Patient Info / FAQ / Total Hip Replacement

WHAT IS A HIP REPLACEMENT ?

• Osteoarthritis
  • As you get older, the hip can wear out through overuse, obesity, or heavy manual labor
  • Normal wear and tear can add up*. Cartilage may begin to wear away (osteoarthritis)
  • As the bones rub together they become rough and pitted, narrowing the space in the joint
• Inflammatory Arthritis
  • Various reasons cause inflammation in the lining of the joint
  • In these conditions, more than one joint is usually affected
  • The joints arc hot, swollen, and painful
  • Deformity is common
• Avascular Necrosis
  • Can occur for no reason (idiopathic) or can be secondary to a number of conditions such as long-term use of alcohol or steroids
  • Due to loss of blood supply to the bone. If the bone dies (necrosis), the joint becomes arthritic
  • This pain often comes on quite suddenly and may increase rapidly
  • Can happen at any age

• Fracture
  • A bad fall or blow to the hip can fracture the bone*. If the broken bone does not heal properly the joint may slowly wear down
• Ligament Injury
  • Can cause instability of the knee and can lead to premature arthritis
• Childhood Hip Problems
  • Can result from a childhood problem such as dysplasia, congenital dislocation, infection, poor blood supply, and trauma
• Infection
  • Infection can destroy the cartilage lining leading to osteoarthritis
• Other Causes
  • Bad injury that did not heal properly*. Obesity*. Long term exposure to sports or heavy manual labor*. Other rare diseases affecting bones or soft tis

• No painful hip for the entire life
• Improved quality of life with active lifestyle

• Prosthesis will enable easy and pain-free movement
• Years of reliable function

• Severe disability
• Interference with leisure activities
• Affected walking or mobility

• Difficulty to perform basic activities such as putting on socks and shoes
• Inability to sleep well
• Conservative treatment such as analgesia, anti-inflammatories, weight loss, physiotherapy, and aids like crutches or cane fails

• Blood Tests
  • Blood tests to ensure blood count is normal and there are no major medical problems*. Knee replacement is a major operation; you do not want to be infected by diseases transmitted by blood*. Blood will be tested for AIDS and hepatitis*. The results can take up to two weeks
• ECG
  • Cardiograph of your heart to ensure there are no underlying cardiac problems
• Urine Sample
  • To ensure absence of urinary tract infection*. Any pre-surgery infection such as infected toenail, skin lesion, throat infection, gum or dental infection greatly increases your chances of joint replacement infection following surgery*. Any infection found can be treated with simple antibiotics prior to surgery

• X-RAYS
  • Always bring knee X-rays to hospital
• INFORMATION
  • Everything you need to know about what to do before, during and after your stay in hospital will be discussed at length*. Stop aspirin and anti-inflammatory medications 10 days prior to surgery as they can cause bleeding*. Stop any naturopathic or herbal medications too 10 days before surgery*. Continue with other medications unless specified*. Notify your surgeon if you have any abrasions or pimples around the knee*. Stop smoking for as long as possible prior to surgery

• An Anaesthetist will see you before the surgery
• They will discuss with you then if they are going to do a spinal, epidural, or general anaesthetic before taking you to the OT
• A urinary catheter will be placed in your bladder to measure your fluid balance during and after surgery
• A cut is made in the skin and underlying tissues to expose the hip
• The hip joint is dislocated and femoral head is cut

• Special instruments make accurate cuts to fit the prosthesis
• Trial components are put in first to ensure everything fits properly
• Bone is then cleaned to remove debris
• Real components are then inserted
• Drains are usually inserted
• Wound is then carefully closed
• After dressing the wound, you are taken to recovery

• Your hip will have adhesive dressing on it
• A large, triangular pillow will be placed between your legs
• Your fluid input and output is measured carefully
• A drip in the arm will be used to give you fluid, replace blood during the operation and for antibiotics
• Pain medication may be injected into a muscle or delivered by IV into the blood stream (Patient Controlled Analgesia [PCA] allows you to control your pain medication. When you push a button, pain medication is pumped through an IV line)
• The drip, drains and catheter are removed on your surgeon’s advice approximately 24 hours after surgery

• Blood will be taken 24-48 hours after the operation to check your haemoglobin and blood chemicals
• Your exercise regime will begin as soon as you are capable and will continue during your hospital stay and at home
• It will initially be supervised by a physiotherapist
• You may be most likely be discharged 5-7 days post operation
• You may be sent to a rehabilitation center straight from the hospital for hydrotherapy and physiotherapy
• Sutures usually dissolve or are removed after about 10 days

• When you leave hospital you may still need tablets
• It is best to avoid anti-inflammatory medicines if you have arthritis
• Sleep with a pillow between your legs for 6 weeks to avoid possible dislocation

• 95% pain reduces by 12 weeks and walking resumes
• It is extremely important to get the knee straight and regain movement early
• Normally, by 3 months, you can start golf, bowling, stationary bike ride, bush walk, double tennis, and swimming

