Total Hip Replacement surgery
Total Hip Replacement may be considered as a surgical treatment option for those patients experiencing severe pain and stiffness of their hip that is significantly limiting their ability to perform activities of daily living, such as walking and climbing stairs, or other leisure pursuits you enjoy but now can’t do, for example, walking for exercise, cycling, golf, doubles tennis. The aim of a total hip replacement is to minimise hip pain, restore function, increase independence and participation in activities of daily living and leisure pursuits.
Most commonly total hip replacement surgery is performed on patients who have degenerative joint disease such as osteoarthritis of the hip joint. A total hip replacement may also be performed for patients who have chronic pain and reduced function of the hip joint due to other conditions such as rheumatoid arthritis, osteonecrosis, injury, fractures and bone tumours. To learn more about hip osteoarthritis please click on this link under Conditions.
A total hip replacement procedure involves the removal of your painful hip joint, which is replaced with an artificial joint called a ‘prosthesis’. Your hip is an articulating ‘ball and socket’ type joint. The ‘ball’ is the head of your femur that articulates with the ‘socket’, which is a cup-like depression (acetabulum) of your pelvis. During the surgery the head of the femur is removed and replaced with a prosthetic ball (metal or ceramic) that sits on a metal stem. The stem is inserted into the inner canal of the femur to anchor in the bone. The prosthetic socket used is either a cemented or cementless plastic or titanium socket that is used in conjunction with a plastic or ceramic liner. The prosthetic socket is implanted into the worn acetabulum of the pelvis.
Making the decision to proceed to a total hip replacement is a collaborative one between the patient, general practitioner and orthopaedic surgeon. The patient is able to make an informed choice to proceed following a thorough discussion of the benefits of surgery and the risks of surgery.
Frequently Asked Questions
The aim of total hip replacement surgery is to minimise hip pain, restore function and improve quality of life to allow you to do the activities that are important to you and that you enjoy doing. Most patients experience a remarkable decrease in their hip pain following surgery. This allows them to perform tasks that may have been difficult such as putting shoes and socks on, going for a long walk, hiking, and lawn bowling. It is expected that surgical improvements will continue for up to a year after surgery.
- Intraoperative fracture is a rare occurrence. (<1%)
- Nerve Injury is a rare occurrence. (<1/1000)
- Vascular Injury is a rare occurrence (<1/1000)
- Deep Vein Thrombosis and Pulmonary Embolism
- Dislocation – 1%
- Leg Length Difference- 1%
- Infection is the most serious complication, and occurs approximately 1% of the time, despite a number of ways used routinely to minimize infection (antibiotics for a period before and after surgery, sterile skin preparation before surgery and meticulous wound care after surgery).
If a deep infection is confirmed, this is treated by further surgery and prolonged antibiotics. - Late Complications such as wear of the components and loosening of the implants tend to occur many years (usually >10) after the surgery.
Yes, before your total hip replacement surgery you will be provided with an appointment time to attend a Pre-Admission Clinic at the hospital you are having your operation in. You will be contacted by the hospital and provided with an appointment time, which is usually at least four weeks prior to your scheduled surgery. During this appointment you will be reviewed by a multi-disciplinary team and may have a review x-ray of your hip, an x-ray of your chest and a blood test.
There are a number of steps that you can take to prepare for your total hip replacement to ensure the best possible outcome. These are:
- Continue with regular exercise including strengthening and stretching activities such as walking, swimming and cycling.
- Ensure that your skin remains free from any cuts, scratches, boils or abrasions to limit risk of a skin infection.
- Cease smoking at least two weeks prior to surgery to minimise risk of Deep Venous Thrombosis.
- Maintain your weight and if discussed with your surgeon lose weight prior to surgery.
- Cease medications such as ASPIRIN, WARFARIN or Fish oil at least ten days prior to your surgery. If required Dr Prodger will liaise with your Cardiologist regarding your blood thinning medication.
On return to the ward after surgery, the nursing staff will ensure your pain is well managed. Most individuals who have a total hip replacement will get out of bed, stand and walk the same day, or the next morning. A physiotherapist will aid in walking and instruct on exercises to start your rehabilitation. An intravenous cannula (“drip”) will still be in your arm to administer antibiotics for the first 24 hours.
Pain management is crucial to a successful recovery and a variety of techniques are used that will be discussed with you by both Dr Prodger and the Anaesthetist before your surgery.
