EVERY PATIENT AND EVERY OPERATION IS UNIQUE AND THEREFORE THIS RAPID RECOVERY HIP REPLACEMENT GUIDE WILL NOT BE ABLE TO ANSWER ALL YOUR QUESTIONS. If you have any questions, simply book a consultation today.
Rapid Recovery Hip ReplacementKunal Shah2021-07-01T23:44:05+10:00
Rapid recovery programmes were first described by a Danish surgeon Henrik Kehlet in 1997 . The aim is to target factors that delay the post operative recovery following your total hip and knee replacement surgery to help an individual recover faster and safely. The rapid recovery programme is evidence based that requires a multimodal approach via a coordinated clinical pathway. A multidisciplinary approach will help achieve the best possible outcome for our patients.
We know that osteoarthritis of the hip can significantly affect the quality of life. Osteoarthritis of the hip occurs less commonly in patients as young as in their 40s and more commonly in the 60 to 70 years old group. Patients with femero-acetabular impingement syndrome and hip dysplasia could get premature arthritis of the hip joint.
Total hip replacement surgery has been shown to provide an excellent quality of life improvement.
Over the last decade rapid recovery programmes have successfully demonstrated benefits to individuals undergoing total hip replacement surgery.
Individuals with arthritis in their hip can enter a rapid recovery joint replacement pathway following discussion with Mr Parminder J Singh at any of his consulting locations in Melbourne, to assess their eligibility. The individual case complexity will determine if you are suitable to enter a rapid recovery programme.
Rapid recovery is a technique that has a number of advantages, such as:
helps reduce the pain after surgery
enables early mobilization
reduces the post-operative medical complications
reduces the length of stay in hospital
improved pace and quality of recovery
Rapid recovery following your hip replacement utilizes a structured approach to reduce the multiple variables associated with each individual.
The rapid recovery programme can be divded into 3 main phases; namely the preoperative, intraoperative and post operative phases.
Pre-operatively – Prior to your hip replacement surgery, Mr Parminder J Singh will arrange for you to see a peri-operative physician. The physican will perfom a detailed medical assessment and help optimse any medical conditions you have prior to your surgery. For example if there is any pre-operative anaemia, this should be improved prior to any surgery to enhance your recovery. Likewise, if you have any diabetes, this will need to be assessed and opimised prior to your surgery to mininise any risk of post operative infection.
With respect to eating prior to your surgery, solid food is allowed 6 hours prior to your surgery. However, a more cautious approach in patients with morbid obesity and or poorly controlled diabetes may require further consideration.
With respect to pre-operative hydration, clear fluids 2 hours prior to your surgery helps reduce dehydration . The selection of pain relief before your surgery 2 hours before combined with following your surgery is important with respect to your mobilization.
Intra-operatively – Parminder J Singh will perform a minimally invasive anterior or mini posterior approach (direct superior approach) to implant the hip replacement.
Injection of local anesthetic into the soft tissue around the hip joint will help reduce the pain and reduce the amount of pain medication immediately after your surgery.
Post operatively – Following your hip replacement surgery, opioid based medications can produce more side effects to your body leading to a slowing of your recovery. In particular, opiods can increase your post operative nausea and delay recovery. Reducing the number of drains such as urinary catheter can also help enhance your recovery. Trying to mobilize 4-6 hours on day 1 wearing your own clothes under the supervision of the physiotherapist is an important step to take on your journey to rapid recovery. A rapid recovery joint replacement programme will help improve the patient experience to a level where individuals feel confident and safe to return home. The rapid recovery programme is not suited for everyone; however, Mr Parminder J Singh will discuss your eligibility on a case-by-case basis. If you are interested in exploring the option of a rapid recovery joint replacement programme, you can schedule a personal consultation with Dr. Singh, at any of his consulting locations in Melbourne.
Generally this varies between patients and whether they went to go home directly or to a rehabilitation centre after their hip replacement. It is important to check your insurance covers your for rehabilitation prior to your surgery. On average patient’s will be asked to walk the same day as their surgery or the following day under the supervision of the physiotherapist. Patients are typically discharged from hospital on average 3-5 days after their surgery. No patient will be discharged from hospital if they are not confident to manage at home. Patients should be given information about telephone numbers or other methods of contacting the hospital or the orthopaedic service, should problems occur.
The time will vary between patients and Mr Parminder Singh will advise you if it is safe to fully weight bear with your crutches or partially weight bear. This varies particularly if bone graft was used during your hip replacements. Generally, however, patients will use crutches for approximately 2-6 weeks after their surgery. Patients tend to progress from a walking frame to two crutches, one crutch and finally independent walking.
