TOTAL HIP REPLACEMENT

What Is a Hip Replacement?
Hip replacement, or arthroplasty, is a surgical procedure in which the diseased parts of the hip joint are removed and replaced with new, artificial parts. These artificial parts are called the prosthesis. The goals of hip replacement surgery include increasing mobility, improving the function of the hip joint, and relieving pain.

Who Should Have Hip Replacement Surgery?
People with hip joint damage that causes pain and interferes with daily activities despite treatment, may be candidates for hip replacement surgery. Osteoarthritis is the most common cause of this type of damage. However, other conditions such as rheumatoid arthritis (a chronic inflammatory disease that causes joint pain, stiffness, and swelling), osteonecrosis (or avascular necrosis, which is the death of bone caused by insufficient blood supply), injury, fracture, and bone tumors also may lead to breakdown of the hip joint and the need for hip replacement surgery.

In the past, doctors reserved hip replacement surgery primarily for people over 60 years of age. The thinking was that older people typically are less active and put less stress on the artificial hip than do younger people. In more recent years however, doctors have found that hip replacement surgery can be very successful in younger people as well. New technology has improved the artificial parts, allowing them to withstand more stress and strain and last longer.

Today, a person’s overall health and activity level are more important than age in predicting a hip replacement’s success. Hip replacement may be problematic for people with some health problems, regardless of their age. For example, people who have chronic disorders such as Parkinson’s disease, or conditions that result in severe muscle weakness, are more likely than people without chronic diseases to damage or dislocate an artificial hip. People who are at high risk for infections or in poor health are less likely to recover successfully. Therefore they may not be good candidates for this surgery. Recent studies also suggest that people who elect to have surgery before advanced joint deterioration occurs tend to recover more easily and have better outcomes.

Why Do People Have Hip Replacement Surgery?
For the majority of people who have hip replacement surgery, the procedure results in:

• a decrease in pain
• increased mobility
• improvements in activities of daily living
• improved quality of life.

What Are Alternatives to Hip Replacement?
Before considering a total hip replacement Mr Richardson may try other methods of treatment, such as exercise, walking aids, and medication. An exercise program can strengthen the muscles around the hip joint. Walking aids such as canes and walkers may alleviate some of the stress from painful, damaged hips and help you to avoid or delay surgery.

What Are Possible Complications of Hip Replacement Surgery?
New technology and advances in surgical techniques have greatly reduced the risks involved with hip replacements.

The most common problem that may arise soon after hip replacement surgery is hip dislocation. Because the artificial ball and socket are smaller than the normal ones, the ball can become dislodged from the socket if the hip is placed in certain positions. The most dangerous position usually is pulling the knees up to the chest and twisting the leg at the same time. This can occur when sitting in low chairs, or when dressing.

The most common later complication of hip replacement surgery is an inflammatory reaction to tiny particles that gradually wear off of the artificial joint surfaces and are absorbed by the surrounding tissues. The inflammation may trigger the action of special cells that eat away some of the bone, causing the implant to loosen. To treat this complication, the doctor may use anti-inflammatory medications or recommend revision surgery (replacement of an artificial joint). Medical scientists are experimenting with new materials that last longer and cause less inflammation. Less common complications of hip replacement surgery include infection, blood clots, and heterotopic bone formation (bone growth beyond the normal edges of bone).

To minimize the risk of complications, it’s important to know how to prevent problems and to recognise signs of potential problems early and contact your doctor. For example, tenderness; redness and swelling of your calf; or swelling of your thigh, ankle, or foot could be warning signs of a possible blood clot. Warning signs of infection include fever, chills, tenderness and swelling, or drainage from the wound. You should call your doctor if you experience any of these symptoms.

When Is Revision Surgery Necessary?
Hip replacement is one of the most successful orthopaedic surgeries performed. However, because more people are having hip replacements at a younger age, and wearing away of the joint surface becomes a problem after 15 to 20 years, replacement of an artificial joint, which is also known as revision surgery, is becoming more common. It is more difficult than first-time hip replacement surgery, and the outcome is generally not as good, so it is important to explore all available options before having additional surgery.

Doctors consider revision surgery for two reasons: if medication and lifestyle changes do not relieve pain and disability, or if x rays of the hip show damage to the bone around the artificial hip that must be corrected before it is too late for a successful revision. This surgery is usually considered only when bone loss, wearing of the joint surfaces, or joint loosening shows up on an x ray. Other possible reasons for revision surgery include fracture, dislocation of the artificial parts, and infection.

