HIP REPLACEMENT MELBOURNE

When should you consider hip replacement suHip replacement Melbournergery?

Hip Replacement Melbourne – A hip replacement may become necessary if you have damaged your hip or have an arthritic hip. If the damage, pain or arthritis in your hip has not responded to conservative (non-operative) treatment, you may well be a candidate for total hip replacement surgery.

You should consider Total Hip Replacement surgery when you have:

  • Hip Arthritis confirmed on your X-ray
  • Hip pain that is not responding to analgesics or anti-inflammatories
  • Your daily activities limited by your hip pain
  • Pain keeping you awake at night
  • Stiffness in the hip making movement difficult.

The great news is that hip replacement surgery is one of the most effective operations known and could give you many years of freedom from hip pain.

Hip replacement due to arthritis

Arthritis is a general term covering a number of conditions where the joint surface (cartilage) wears out. The joint surface is covered by a smooth articular surface that allows pain free movement in the joint. This surface can wear out for a number of reasons, often the definite cause is not known.

When the articular cartilage wears out, the bone ends rub on one another and cause pain. In general, but not always, it affects people as they get older. This disorder is called Osteoarthritis.

Other causes of Arthritis may include but not limited to:

  • Childhood disorders – Perthe’s disease, Hip dislocation or slipped epiphysis
  • Growth abnormalities of the hip – A shallow socket joint may lead to premature arthritis
  • Trauma – Broken hip resulting from a fall
  • Stress on the hip joint – Overuse or excess weight
  • Avascular necrosis – Loss of blood supply
  • Infection
  • Connective tissue disorders
  • Inactive lifestyle – Being overweight may put extra force through your joints
  • Inflammation – Rheumatoid arthritis.

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What is happening in an arthritic hip?

Common symptoms of an arthritic hip joint include pain, fatigue, stiffness and limited movement.

A singular or combination of the following factors may contribute to these symptoms:

  • The cartilage lining is thinner than normal or completely absent
  • The degree of cartilage damage and inflammation varies with the type and stage of arthritis
  • The capsule of the arthritic hip is swollen
  • The joint space is narrowed and irregular in outline; this can be seen in an X-ray image
  • Bone spurs or excessive bone can also build up around the edges of the joint.


How do we diagnose Arthritis on your hip?

The diagnosis of osteoarthritis is made on history, physical examination and X-rays. There is no blood test to diagnose Osteoarthritis (wear and tear arthritis).

The potential benefits of hip replacement surgery

Prior to surgery you will usually have tried some simple treatments such as simple analgesics, weight loss, anti-inflammatory medications, modification of your activities, walking sticks, physiotherapy.

The decision to proceed with hip replacement surgery is a cooperative one between you, your surgeon, family and your local doctor.

Benefits of hip replacement surgery may include:

  • Reduced hip pain
  • Increased mobility and movement
  • Correction of deformity
  • Equalisation of leg length (not guaranteed)
  • Increased leg strength
  • Improved quality of life, ability to return to normal activities
  • Enables you to sleep without pain.

What is an anterior hip replacement?

Technology and techniques for hip replacement surgery are constantly improving. An anterior hip replacement describes where the surgical incisions take place in the operation. Anterior means the front, so the surgery takes place from the front rather than the traditional side approach. New technology and surgical equipment  have now made this approach to surgery easier.

What are the potential advantages?

The advantages of this approach may include:

  • Less pain
  • Muscle sparing
  • Faster recovery.

The anterior hip replacement approach is a technically more difficult procedure and does come with higher risks. This procedure allows for better and easier access of an x-ray machine during the procedure allowing a more accurate positioning of the new hip joint and immediate correction of any components. The theory is that if the positioning of the new hip joint is more accurate then the components are more likely to last longer and less likely to need a revision procedure.

In reality it I going to take 10 to 15 years to see if this correct. The Australian Joint registry currently tracks all joint replacements in the country and this now includes which approach is used. The answer will be available in the future.

Is an anterior hip replacement for you?

You may or may not be suitable for and anterior based on your:

  • Body size
  • Anatomy of the femur (thigh bone)
  • Anatomy of the pelvis (hip bone)
  • Previous surgery and;
  • Other underlying systemic conditions like osteoporosis.

In conclusion  the anterior hip replacement is a good option for most people who undergo the procedure. It offers some advantages over the more traditional approaches and it should be discussed with your surgeon in depth before surgery. Total hip replacement as a whole is already a very reliable procedure even in the absence of this approach.

Before your hip surgery operation

You should have any other medical, surgical or dental problems attended to prior to your surgery. During your recovery you will also need some help around the house. Best make these arrangements prior to surgery.

Your surgeon will ask you to undertake:

  • A general medical check-up with a physician
  • Routine blood tests and any other investigations required prior to your surgery
  • Cease aspirin or anti-inflammatory medications 10 days prior to surgery as they can cause bleeding
  • Cease any naturopathic or herbal medications 10 days before surgery
  • Stop smoking as long as possible prior to surgery.

On the day of your surgery

What happens on the day of your surgery:

  • You will be admitted to hospital
  • Further tests may be required on admission
  • You will meet the nurses and answer some questions for the hospital records
  • You will meet your anaesthetist, who will ask you a few questions
  • You will be given hospital clothes to change into and have a shower prior to surgery
  • The operation site will becleaned and shaved

Approximately 30 mins prior to surgery, you will be transferred to the operating theatre.

Hip replacement – Surgical procedure

An incision is made over the hip to expose the hip joint.

The acetabulum (socket joint) is prepared using a special instrument called a reamer. The acetabular component is then inserted into the socket. This is sometimes reinforced with screws or occasionally cemented. A liner which can be made of plastic, metal or ceramic material is then placed inside the acetabular component.