During your inpatient stay in hospital, the physiotherapist will go through any particular hip precautions which will vary depending on if you surgery in undertaken using the anterior muscle sparing approach or mini-posterior approach. Generally the extreme range of motion should be avoided initially, sitting on low seats and reaching for objects on the floor to reduce the risk of hip dislocation.
Put the passenger seat as far back as possible. Stand with your back to the car with knees touching the seat. Gently lower yourself down onto the seat with your bottom as far onto the seat as possible, sliding your operated leg out in from of you. Swing your legs round into the car. Getting out of the car is the same procedure in reverse.
Generally, you will require to medication for pain control and reducing the risk of developing clots in your leg. Generally pain control will diminish significantly over the first 2-3 months after your surgery.
Although deep vein thrombosis (DVT) can be demonstrated in 50-60% of patients after primary total hip replacement (THR), it is symptomatic in approximately 2%. The most severe consequence of DVT is fatal pulmonary embolism (PE). Thromboprophylaxis (taking blood thinners) reduces fatal PE by 70% and DVT by 50%.
Prophylactic (preventive) measures are pharmacological and mechanical. Mr Singh recommends a pharmacological agents that has anticoagulant properties to be administered once per day for six weeks. Mr Singh also recommends mechanical measures comprising foot pumps until discharge from hospital and graduated compression stockings for six week.
Yes you will benefit from ongoing physiotherapy following your hip replacement particular during the first 2-3 months after your surgery. Mr Parminder Singh can help you organise this should you need assistance with this. With the less invasive techniques, some patients will require even shorter duration of time with physiotherapy.
Approximately 1-2 % of patients sustain a hip dislocation after total hip replacement. Some sexual positions can increase the likelihood of hip dislocation. In particular during extreme flexion and rotation of the hip. The following article provides some useful information to help guide the patient during sexual activity after their surgery : Sex after hip replacement surgery
During your appointment, Dr Parminder Singh will take a history, examine you and review the relevant radiology. If any further scans are required Dr Singh will request those. Once the diagnosis has been confirmed Dr Singh will discuss the non-surgical option and surgical options of surgery. If no surgery is required Dr Singh may refer you to a physiotherapist for non-surgical management. If surgery is required Dr Singh will consent you for the surgery explained the risk and benefits of the procedure and the expected outcome.
Dr Parminder Singh will see you before the surgery in the waiting bay and ensure all your questions have been answered prior to surgery.
Dr Parminder Singh will examine your hip, thigh and leg making sure there are no open wounds or signs of skin infection.
If there are any signs of infection, you surgery will be cancelled and rescheduled for another day. Once this has been check Dr Parminder Singh will draw an arrow on the side of your thigh confirming with you the side of surgery. Dr Parminder Singh will check your consent form to again confirm the operation being performed and side of surgery.
Following your surgery, you will recover on the ward. Most individual stay three to four nights in the hospital and will be seen by the physiotherapist on the ward to facilitate mobilisation using crutches for the first 1-2 weeks.
Some individuals will use the crutches for longer depending on the type of injury and treatment required. Dr Parminder Singh will see you in his rooms approximately 10-14 days after the hip replacement surgery and inspect the hip wound.
The stitches will be removed during this appointment. Dr Parminder Singh will also explain the operative findings and recommended precautions and rehabilitation required. Another appointment will typically be organised for you around 6-8 week after this date to assess your progress. In the meantime, rehabilitation is usually recommended with a physiotherapist who has experience with hip replacement patients.
It is important to follow the hip precautions Dr Parminder Singh recommends to allow for the best possible outcome.
Further appointments will be made at approximately 6 and 12months post operatively and check x-rays will be requested. Dr Parminder Singh recommends to allow approximately 3 months for the soft tissue healing from the surgery and hip precautions during this period. The bone healing will continue for up to 12 months after surgery and Dr Singh will check this for you during the following up appointments. In terms of longer term, Dr Singh will review you in 5, 10, 15, 20 years after your hip replacement with regular x-rays.
Book a Consultation
Committed to improving the quality of patient advice, treatment and care in the field of orthopaedics, book a one-on-one consultation with Dr Parminder J Singh today.
21 Erin Street, Richmond VIC 3121 Book a consultation on: (03) 9428 4128
85 Wilson Street, Brighton VIC 3186 Book a consultation on: (03) 9428 4128
116-118 Thames St, Boxhill VIC 3128 Book a consultation on: (03) 9428 4128
Waverly Private Hospital, 343-357 Blackburn Rd, Mt. Waverley VIC 3149 Book a consultation on: (03) 9428 4128
389 Canterbury Road, Forest Hill VIC 3131 Book a consultation on: (03) 9428 4128
16 Brantome Street, Gisborne VIC 3437 Book a consultation on: (03) 9428 4128