The hip is a ball and socket type joint. It is formed by the acetabulum (socket) and the femoral head (ball). Arthritis of the hip is a condition where the joint surfaces become damaged and irregular. The causes of arthritis include age-related ‘wear and tear’, chronic inflammatory disease, traumatic arthritis, avascular necrosis, fractures of the hip, dislocations and some birth defects.
A normal hip joint An arthritic joint
The treatment options for osteoarthritis may include doing nothing, analgesia, activity modification, walking aids, injections and a total hip replacement (THR). A THR is an operation performed to replace the damaged hip joint. The procedure involves cutting the skin and putting a cup (shell and liner) into the acetabulum. A stem is put into the femur with a ball on the top (called a head).
A Total hip Replacement
There are many different types of hip replacement designs. Some surgeons advocate the use of robots or computer navigation technology to help make accurate cuts. This technology is limited at present.
Younger patients may benefit from ‘mini-hip’ or resurfacing hip replacements. The idea is that less bone is removed using these hips, but there may also be some disadvantages.
Another technology is the use of custom selected or made hip replacement implants. This involves obtaining a CT scan before surgery. Mr. Asopa uses this technology aims to restore the hip anatomy as it may provide superior outcomes compared to standard off-the-shelf total hip replacements. Further information is available from Symbios Orthopaedics.
‘Pre-rehabilitation’ or physiotherapy before surgery to strengthen muscles and improve range of motion may help early recovery and improved outcomes following surgery.
The Operative Technique
A THR involves opening the hip and removing the ball (femoral head) and clearing the surface of the socket (acetabulum). A metal cup with either a ceramic or polyethylene liner is placed into the socket. A metal stem (with or without cement) is fixed into the femur. A metal or ceramic head is applied to the top of the femur. The soft tissues and muscles are repaired following surgery.
The benefits of Total Hip Replacement surgery
The aim of surgery is to eliminate the pain and stiffness experienced with arthritis.
Risk of Surgery
The risks of hip replacement surgery include infection, deep vein thrombosis and pulmonary embolism (blood clots), pain, stiffness, damage to nerves (causing numbness or weakness which may be temporary or permanent) and blood vessels. There is a risk of dislocation and leg-length discrepancy, fracture of the bone, and persisting pain. Death is a rare. Hip replacements are mechanical devices. They have a failure rate of under five percent at 10 years. There are risks related to the anaesthetic. The anaesthetist will discuss these with you. You will be asked to sign a consent form following a discussion of the risks of surgery.
What to expect on the day of surgery?
On the day of surgery, you will see the surgeon and anaesthetist. The anaesthetist will discuss anaesthetic options. These may include general or regional anaesthetic. The nurses will prepare you for the operation. The surgical procedure takes approximately two hours. Near the end of the operation, the hip will be injected with local anaesthetic to reduce the pain. Afterwards, you will go to recovery. When you have safely recovered from the anaesthetic, you will be sent to the ward. You will be given antibiotics at the time of surgery to prevent infection. These may be continued afterwards. You will be given blood thinners following surgery which will need to be continued following discharge.
After the operation
You will be encouraged to mobilise as soon as is safe following surgery. This is to improve the blood flow and give you confidence. As the local anaesthetic wears off, you will experience an increase in pain. It is important that you take your pain killers regularly and continue to work on your exercises during this time. The pain will improve over time.
Length of stay in hospital
There is a general trend in reducing the length of stay in hospital following surgery. Some patients may go home on the same day or the day after. Sometimes discharge from hospital can be after 2-3 days.
How do I look after the hip following discharge?
You need to keep the wound dry and protected using a dressing until it has healed (about 2 weeks). Advice will be given to you before discharge from the hospital. You will be given exercises before discharge.
It is important to plan for physiotherapy following discharge to help with improving the range of motion and strength of the knee.
The wound will be reviewed two weeks following surgery to ensure that it has healed without complication. If there are any concerns, it is important that the wound is seen by the surgeon.
You will be reviewed six-weeks following surgery to assess your progress.
Physiotherapy is useful following discharge. This will be discussed with you.
Do not hesitate to contact me if you require further information.