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Complex Primary Hip Replacement

Introduction

A hip replacement is considered complex when there are compromised bony or soft-tissue conditions in the hip joint. Such conditions may include dysplastic hip, ankylosed hip, prior hip fracture, protrusio acetabuli, certain neuromuscular conditions, skeletal dysplasia, and previous bony procedures around the hip. Additionally, difficulties may arise due to factors like obesity, skin problems, and soft tissue issues around the hip joint.

Indications and Contraindications

Indications for Complex Primary Hip Replacement Surgery:

  • Severe Osteoarthritis: When conservative treatments fail to alleviate pain and dysfunction caused by advanced osteoarthritis in the hip joint.

  • Rheumatoid Arthritis: In cases of severe hip joint damage due to rheumatoid arthritis.

  • Hip Fractures: Complex hip fractures, including those involving the hip socket (acetabulum) or extensive damage to the femoral head.

  • Hip Dysplasia: Severe hip dysplasia that leads to structural abnormalities in the hip joint, causing pain and instability.

  • Avascular Necrosis: When the blood supply to the femoral head is compromised, leading to bone death and collapse of the hip joint.

  • Developmental Deformities: Congenital or developmental deformities of the hip joint that result in pain and dysfunction.

Contraindications for Complex Primary Hip Replacement Surgery:

  • 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.

  • 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.

The decision to proceed with complex primary hip replacement surgery should be made after a thorough evaluation by a healthcare professional, considering the individual patient’s specific medical history, condition, and overall health.

Benefits & Risks of Complex Primary Hip Replacement Surgery

Benefits of Complex Primary Hip Replacement Surgery:

  • 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: Complex primary 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, complex primary hip replacement can offer a long-term solution, potentially 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 of Complex Primary Hip Replacement Surgery:

  • 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 anesthesia poses its own set of risks, including allergic reactions and complications related to underlying medical conditions.

Pre-Surgery Information for Complex Primary Hip Replacement Surgery

This is what can be expected before surgery:

  1. Patient Evaluation: A thorough assessment of the patient’s overall health, medical history, and orthopaedic condition. When necessary, your health might need optimisation and we may refer you to another specialist.
  2. Medications: Inform your healthcare provider about any medications you’re taking, as some may need to be adjusted before surgery. You should stop taking aspirin or anti-inflammatory medications 10 days prior to the surgery. Also, you should discontinue any naturopathic or herbal medications during this period.
  3. Imaging: X-rays, CT scans, and MRIs are used to evaluate the extent of damage and plan the surgery. CT scans are especially helpful in planning the surgical steps.
  4. Skin preparation: The night before and on the morning of the operation, you will be asked to wash the leg with a sponge provided at the pre-admission clinic. If there is any suspicion of an iodine allergy, a Betadine Skin test might be used.
  5. Bowel Prep: Glycerin suppositories will be provided at the pre-admission clinic, and you will need to administer them the evening prior to the surgery. An instruction leaflet will be given to guide them.
  6. Patient education: During a physiotherapy assessment, a qualified physical therapist will provide you with personalised instructions on gait training, the use of crutches, and pre- and postoperative exercises. You will be fitted with crutches to take home and practise before the surgery.

On the day of the Surgery

  • Surgical paperwork will be administered by the nurses, and the anaesthetist will meet with the patient to ask a few questions.
  • A hospital gown will be given, and the operation site will be shaved and cleaned.
  • Betadine skin prep will be applied to the area above the operation site and wrapped.
  • All x-rays are to be sent with the patient to the theatre.

Surgical Procedure for Complex Primary Hip Replacement Surgery

Complex primary hip replacement surgery is a sophisticated orthopaedic procedure that typically follows these general surgical steps:

  • Anaesthesia: The patient is placed under either general anaesthesia or regional anaesthesia.

  • Incision: The surgeon makes an incision over the hip joint, which can vary in length depending on the complexity of the case. 

  • Femoral Preparation: A variable amount of femoral bone is resected, depending on the surgical plan.

  • Acetabulum Preparation: The acetabulum (hip socket) is prepared and in complex cases may need some additional reconstruction.

  • Implant Placement: High-quality prosthetic components are securely inserted into the prepared areas. These components mimic the natural joint’s function.

  • Closure: After ensuring the stability and proper alignment of the components, the surgeon closes the incision with sutures.

  • Recovery and Post-Operative Care: The patient is closely monitored during the initial recovery period. Rehabilitation, including physical therapy, is initiated to regain strength and mobility in the hip joint.

Complex primary hip replacement surgery requires the expertise of a skilled orthopaedic surgeon. The choice of surgical approach and implant components may vary based on individual patient factors and the nature of the hip condition being treated. The goal is to relieve pain, improve mobility, and enhance the patient’s quality of life.

Post-operative Care for Complex Primary Hip Replacement Surgery

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.

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

This treatment could be eligible for our No 'Out-of-Pocket' Expenses Program

For further information, click here or to check your eligibility, please contact our team.