What Types of Exercise Are Most Suitable for Someone With a Total Hip Replacement?
Proper exercise can reduce stiffness and increase flexibility and muscle strength. People who have an artificial hip should talk to their doctor or physical therapist about developing an appropriate exercise program. Most of these programs begin with safe range-of-motion activities and muscle-strengthening exercises. The doctor or therapist will decide when you can move on to more demanding activities. Many doctors recommend avoiding high-impact activities, such as basketball, jogging, and tennis. These activities can damage the new hip or cause loosening of its parts. Some recommended exercises are walking, cycling and swimming.

TOTAL HIP REPLACEMENT
CARE OF YOUR HIP AFTER SURGERY

Mr Richardson will expect you to remain in hospital until you are comfortable, medically stable, mobilising safely and independent in self care. Typically you will be ready for discharge 3-4 days after your surgery. If you are at all worried about going home around this time, then please discuss it with Mr Richardson or the nursing staff looking after you. Inpatient rehabilitation is available for you if you live alone, or require additional time to regain your independence.

Crutches
To improve your recovery and to minimise the risks of complications you will be encouraged to mobilise as soon as possible. You will be able to fully weight bear through your new hip, but will need crutches or gait aids for 2-3 weeks before your muscles have recovered their strength to be able to walk unaided. Please continue to use a single crutch or walking stick until you no longer limp when walking.

Analgesic/ Pain relief
A Total Hip Replacement is a big operation, but the recovery is usually relatively quick. You will be given a pre-medication before your surgery which will continue for the first 4 weeks post-operatively. Your wound and all soft tissues will be infiltrated with local anaesthetic, making your procedure as pain free as possible. This will enable you to stand and walk immediately after your surgery, with the aim of weight bearing the same day as your surgery. You will require strong narcotic based pain relief for the first 48 hours, but usually by the time of discharge it will no longer be required.

Regular paracetamol (Panadol Osteo) and an anti-inflammatory will be all that is required. You may still require something stronger at night, however it is best to avoid stronger analgesics during the day unless absolutely necessary. If the stronger pain killers are continued, the side effects such as nausea, lethargy, confusion and constipation will worsen. Constipation is very common and you will be offered a laxative to help, which you are encouraged to keep taking until you are off all narcotic medications.

If you experience worsening pain after discharge then please consult your GP or contact Mr Richardson’s rooms for further advice.

Wound
Mr Richardson sutures all his wounds with a dissolving suture. As a result, nothing needs to be removed.

Your wound will have the post-operative dressing left intact for your hospital stay. Prior to discharge your dressing will be taken off. Small pieces of tape (steristrips) will be removed. There will be 2-3 cm of suture at the ends of the wounds which will be lifted up and trimmed flush with the skin. The wound will then be sprayed with a clear dressing. Nothing further needs to be done to the wound. You can then shower safely over the wound, with no other dressing required.

Please do not soak the wound in a bath, or swim in pool for a minimum of 2 weeks. You may do so after 2 weeks if the wound is perfectly clean and dry.

It is normal for a wound to be warm and swollen after surgery. Some redness around the wound can also be normal healing. At no stage should antibiotics be given for any of these symptoms.

However,

IF AT ANY STAGE AFTER DISCHARGE YOU EXPERIENCE A DISCHARGE FROM THE WOUND PLEASE CONTACT MR RICHARDSON IMMEDIATELY.

Physiotherapy
Your physical therapy will commence as soon as you are able. Typically you will be stood and taken for a short walk as soon as you are capable after surgery.
Your physiotherapist will give you an exercise programme, which will change as you progress. It is important to continue with this until your post-op review with Mr Richardson at the 6-week mark.

It is very common after a hip replacement for your operated leg to feel a little long. This is because the worn out hip has been restored to its proper length, and contractions limiting movement have been released. The sensation of being long will disappear as you recover. Please do NOT use any shoe raises or wedges during this time to try and balance yourself out. Doing so will only recreate the contractures which have just been fixed.

Driving
You are not allowed to drive for a minimum or 6 weeks. Mr Richardson will assess your progress at the 6 week post-operative appointment as to when you may resume driving.