Total hip replacement is a common and very successful operation with over 15,000 being performed in Australia each year.
The hip joint is a ball and socket joint which is held together by ligaments, tendons and muscles.
Like all joints in the body the surfaces of the joint are covered with smooth, protective cartilage.
Arthritis occurs when this smooth cartilage is damaged causing bone to rub on bone, with symptoms of pain, catching and giving way, stiffness and limping.
A total hip replacement can be performed under general anaesthesia or a spinal anaesthetic and your anaesthetist will advise you which is best for you.
The operation involves dislocation of the hip joint, then removal of the ball (or femoral head), then hollowing out the upper part of the femur (thigh bone) to allow insertion of the femoral component or prosthesis.
The hip socket cartilage is then removed which will allow insertion of the prosthetic cup into the acetabulum (or pelvic socket).
The femoral component with the ball of the prosthesis is then snapped into the socket to form the new artificial hip joint.
A drain is inserted into the wound, which is then stitched closed.
- Wear and tear, usually age related – osteoarthritis is the commonest form
- Rheumatoid arthritis – rare nowadays
- Fracture of the hip – usually in older people
- Trauma and dislocations
- Avascular necrosis – the ball (or head) of the femur loses its blood supply and dies
The Decision to Have Surgery
This should be made only after a lengthy discussion with your surgeon and you have a complete understanding of what the operation involves, its advantages and information regarding potential complications.
Most modern total hip replacements should last 15 to 20 years or even longer but there are restrictions involved after the surgery. You cannot jog or jump on these prostheses and most active sports should not be undertaken. One can play bowls, golf, bushwalking, and go to the gym as long as impact exercise is avoided.
After completion of the total hip replacement you will spend one to two hours in the recovery ward and are then transferred back to your room in the hospital.
The day after surgery your rehabilitation begins with your physiotherapist. Initially just standing out of bed, to taking a few steps the next day, to walking around the ward.
You will be shown how to dress, bathe, negotiate stairs, and aids at your home will be organised for your eventual return. Your stay in hospital varies from five to seven days depending on your progress.
For the first six weeks after the surgery, accidental dislocation of your hip prosthesis is a risk and to avoid this the following is a very strong recommendation:
- Do not sit in low furniture
- Do not lie on your side in bed
- Do not cross your legs while sitting or lying in bed
- Do not twist or pivot on the operated leg when standing
- Use an elevated toilet seat
- Use slip on shoes to avoid tying laces
Pain and swelling around the hip usually settles within six to eight weeks. Muscle strength takes several weeks to return and until it does you may need to use a walking stick.
After Discharge from Hospital
Your surgeon will review you at regular intervals during the first year. He will organise these.
In the early stages after the surgery, report any high temperatures, fevers, increasing pain in the wound, drainage from the wound to your surgeon. It is preferable that your own surgeon deals with all post-operative complications, rather than your General Practitioner.