurs it needs to be put back into place with an anaesthetic. This rarely becomes a recurrent problem needing further surgery.

Blood clots (Deep Vein Thrombosis)

These can form in the calf muscles and travel to the lung (pulmonary embolism). These can occasionally be serious and even life threatening. If you experience calf pain or shortness of breath at any stage, you should notify your surgeon.

Damage to nerves or blood vessels

This is also rare but can lead to weakness and loss of sensation in part of the leg. Damage to blood vessels may require further surgery if bleeding is ongoing.

Wound irritation

Your scar can be sensitive or have a surrounding area of numbness. This normally decreases over time and does not lead to any problems with your new joint.

Leg length inequality

It is very difficult to make the leg exactly the same length as the other one. Occasionally the leg is deliberately lengthened to make the hip stable during hip replacement surgery. There are some occasions when it is simply not possible to match the leg lengths. All leg length inequalities can be treated simply with a platform shoe on the shorter side.

Wear

All joints eventually wear out. The more active you are, the quicker this will occur. In general 80-90% of hip replacements have proven to last for roughly 15-20 years.

Failure to relieve pain

It is very rare for total hip replacement surgery to fail in relieving pain but may occur especially if some pain is coming from other areas such as the spine.

Unsightly or thickened scar

This is an unavoidable side effect of hip replacement treatment.

Limp due to muscle weakness

This should improve over time, but if the condition deteriorates you should contact your surgeon.

Fractures (break) of the femur (thigh bone) or pelvis (hipbone)

This is also rare but can occur during or after surgery. This may prolong your recovery, or require further hip replacement surgery. Discuss your concerns thoroughly with your orthopaedic surgeon prior to treatment.

We understand that total hip replacement surgery is not a pleasant prospect for anyone, but for some people with arthritis, it could mean the difference between leading a normal life or putting up with a painful, debilitating condition. Oz Orthopaedics treatment for hip replacement surgery in Melbourne is the best way to help restore function to your damaged joints as well as relieve pain.