Hip Replacement

Introduction

Hip Arthroplasty, otherwise known as Hip Replacement is a surgical procedure to replace the articular part of the hip joint with an artificial joint. The aim is to take away pain, restore function, preserve anatomy and improve quality of life. Hip replacement has completely revolutionised the nature in which the arthritic hip is treated and is considered to be one of the most successful orthopaedic interventions of its generation.  

Indications and Contraindications

Indications  

 The most common indication for a hip replacement is degenerative arthritis (osteoarthritis) of the hip joint. This type of arthritis is generally seen with ageing, congenital abnormality of the hip joint, or prior trauma to the hip joint. Other conditions leading to hip replacement include bony fractures of the femoral neck at the hip joint, rheumatoid arthritis, osteonecrosis (death of the femoral head) and developmental dysplasia of the hip. 

Contraindications  

  • Active Infection: A current infection, whether in the hip joint or elsewhere in the body, is a contraindication, as it poses a risk of implant contamination.
  • Poor General Health: Patients with severe underlying medical conditions, such as uncontrolled heart disease or severe lung disease, may not be suitable candidates due to increased surgical risks.
  • Inadequate Bone Quality: Insufficient bone quality or quantity in the hip region may make it challenging to securely anchor the implants, making the procedure less viable, or requiring complex reconstructive measures.
  • Metal Allergies: Known allergies to metal, as many hip replacement implants contain metal components.
  • Advanced Osteoporosis: Severe osteoporosis may compromise implant stability and fixation in the bone.
  • Unrealistic Expectations: Patients with unrealistic expectations regarding the outcome of the surgery or who are unwilling to adhere to post-operative care and restrictions may not be suitable candidates.

Benefits and Risks

Although the benefits of successful hip replacement surgery are great, the patient does have a duty of taking care of the new artificial hip by avoiding movements that will stress or damage its components. It is particularly important to avoid prohibited positions of the leg (these will be outlined in your consultation and repeated again post-surgery) and to promptly treat any unavoidable infections if they arise.

Benefits

  • Pain Relief: The procedure can provide significant pain relief and improved quality of life for patients suffering from severe hip joint conditions, such as osteoarthritis or hip fractures.
  • Improved Mobility: hip replacement can restore mobility and functionality, allowing patients to engage in daily activities and enjoy a more active lifestyle.
  • Joint Stability: It enhances joint stability and can correct structural abnormalities, which may reduce the risk of falls and related injuries.
  • Long-Term Solution: when successful, an artificial hip is a long-term solution with benefits lasting for decades.
  • Enhanced Quality of Life: Patients often experience an improved overall quality of life, including better sleep and reduced pain during routine activities.

Risks

  • Infection: There is a risk of post-operative infection, which may necessitate further surgery or prolonged antibiotic treatment.
  • Blood Clots: Patients are susceptible to deep vein thrombosis (DVT) and pulmonary embolism, which can be life-threatening if not managed properly.
  • Implant Wear and Loosening: Over time, the hip replacement components may wear or become loose, requiring revision surgery.
  • Nerve or Blood Vessel Damage: Injury to nearby nerves or blood vessels during surgery is a potential risk, although it is relatively rare.
  • Dislocation: The hip joint can dislocate, particularly in the early post-operative period, necessitating closed or open reduction.
  • Rehabilitation Challenges: Rehabilitation can be demanding and may involve complications such as muscle weakness, joint stiffness, or instability.
  • Allergic Reactions: Patients with metal allergies may experience adverse reactions to metal implants.
  • Anesthesia Risks: General anaesthesia poses its own set of risks, including allergic reactions and complications related to underlying medical conditions.

Surgical Approach

  • Anterior approach: Anterior means to surgically approach from the front of the hip joint instead of lateral (side) or posterior (back). Muscles do not need to be cut or detached from the pelvis or femur. Recovery from Anterior Hip Replacement surgery is much quicker than recovery from traditional hip replacement surgery. Less post-operative pain than traditional hip replacement surgery. Return to daily activities faster compared to traditional hip replacement surgery. Although the suitability of patients for this approach is subjective, in our practice it is our gold standard approach to any hip replacement surgery.
  • Other possible approaches are: The posterior, the lateral, and the anterolateral hip approach. Although all carry their own benefits, we consider the anterior approach to be superior for the vast majority of our patients.

