Hip Replacement Surgery

Nowadays hip replacement surgery has become a commonplace procedure.Total hip replacement (THR) is a surgical procedure that relieves pain from most kinds of hip arthritis, improving the quality of life for the large majority of patients who undergo the operation.

 
Total Hip Joint Replacement Frequently Asked Questions (FAQ)
 
Commonly Asked Questions Post Operation Hip Surgery
 

What is a Total Hip Joint Replacement?

Total hip joint replacement is one of the great orthopaedic surgical advances of this century. It resulted from the pioneering efforts of Sir John Charnley, an orthopaedic surgeon who worked with engineers to develop the techniques and materials used in hip joint replacement.

When replacing a diseased hip joint, an orthopaedic surgeon inserts an artificial joint called a prosthesis. In New Zealand thousands of total hip joint replacements are performed each year by orthopaedic surgeons.

 
Why is a Total Hip Joint Replacement necessary?

The most frequent reason for performing a total hip joint replacement is to relieve the pain, and disability of severe arthritis. The surfaces of the joint may be damaged by osteoarthritis which results in the wearing away of the hyaline cartilage in the joint.

The joint may also be damaged by rheumatoid arthritis. In rheumatoid arthritis, the synovium produces chemical substances that attack the joint surface and destroy the cartilage. The hip joint may also be damaged by other diseases or by injury.

The swelling, heat and stiffness that occur in a damaged joint are the signs of inflammation. Inflammation is the body's natural reaction to disease or injury. Inflammation is usually temporary, but in arthritic joints it may be long lasting and result in a disability.

Because of the pain and stiffness,the person often avoids using the arthritic joint. Muscles around the joint tend to become weak, making it even more difficult for the joint to move. When arthritis has caused severe damage to the hip joint, a total joint replacement may allow the person to return to everyday activities

 

How do you Diagnose an Arthritic Joint?
Diagnosing an arthritic joint involves taking a thorough medical history, noting the patient's symptoms, performing a physical examination, doing laboratory tests, and taking x -rays. All of which are important to show the extent of damage to the joint.
 
What happens after diagnosis for Arthritic Joint has been made?
Once the diagnosis has been made, total joint replacement will be considered only after non-surgical treatment has failed to relieve pain and disability. Non-surgical treatment may include: isometric exercises, pain killing medication, anti-inflammatory drugs and the use of a stick or cane. Other surgical alternatives to total hip joint may be considered
 
How is Total Hip Joint Replacement performed?

A total hip joint replacement involves a surgical operation. The patient is given an anaesthetic, and the surgeon replaces the damaged parts of the joint with artificial materials. In the hip joint, the damaged ball is replaced by a metal or ceramic ball with a metal stem that fits down the femur. A new plastic socket is implanted into the pelvis to replace the old, damaged socket.

The materials used in total hip joint replacement are designed to enable the joint to move in the same way as a normal joint.

The artificial components are generally composed of a metal or ceramic ball that fits closely into a matching, high density plastic, cup. The metals are varied and include stainless steel, or alloys of cobalt, chrome, and titanium.

The plastic material is usually a ultra-high molecular weight polyethylene that is extremely durable and wear resistant. An acrylic bone cement is often used to anchor the artificial joint to the bone. "Cementless" joint replacements have also been developed. In these replacements, the prosthesis and the bone are made to fit intimately together.

Studies have shown that hip replacements, with cemented stems and cementless sockets ( also known as "hybrid" hips) are also very satisfactory.

 
What is the Recovery Period following a Total Hip Joint Replacement?
The recovery period following surgery will vary depending on the patient. In general, the orthopaedic surgeon will encourage the patient to use the new joint soon after the operation. Usually the patient will be standing and beginning to walk within several days. The patient will normally use crutches or cane for a period of time. The patient will also learn to do appropriate exercises to move and strengthen the joint.
 
What are the Benefits of Total Hip Joint Replacement?

The main benefit to the patient after total hip joint replacement is pain relief,which is often quite dramatic. Most patients will have some soreness in the replaced joint after the operation, this discomfort occurs because of the surgery and because the muscles surround the joint are weak from inactivity. The soreness may last for several weeks or months. Muscle power, lost through inactivity, usually returns with exercise when the pain is relieved.

Motion of the joint will generally improve. The extent of the improvement will depend on how stiff the joint was before the operation. An extremely stiff joint will continue to be stiff for sometime after total hip joint replacement. A hip joint replacement can enable a person to perform the activities of daily living without pain and stiffness.

 
What are the Risks of Total Hip Joint Replacement?
There are risks with any surgical procedure. The person considering total hip joint replacement should tell the orthopaedic surgeon about any additional medical conditions that might complicate the surgery. The patient's regular doctor should be told of the proposed surgery. Before the operation, the patient should discuss with the anesthetists the type of anaesthetic and possible risks involved.
 
What are the Possible Complications of Total Hip Joint Replacement?

