Total hip replacement (THR) is an established, long-lasting surgical procedure which has demonstrated excellent outcomes in relieving the pain associated with hip arthritis. The decision to proceed with hip joint replacement surgery is yours and does not need to be rushed. You should take time to consider whether joint replacement is right for you.
The hip is a ball-and-socket joint. The ball is formed by the top of the thigh bone (femoral head) and the socket is formed by the bony pelvis (acetabulum). The joint is lined by hyaline cartilage, which is smooth and allows for frictionless movement. Degeneration of hyaline cartilage results in osteoarthritis, with increasing friction between the bones resulting in pain and stiffness. Hip replacement is most commonly performed for hip osteoarthritis, but can also be used to treat rheumatoid arthritis, osteonecrosis, or a hip fracture.
During the surgery, the damaged bony ball and socket are removed and new components are inserted. The replacement components are made of metal or ceramic, with a plastic (polyethylene) liner placed between the ball and socket to allow for safe, frictionless movement. Depending on your age and the quality of your bone, either a cemented or cementless component will be used. The surgical incision is closed using stitches, and dressings are put on your skin. Once you are asleep, surgery generally takes around an hour to perform.
Various types of approaches can be used to access the hip joint, and some have theoretical advantages over others. In general, I prefer approaches which minimise the number of muscles which need to be moved to access the hip joint to aid in a rapid post-operative recovery.
My assistant will help you through the booking process and will be able to give you a quote for your surgical fees at this time.
In most cases you should continue with any regular prescribed medications in the lead up to your surgery. Please let me know if you:
Hip joint replacement can be performed under general or spinal anaesthesia. My assistant will give you the details of my anaesthetist at the time of your surgical booking. They will contact you prior to surgery to discuss the plan for your anaesthesia, and risks that may be specific to you.
You will be admitted to hospital on the day of surgery. You will be advised of your admission time in the days leading up to your surgery.
Your hospital stay will generally range from 1 to 5 days. Occasionally patients will require transfer to the rehabilitation ward of the hospital for a more prolonged stay. If required, we can arrange this during your hospital admission. A physiotherapist will visit you twice per day whilst in hospital. It is important to also perform your prescribed exercises and activities on your own to enhance recovery. Once discharged, I recommend you see a physiotherapist on a regular basis until you have recovered to a satisfactory level. I can help you with referrals to local physiotherapists. If you already have an existing relationship with a physiotherapist then you may also return to their care.
First 2 Weeks
The goals in the first 2 weeks after surgery are to:
Overlying the surgical incision is an adhesive dressing, which can remain in place if clean and dry. I will check the healing of your wound at our follow-up appointment approximately 2 weeks after surgery.
There are a number of options for pain relief, and my anaesthetist will discuss these with you. Once discharged from hospital, you will have pain relief medication that you can take to help with your comfort levels. Initially patients require some regular pain relief, consisting of regular paracetamol and anti-inflammatories if indicated. For periods of increased pain during the day (breakthrough pain), you will be prescribed a faster acting pain medication to take. Some of these pain relievers can have side effects such as nausea, stomach upset or sedation. Doses can be tailored to try and reduce these side effects and to keep you as comfortable as possible. It might be necessary to avoid certain activities (e.g. driving) if you are prescribed stronger pain medication.
The exact time until you return to driving is variable depending on your recovery and the leg that has been operated on. The Australian Orthopaedic Association (AOA) recommends a period of at least 6 weeks after surgery before you consider recommencing driving.
At a bare minimum, you should have 2 weeks off to allow the incision to heal and your mobility to improve. Most patients will require more than 2 weeks off work.
Any planned dental work or current dental problems should be dealt with prior to your hip replacement. If you have dental work at any time after your hip replacement, let your dentist or surgeon know that you’ve had joint surgery. The dentist may opt to prescribe you antibiotics to prevent infections that can spread from the mouth to the hip joint replacement via the bloodstream.
The risk of joint replacement infection is about 1%. This may occur at any time after surgery, as infection can spread to your hip from another part of your body. In the event you do have a joint infection, it is important to seek treatment as soon as possible. Oral antibiotics will not treat this problem and you will require surgery to wash the hip joint out. Occasionally those with resistant infections will require surgery where the existing hip replacement is removed and a new replacement inserted after a period of antibiotics (Revision Hip Replacement).
If you are concerned about an infection, please contact me as soon as possible. During business hours the best point of contact is via my assistant on 08 9212 4292. After hours, please contact the hospital where you had your surgery, and ask them to get in touch with me. Failing this, present to your local Emergency Department for review.
This is usually an infection limited to the skin of the lower leg, with redness and swelling around the operative site. It is important to contact me if this is the case, as you will need treatment to prevent infection from spreading to the hip joint.
It’s important to adhere to the restrictions which are placed on your movements in the first 6 weeks after surgery. Dislocation is usually painful with shortening of the leg and inability to weight bear.
If you think you may have dislocated your hip replacement, present to your nearest Emergency Department for assessment.
Ankle and Foot Swelling
This is normal to an extent after surgery and reflects the effects of gravity on a swollen hip.
Blood Clots may form in the deep veins of the calf or leg. Rarely these clots can travel to your lungs (known as pulmonary embolus), which can affect your breathing. During your inpatient stay I generally prescribe blood thinners to help prevent clot formation, although there is no medication that is 100% effective in preventing clots. In the event that you do have a large clot, you may require longer term blood thinning medication.
Need for Revision Surgery
For most patients, a hip replacement will last for life. However, if the prosthesis wears out or breaks, revision surgery will be required to remove the existing prosthesis and insert a new one. Revision surgery is often more complex than the initial surgery and is associated with longer recovery time.
Damage to Structures in the Hip Joint
is very rare. If there is damage to a surrounding structure, repeat surgery may be required to restore function.
REPORT TO DR RADIC IF YOU EXPERIENCE ANY OF THE FOLLOWING:
If you are considering a hip replacement, make an appointment with Dr Radic to discuss your treatment options.
For all appointments and enquiries, please contact us on:
Alternatively, please call the switchboard on 08 9212 4200 and ask for Dr Radic's rooms.
Perth Orthopaedic & Sports Medicine Centre
31 Outram Street
West Perth WA 6005
Antony Street Specialist Centre
6-8 Antony Street
Palmyra WA 6157
100 Stephenson Ave
Mount Claremont WA 6010
36 Frederick St
Djugun WA 6725