AIM OF THE TOTAL HIP REPLACEMENT

The principle aims of the hip replacement are to reduce your pain, correct any deformity, enhance your mobility that is impeded by your hip and improve the quality of your life. This can be achieved in up to 95% of cases. The hip replacement involves replacing a hip joint that has been damaged or worn away, usually by arthritis or injury.

WHAT IS ARTHRITIS?

Osteoarthritis is characterised by joint pain and mobility impairment associated with the gradual wearing of cartilage. The wear and tear of the joint frequently results in pain, stiffness and reduced movement. The clinical diagnosis is usually based on the presence of joint symptoms and evidence of a reduction of joint space seen on the x-ray. There are different types of arthritis causing joint pain for example osteoarthritis, rheumatoid arthritis and post traumatic arthritis.

HOW COMMON IS ARTHRITIS?

Osteoarthritis is the most common form of chronic arthritis. The condition affects approximately 1.4 million Australians, or approximately 7.3% of the population. The prevalence of osteoarthritis increases with age. Osteoarthritis most commonly develops between the ages of 45 to 90 years. The pain and disability associated with osteoarthritis affects approximately 10% of men and 18% of women over 60 years of age. The incidence and prevalence of osteoarthritis will continue to rise as the population ages. The hip is the second most commonly affected joint in the body.

THE HIP JOINT

The hip joint is a ball and socket joint. The hip joint allows movement to occur between the thigh bone (femur) and the hip bone (pelvis). The pelvis contains the socket (acetabulum) and the ball shaped head of the femur fits into the acetabulum.

The outer surface of the femoral head and the inside surface of the acetabulum are covered with cartilage which allows low friction free movement between the two surfaces. The hip joint is covered by ligaments that help stabilise the joint. The hip joint movements are initiated and controlled by the muscles in the buttock, groin and thigh.

Dr Singh will discuss the best way to implant your hip replacement based on your individual circumstances. Dr Singh can implant your hip replacement with through the front of your hip using the minimally invasive muscle sparing anterior approach or through the mini-posterior approach. Usually both techniques work very well with excellent outcomes.

During your surgery Dr Parminder Singh will replace your hip joint with the artificial hip replacement. Dr Singh will insert a pain catheter into your hip joint which will help reduce your post-operative pain and potential reduce your morphine requirements. This should make you feel less nausea following your surgery and potentially allow you the opportunity to mobilise sooner after your hip replacement. Your wound will be covered with a waterproof dressing.

YOUR POST-OPERATIVE RECOVERY

The pain pump will be removed 24 hours after your surgery. Generally the physiotherapy will assist with your mobilisation on the same day or the following day after your surgery. Dr Singh and the peri-operative physician will see you after the surgery and coordinate a safe and smooth recovery. Check blood test will be undertaken the following day, 2 post-operative doses of antibiotics will be administered 8 and 16 hours after your surgery. A routine post-operative x-ray will be requested for Dr Singh to review he is satisfied with the position of the hip replacement components. Patients tend to either go home directly or to a rehabilitation service depending on your individual personal circumstances. On average, patients will go home after 3-5 days after their surgery. No one will be sent home until the patient feels safe and confident to mobilise safely. You will be advised by the physiotherapist to avoid crossing your legs or twisting your hip inwards and outwards particular during the first 6 weeks. Most patients will develop swelling and bruising around the thigh and operative site, by using an intermittent ice pack can help assist sooth the operative site and reduce swelling.

Most of the time complications do not occur. However, every operation has risks. These can be related to the anaesthetic itself or to the surgery. Anaesthetic complications are rare and include unexpected reaction to the anaesthetic. During the surgery there is a risk of excessive bleeding or injury to a nerve or major blood vessel. There is also a risk of developing a blood clot following total hip replacement surgery.

When you return home, you will experience some initial temporary restricted mobility that will eventually recover. Some modifications you might consider to your home to make the early transition easier and safer include:

WALKWAYS
Remove loose rugs to avoid tripping. If the rugs cannot be removed consider the application of a non-skid backing.

TOILETS
You will need to toilet seat raise for the first six week to reduce the risk of your hip dislocating after your surgery.

STAIRS
You may find it easier for the first six weeks to move your bed downstairs onto the ground floor particular if you find it difficult to ascend and descend stairs.

Dr Parminder Singh’s secretary will organise a post-operative wound review approximately 10-14 days following your surgery. Dr Singh will inspect your wound during this appointment and remove stiches or staples. This will be an opportunity for you to ask any further questions. A further appointment will be organised for you at approximately 6-8 weeks later to assess your progress. Generally, you are likely to be walking with either one or no sticks at this stage and safe to return to work and driving.

You hip replacement will continue to heal over the course of the next 12 -18 months and Dr Singh will organise to see you at 6 months and 12 months after your surgery. At these appointments, Dr Singh will organise x-rays to assess how the bony is attaching to the components inserted into your hip.

PHYSIOTHERAPY FOLLOWING YOUR TOTAL HIP REPLACEMENT GUIDELINES

Dr Parminder Singh recommends working closely with an experienced physiotherapist will facilitate your rehabilitations and improve your confidence and strength back in your hip. Patients will vary how much time they will spend in hospital and the speed at which they achieve their milestones in the recovery pathway for a total hip replacement. Dr Parminder Singh however, generally recommends early mobilisation to help reduce complications of sitting in bed.

The following precautions are important to reduce the risk of dislocation. They should be followed particularly during the first 6 weeks after your hip replacement.