Most patients are in hospital for 3-4 days following surgery, however once your pain is managed and you have reached all the goals the physiotherapist has set (getting in and out of bed, getting to the bathroom, climbing stairs etc.) you will be safe to go home. For some people this is as early as the next day, for others they may need extra time in a Rehabilitation Ward. This decision depends a lot on your general medical health and social support. It is usual for patients to be discharged home with a walking aid such as crutches or a wheelie walker.
You will be discharged home with subcutaneous (“dissolving”) sutures from the surgical wound. It is important to keep your wound clean and dry following discharge home. The wound will be reviewed 10 – 14 days after your surgery at your follow up appointment with Dr Prodger. It is recommended that you wear compression stockings for four weeks after your surgery.
It is important to adhere to the following hip precautions for the first six weeks after your total hip replacement to prevent dislocation of your hip joint. These are:
- Do not bend your hip forward past 90 degrees (‘L shape’) when lying, sitting or standing.
- Do not cross your legs at the knee or ankle when lying down, sitting or standing.
- Do not twist your hip joint in or out
In practice you can follow the guidelines below when performing your activities of daily living. If you are unsure of how these guidelines may apply to your home environment please consult an Occupational Therapist who can assist in equipment prescription and education regarding activities of daily living in the home environment.
Lying Down
- Ensure that your bed height is higher than your knee, preferably approximately 5cm above your knee crease.
- When lying down or sleeping, lie on your back with a pillow between your knees to avoid your knees from touching
- Do not lie on your affected side
- If lying on your unaffected side place a pillow between your knees
- Lie on the same side of the bed as your affected leg to allow for easier transfers out of bed.
Sitting
- To avoid bending your hip past 90 degrees it is important to sit on a high chair. As a guide the height of the chair should be 5cm higher than your knee crease.
- Sit on a firm chair with a backrest and armrests.
- Do not sit on low chairs, sofas, soft chairs, rocking chairs or stools.
Transfers
- When transferring out of bed, shift your bottom across to the side of the bed.
- Lead with your affected leg when swinging your legs out of bed, avoiding bending past 90 degrees at the hip joint.
- When transferring out of a chair, shift your bottom to the edge of the chair and lead with your affected leg when pushing into an upright position.
Showering / Bathing
- If you have a shower recess it is recommended that you sit on a shower chair or shower stool with arms for safety. Ensure that the chair is 5cm above the height of the back of your knee.
- If you have a shower over the bath use a raised bath transfer bench. Ensure the height is above your knee height.
- Do not bend forward to adjust the control of the taps when sitting.
- Do not bend forward to wash your lower legs – use a long handle sponge.
Toileting
- Use a raised over toilet frame when sitting on the toilet, ensuring the height is above your knee height.
- Avoid twisting of your leg when attending to personal hygiene.
Dressing
- Sit down when getting dressed. Use long handle aids such as shoe horn, sock aid and dressing stick.
- Do not bend forward to reach your feet when putting on shoes and socks. Instead wear slip on shoes, or use a long handle shoe horn and sock aid.
- Do not bend forward to put on long pants, or raise your affected leg to put your foot into long pants. Instead use a long handle dressing stick. Put long pants on your affected leg first.
Household chores
- Do not bend forward to pick something off the floor. Instead use a long handle reacher.
It is recommended that patients do not drive a manual or automatic car for a minimum of six weeks after a total hip replacement. This is irrespective of the side of the surgery. After this time the patient can decide to return to driving when they feel confident and safe when in control of their vehicle.
For the first two months you will be encouraged to perform gentle exercise regularly, such as walking, swimming, hydrotherapy or use of an exercise bike. Following this and when you feel ready you will be able to gradually return to the leisure activities you enjoy such as hiking, golf and bowls.
High impact activities such as running, manual labour, heavy lifting and high intensity sports should be avoided – Dr Prodger can advise about particular activities that are relevant to you.
A hip replacement may become infected at any stage post operatively from day one post surgery to a number of years after surgery. To minimise the risk of an infection you can take the following steps:
Take antibiotics prior to any dental work or medical procedure (as discussed with Dr Prodger or your dentist)
Ensure that you are reviewed by a general practitioner if you have a suspected urinary tract infection
Contact your doctor if you have any signs of an infection such as warmth, redness or swelling around the joint and fever.