• Infection
  • Infection may be superficial (i.e., in the skin) or deep (around the prosthesis)*. Infection rates of about 1% have been globally reported*. Any infection will be treated aggressively with antibiotics*. Occasionally, re-operation is necessary to clean it out*. In very rare circumstances, knee replacement is removed and another one is put in 6-8 weeks after the infection has cleared up
• Fracture of the femur or pelvis
  • This may occur during surgery and may, at times, not be recognized*. It may require more extensive surgery during the operation and occasionally a re-operation too*.It may require you to stay in traction for a few weeks after the surgery
• Damage to nerves or blood vessels
  • Nerves or blood vessels may get damaged during the surgery*.They may get repaired at the time if recognized timely*. It may otherwise require a second operation*.Very rarely, a damaged nerve does not recover on its own*.In case of no recovery, it can lead to poor function of the leg below the joint replacement because of weakness or sensory loss*. Sleep with a pillow between your legs for 6 weeks to avoid possible dislocation
• Blood Clots
  • Clots can form in calf muscles and travel to the lungs*. These can occasionally be serious and even life threatening*. They have to be treated immediately*. Occasionally, instead of blood, fat can go to the lungs, which may cause temporary shortness of breath
• Wound Irritation or Breakdown
  • The operative scar cuts some skin nerves, creating numbness around the wound, particularly on the outside*. This does not affect the function of your joint but may be irritating*. Eventually, this numb feeling improves and does not worry most people*. Occasionally, instead of a numb sensation you may have burning or a hypersensitive sensation in the wound*. This usually settles down over many months but, occasionally, can be long term and troublesome. Sometimes, it aches and itches around the scar for many months. This can become worse in cold weather. Wound breakdown is rare, but if it does occur it may require surgery to repair it. You may also get a reaction to the sutures used, causing a small pimple on your scar
  • They can usually be treated with an antiseptic dressing and sometimes require a short course of antibiotics

• Truchanteric Bursitis
  • It is not uncommon to get inflammation where the muscles pass over the trochanter (the prominent part of the femur bone, adjacent to the hip)*. The trochanteric bursitis and usually improves over time as your limp improves. Occasionally, injections are given into the painful area. Sometimes, people can have long-term discomfort in this area. Normally, by 3 months, you can start golf, bowling, stationary bike ride, bush walk, double tennis, and swimming
• Dislocation
  • After the operation, the new hip may dislocate. Only 2-4% dislocation has been recorded*. It is rare for the hip to continue dislocating but occasionally further surgery is required
• Wear
  • Long-term complications of total hip replacement is the wearing of the ball and socket*. The joint is like a tyre, which will wear out faster for someone who does heavy manual labor, plays a pounding sport like jogging, or is very overweight than a more sedentary person*. Conventional unicompartmental knee replacements have about an 85-95.4% fifteen-year survival*. Continual technological improvements allow these components to last longer*. If there is significant wear in the joint, the liner may need to be replaced*. Wear can sometimes causes loosening of the joint and the whole joint may then need replacing
• Osteolysis
  • This occurs when part of the bone is reabsorbed or disappears*. It results in small wear particles setting up a reaction in the body causing this bone rcabsorbtion*. Occasionally, your surgeon may recommend a procedure to change the liner or bone graft
• Limp
  • This is usually temporary and improves over a 12-month period*. It is a result of muscle weakness*. It can however persist, especially if you have had a limp for a long time prior to surgery or if you have a major anatomical problem associated with or causing your arthritis e.g. congenital dislocation of the hip
• Heterotopic Ossification
  • Bone forms in the soft tissues surrounding the hip*. It can cause discomfort and stiffness and occasionally needs to be excised*. It is quite rare in the hip
• Breakage of the Implant
  • In case of this occurrence, reoperation may be required to remove and replace the broken implant

This operation is generally very successful. Almost 98% people have no complaints post the surgery. Although some people also experience unexplained pain. About 90-95% of hip replacements survive the fifteen-year period, but this also depends on a number of variables such as age and activity level.

• There are precautions necessary to undertake after hip surgery.
• Limit hip bending
• Do not bend it more than 90 degrees
• Avoid turning the hip inwards while it is bent
• Avoid crossing your legs or ankles even when sitting, standing, or lying
• When sitting, keep your hips below the level of your hips
• Avoid chairs that are too low

• You may sit on a pillow to keep your hips higher
• Avoid bending over at the waist
• Consider purchasing a long-handled shoehorn or a sock aid to help you put on and take off your shoes and socks without bending over
• And an extension reach or grabber to help in picking up objects that are too low
• An elevated toilet seat may be necessary to keep the hips lower

• Remember this is an artificial hip and must be treated with care
• The more active you are, the quicker it will wear out
• You can drive when you have regained muscle control, usually by 6 weeks
• Avoid falling down
• Your hip may make the alarm go off in a metal detector at the airport. Keep a doctor’s note handy to inform them about your joint replacement

• Prevention of infection is vital
• In case of any infections, meet your local doctor straight away for treatment
• In case of increasing pain in the joint or high body temperature, visit a doctor or hospital immediately
• Prescribed antibiotics must be taken for infection anywhere in the body

• Avoid pounding activities that put a lot of stress on the joint
• Walking is good
• Swimming in a pool or light surfing is safe
• Doubles tennis is allowable but nothing more aggressive

• Contact sports are forbidden
• Jogging can be detrimental
• Skiing on groomed slopes is okay if you are a good skier
• Bowling and golf should not be a problem