Pre-Surgery Information

Post-surgery care following complex primary hip replacement is essential to ensure a successful recovery. Here are some key aspects:

  • Immobilisation and Weight-Bearing: Patients may initially use crutches or a walker to avoid putting excessive weight on the operated hip. The surgeon will provide specific weight-bearing guidelines that should be closely followed to protect the joint.
  • Pain Management: Medications are prescribed to manage post-operative pain. Patients should adhere to the prescribed regimen and communicate any concerns about pain control with their healthcare provider.
  • Physical Therapy: Physical therapy is a critical component of recovery. Therapists design a customized exercise program to improve strength, flexibility, and joint mobility. Patients should diligently participate in these exercises to aid their rehabilitation.
  • Wound Care: Proper wound care is essential. Keep the surgical site clean, dry, and inspect for signs of infection, such as redness or swelling.
  • Activity Restrictions: Patients should adhere to activity restrictions and avoid high-impact activities or movements that could stress the hip joint, especially in the early post-operative period.
  • Follow-Up Appointments: Regular follow-up appointments with the surgeon are crucial to monitor progress and address any concerns or complications that may arise.
    •  1 week postop: for wound check,
    • 2 weeks postop: for sutures removal,
    • 6 weeks postop: for x-ray assessment of healing progressing,
    • 3 months, 6 months, 12 months and later annually for x-ray assessment of healing progress
  • Medication Management: Patients may need to continue medications, such as blood thinners, to prevent blood clots as advised by their healthcare provider.
  • Assistive Devices: In some cases, patients may need assistive devices for an extended period, such as raised toilet seats or grab bars, to enhance safety and mobility at home.
  • Lifestyle Adjustments: Depending on individual circumstances, patients might need to make adjustments to their living space or daily routines to facilitate a smoother recovery.

Comprehensive post-surgery care is vital to a patient’s overall well-being and the long-term success of complex primary hip replacement surgery. Effective communication with the healthcare team and strict adherence to their recommendations are crucial for a smooth recovery process.

Surgical Procedure

Depending on the indications, the procedure will vary slightly but the following is a basic overview of what to expect from hip replacement surgery: 

  1. An incision is made over the front to expose the hip joint. The socket of the hip joint is prepared, and the artificial socket is secured.
  2. The femur is then prepared, depending on the type of the procedure – either only a small surface of the hip’s ball is removed, a whole ball, or a larger section of the proximal thigh bone. The removed fragment is replaced with an artificial component.
  3. All components are fitted together and the muscles and soft tissues are carefully closed. 

Post-Surgery Information

The following is what can be expected post-Hip Replacement surgery:  

  • Day 1: Exercises in bed, up with physiotherapist during the late am or pm at physiotherapist’s discretion using forearm support frame and weight bearing as tolerated. Sit out of bed as tolerated. 
  • Day 2: Progress mobility with the physiotherapist. 
  • Day 3:  Commence crutches if able. 
  • Day 4-6: Education handouts will be given detailing ‘Care of hip’ and ‘Home Exercise program’. Stair practice and discharge information will be provided. By this stage, the patient should be able to get out of bed, sit in a chair and use the toilet independently. 
  • Day 5-7: If the patient is independent, they will be discharged directly home. Patients may be discharged earlier if they are transferred to a rehabilitation facility. 

  • Follow-Up Appointments: Regular follow-up appointments with the surgeon are essential to monitor progress and address any concerns or complications that may arise.

    •  1 week postop: for wound check, 
    • 2 weeks postop: for sutures removal, 
    • 6 weeks postop: for x-ray assessment of healing progressing,
    • 3 months, 6 months, 12 months and later annually for  x-ray assessment of healing progress

 

Post-op precautions

  • It is important that you avoid any movements that will stress, damage or lead to the dislocation of your new hip. 
  • Avoid crossing your legs and extending your hip fully. 
  • Avoid low chairs and bending over to pick things up. Grabbers can be helpful with this as well as shoe horns.
  • Avoid turning your foot or any other forced movements, this can lead to dislocation.

Concerns

If patients are worried about their level of pain, experience significant bleeding, or notice fever or redness around the surgical site, they should contact the office immediately. If assistance is needed after hours, patients can contact the hospital where the surgery was performed, and they will contact Professor Al Muderis on their behalf.

Norwest Private Hospital: (02) 8882 8882

Macquarie University Hospital: (02) 9812 3000

Call on +61 2 8882 9011

X-ray facilities at all locations | Urgent appointments available if necessary.

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Professor Munjed Al Muderis
Professor Munjed Al Muderis is an orthopaedic surgeon and a clinical lecturer at Macquarie University and The Australian School Of Advanced Medicine. He specialises in hip, knee, trauma and osseointegration surgery. He is a fellow of the Royal Australasian College of Surgeons and Chairman of the Osseointegration Group of Australia.
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Disclaimer

Information provided via this website is for educational and communication purposes only. The material presented is neither intended to convey the only, nor necessarily the best, method or procedure, but rather represents techniques and procedures used by Professor Munjed Al Muderis. Professor Munjed Al Muderis disclaims any and all liability for injury and/or other damages which result from an individual using techniques presented on this website. Professor Munjed Al Muderis, to the best of his knowledge, believes the information presented is current and applicable to work being done by orthopaedic surgeons worldwide.