With ANY operation there are risks to nerves, blood vessels, bone, tendons, ligaments, muscle, skin and structures which are not intentionally injured but occasionally are so. The more common complications include:

  • INFECTION: The major potential complication of total joint replacement is infection. It may occur during the hospital stay or after the patient goes home. It may occur even years after the operation. Infections in the wound are generally treated with antibiotics. Deep infections may require further surgery and removal of prosthesis. Spread of infection from another part of the body to a joint replacement has been known to occur. To prevent such infection, persons with total joint replacements are generally given antibiotics before dental cleaning and more extensive dental procedures, as well as before some other types of surgery. If an infection occurs, elsewhere in the boyd, it must be treated promptly with antibiotics.
  • LOOSENING: Loosening of the prosthesis is the most common mechanical problem occurring after total hip joint replacement. Loosening causes pain, and if loosening is significant a second total hip joint replacement may need to be performed. New methods of fixing the prosthesis to bone may minimize or eliminate this problem.
  • DISLOCATION: This complication sometimes occurs after total hip joint replacement, generally in the first few weeks after the operation. In most cases the orthopaedic surgeon can relocate the dislocated hip manually. Only rarely is another operation necessary. A brace may need to be worn for a period of time after a dislocation.
  • WEAR: Although some wear can be measured in artificial joints, it occurs slowly. Wear may contribute to loosening, bit it is rarely necessary to do corrective surgery because of wear alone.
  • BREAKAGE: Breakage of an implanted joint is rare. A second operation is necessary if this occurs.
  • IMPAIRED NERVE FUNCTION: On rare occasions, a nerve in the vicinity of the total hip joint replacement is damaged during the operation. This generally occurs when the orthopaedic surgery must correct considerable joint deformity in order to implant the prosthesis. With time, the nerves usually begin to function normally again
 
Is Total Hip Joint Replacement Permanent?

An old person can expect their total hip joint replacement to last a lifetime. It will give years of pain-free living that would not have been possible otherwise. A young person with a total hip joint replacement who is quite active may have to have a second replacement later.

Materials and surgical techniques are improving rapidly because of the efforts of orthopaedic surgeons working with engineers and other scientists.

 
How long does a Total Hip Joint Replacement Operation take?
Total Hip Joint Replacement Operation takes two hours and you are in hospital between 5 and 7 days. Crutches are usually required for the first 6 weeks. These are provided by the hospital.
 
When can I have a Dental Check Up if I have a Total Hip Joint Replacement?
It is important not to have any infections at the time of surgery, including teeth problems, bladder or skin infections. We suggest that you have a dental check up within 6 months prior to surgery as it is important not to have any major dental work for 6 months after the surgery. Please let me know if you have any infections prior to surgery.
 

How is my new Total Hip Joint different?

You may feel some numbness in the skin around your incision. You also may feel some stiffness, particularly with excessive bending. These differences often diminish with time and most patients find these are minor compared to the pain and limited function they experienced prior to surgery. Your new hip may activate metal detectors required for security in airports and some buildings. Tell the security agent about your hip replacement if the alarm is activated.

 

How long will my leg continue to swell and hurt after hip surgery?

The pain usually decreases rapidly during the first few weeks, but the hip continues to improve for 12 months or even longer. The swelling is due to alterations in fluid return up the limb and will gradually diminish but may take many months. Mobilisation helps, as does elevation when not exercising.

 

How much exercise should I do and how can I tell if I have done too much?

Mild and moderate exercise is beneficial but over-exercise is painful. Be guided by the hip symptoms. Generally the more active you are the better, but within your tolerance.

 

When should I drive after hip surgery?

Driving is an individual matter. Some people regain their co-ordination and reflexes quickly and others take longer. Following hip surgery, you should avoid driving for at least 2-3 weeks, depending on your progress.

 

When should I go up and down stairs after hip surgery?

During the first days after surgery you should learn to walk stairs with a physiotherapist at the hospital. The pace at which you regain agility on stairs depends on individual traits.
 

What kind of shoes should I wear after hip surgery?

High heels should be avoided for the first few months. Otherwise there are no rules regarding shoes.

 

Should I use a heating pad or ice packs after hip surgery?

Both ice and heat can be used to help relieve pain but both can be harmful if left on too long. Never sleep with a heating pad on your hip. It can damage the skin and even cause a severe burn. Ice can be used several times a day. 20 minutes on, 20 minutes off, is the usual regime.

 

For how long should I continue taking my medications after hip surgery ?

Blood thinning medications (Aspirin, Cartia) should be taken for 1 month. All pain medications may be taken as directed for pain. We suggest you use these pain medications regularly for the first 10 days after surgery to prevent pain, after this they can be used just as necessary. If you have any questions about your medications, please ask.

 

Is it normal for the hip to click ?

It is common to have clicking of the artificial joint. It is caused by the movement of the hard joint surfaces or tendons moving across them. As your hip recovers and strengthens it tends to go away.

 

Why do I have trouble sleeping at night after hip surgery?

Sleeping trouble is the most common question. You need patience. Surgical healing takes approximately 6-8 weeks. Therefore you may be slightly uncomfortable for this time. When you sleep your own natural body produced pain killers (endorphins) reduced so the leg and hip can ache. Taking prescribed medication at night (Paracetamol, Tramadol and Gabapentin) will help and heat packs can also help. Also getting out of bed and moving the joint sometimes helps. Keep active during the day and avoid napping during the day as this makes night sleep more difficult. Normal sleep will return as the hip heals. This can take 6 -12 weeks.

 
When can I have a Dental Check Up if I have a Hip Replacement?
It is important not to have any infections at the time of surgery, including teeth problems, bladder or skin infections. We suggest that you have a dental check up within 6 months prior to surgery as it is important not to have any major dental work for 6 months after the surgery. Please let me know if you have any infections prior to surgery.
 
Further Information Total Hip Replacement Surgery :
 
If you have any queries on Total Hip Replacement Surgery please do not hesitate to contact Dr Hugh Blackley's practice rooms during office hours on 09 522 2980