The femur (thigh bone) is then prepared. The femoral head which is arthritic is cut off and the bone prepared using special instruments, to exactly fit the new metal femoral component. The femoral component is then inserted into the femur. This may be press fit relying on bone to grow into it or cemented depending on a number of factors such as bone quality and surgeon’s preference.

The real femoral head component is then placed on the femoral stem. This can be made of metal or ceramic.

The hip is then reduced again, for the last time. The muscles and soft tissues are then closed carefully.

Post operation

You will wake up in the recovery room with a number of monitors to record your vitals statistics including blood pressure, pulse oxygen saturation and temperature.

You will have/be:

  • A dressing on your hip and drains coming out of your wound.
  • Post-operative X-rays will be performed in recovery
  • One or two drips in your arm for fluid and pain relief
  • Taken back to the ward once your are stable.

On the day following surgery – Your drains will usually be removed and your surgeon may encourage you to walk with the assistance of your therapist. Pain is normal but if you are in a lot of pain, tell your nurse.

You will be able to put all your weight on your hip and your Physiotherapist will help you with the post-operative hip exercises.

5-7 days after your surgery – You will be discharged to go home or a rehabilitation hospital depending on your pain and home help access.

10 – 14 days after your surgery – Your stitches are usually dissolvable but if not they will be removed. A post-operative visit will be arranged prior o your discharge. You will be advised about how to walk with crutches for two weeks following surgery and then using walking aids for another four to six weeks.

Post operation precautions

Remember this is an artificial hip and must be treated with care.

AVOID THE COMBINED MOVEMENT OF BENDING YOUR HIP AND TURNING YOUR FOOT IN. THIS CAN CAUSE DISLOCATION.

Other precautions to avoid dislocation are:

  • You should sleep with a pillow between your legs for 6 weeks. Avoid crossing your legs and bending your hip past a right angle
  • Avoid low chairs
  • Avoid bending over to pick things up. Grabbers are helpful as are shoe horns or slip on shoes
  • Elevated toilet seat helpful
  • You can shower once the wound has healed
  • You can apply Vitamin E or moisturizing cream into the wound once the wound has healed
  • If you have increasing redness or swelling in the wound or temperatures over 100.5° you should call your doctor
  • If you are having any procedures such as dental work or any other surgery you should take antibiotics before and after to prevent infection in your new prosthesis – Consult your surgeon for details
  • Your hip replacement may go off in a metal detector at the airport.

Risks and complications

As with any major surgery, there are potential risks involved. The decision to proceed with the surgery is made because the advantages of surgery outweigh the potential disadvantages.

It is important that you are informed of these risks before the surgery takes place. Complications can be medical (general) or specific to the hip.

Medical Complications include those of the anesthetic and your general well being. Almost any medical condition can occur so this list is not complete.

Complications include:

  • Allergic reactions to medications
  • Blood loss requiring transfusion with its low risk of disease transmission
  • Heart attacks, strokes, kidney failure, pneumonia, bladder infections
  • Complications from nerve blocks such as infection or nerve damage
  • Serious medical problems can lead to ongoing health concerns, prolonged hospitalisation or rarely death
  • Specific complications include

Infection – Infection can occur with any operation. In the hip this can be superficial or deep. Infection rates are approximately 1%, if it occurs it can be treated with antibiotics but may require further surgery. Very rarely your hip may need to be removed to eradicate infection.

Dislocation – This means the hip comes out of its socket. Precautions need to be taken with your new hip forever. It a dislocation occurs it needs to be put back into place with an anaesthetic. Rarely this becomes a recurrent problem needing further surgery.

Blood clots (Deep Venous Thrombosis) – These can form in the calf muscles and can travel to the lung (Pulmonary embolism). These can occasionally be serious and even life threatening. If you get calf pain or shortness of breath at any stage, you should notify your surgeon.

Damage to nerves or blood vessels – Also rare but can lead to weakness and loss of sensation in part of the leg. Damage to blood vessels may require further surgery if bleeding is ongoing.

Wound irritation – Your scar can be sensitive or have a surrounding area of numbness. This normally decreases over time and does not lead to any problems with your new joint.

Leg length inequality – It is very difficult to make the leg exactly the same length as the other one. Occasionally the leg is deliberately lengthened to make the hip stable during surgery. There are some occasions when it is simply not possible to match the leg lengths. All leg length inequalities can be treated by a simple shoe raise on the shorter side.

Wear – All joints eventually wear out. The more active you are, the quicker this will occur. In general 80-90% of hip replacements survive 15-20 years.

Failure to relieve pain – Very rare but may occur especially if some pain is coming from other areas such as the spine.

Unsightly or thickened scar

Limp due to muscle weakness

Fractures (break) of the femur (thigh bone) or pelvis (hipbone) – This is also rare but can occur during or after surgery. This may prolong your recovery, or require further surgery. Discuss your concerns thoroughly with your orthopaedic surgeon prior to surgery.

Summary

Surgery is not a pleasant prospect for anyone, but for some people with arthritis, it could mean the difference between leading a normal life or putting up with a debilitating condition. Surgery can be regarded as part of your treatment plan- it may help to restore function to your damaged joints as well as relieve pain.

Discussing any surgical option can be stressful. So if you have any any questions please do not hesitate to email me.
I will get back to you as soon as possible – Dr. David Love.

DL

CONTACT & CONSULTING INFORMATION

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HIP REPLACEMENT MELBOURNE – DR. DAVID LOVE ORTHOPAEDIC SURGEON

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