Anterior Hip Replacement

A Total Hip Replacement is for patients who have severe pain and stiffness in the hip.

Reasons to replace a hip

The most common reason to replace a hip is arthritis. There are many causes of arthritis, but the most common ones include:

• Osteoarthritis. Usually affects people above 50 years old, but can affect people who are younger. It is essentially a ‘Wear and Tear’ process affecting the cartilage of your hip. Cartilage covers the bones of your hip joint, the femoral head (ball) and acetabulum (socket). As you age, your cartilage wears down, causing hip pain and stiffness.
• Rheumatoid arthritis. Is an autoimmune disease in which a special membrane in you hip joint, called the synovial membrane becomes inflamed. This inflammation damages the joint cartilage.
• Osteonecrosis. You hip joint can be affected by a condition called osteonecrosis or ‘bone death’. There are many possible reasons for osteonecrosis which include prolonged steroid use, alcohol abuse or genetics.

Is Hip Replacement Surgery for You?

Whether to have hip replacement surgery should be a joint decision made by:

• yourself
• your family
• your family doctor (GP)
• Dr Phong Tran.

You should consider

• the pros and cons of the operation,
• the possible complications
• alternative treatments other than surgery
• the surgical options

You may benefit from hip replacement surgery, if:

• Your hip pain is severe
• It limits your movements and activites such as walking and climbing stairs
• It impairs your ability to look after yourself such as showering, putting on shoes.
• The pain is present at night and at rest.
• You have tried non-surgical alternatives without success

Degenerative Joint Disease (Osteoarthritis of the Hip)

Nonsurgical options

• Hip replacement surgery should only be considered after trying other options that don’t involve surgery.
• These include
  • pain relieving medications
  • physiotherapy
  • weight loss
  • walking aids such as walking sticks.

What to Expect From Hip Replacement Surgery

It is important to understand what a hip replacement can and cannot do before deciding to undergone the operation.

Most people who have hip replacement surgery, experience a dramatic reduction of hip pain and a significant improvement in movement allowing them to better perform common activities of dailiy living.

However, there are certain things that you cannot do with a hip replacement. Such as

• jogging
• any high impact sports such as football.

You will also be restricted from certain movements that may lead to dislocation of your hip.

Why total hip replacement?

With almost 70 years of history, total hip replacement surgery is a very common and safe procedure for the treatment of severe osteoarthritis.

The main benefits of a successful total hip replacement are:

• Reduction in hip pain: the pain will be rapidly and dramatically reduced and usually eliminated.
• Recovery of mobility: your hip will function with less effort, almost regaining your original mobility.
• Improvement in quality of life: your everyday activities and your social life will no longer be limited by pain and reduced mobility.

What are the complications and risks of having a total hip replacement?

The complication rate following hip replacement surgery is very low.

However, it is important to always understand with potential complications (no matter how small the risk) when considering any operation.

The risks for a total hip replacement include:

Joint infection. Serious complications, such as joint infection, occur in fewer than 2% of patients.

Heart attack and Strokes. Major medical complications, such as heart attack or stroke, occur even less frequently.

Deep vein thrombosis (DVT) Blood clots in the leg veins or pelvis are the most common complication of hip replacement surgery. Dr Phong Tran may prescribe one or more measures to prevent blood clots from forming in your leg veins or, if they do form, measures to prevent them from becoming symptomatic. These measures may include special support hose, inflatable leg coverings, ankle pump exercises, and blood thinners.

Uneven legs. Leg-length inequality may occur or may become or seem worse after hip replacement. Dr Phong Tran will take this into account, in addition to other issues, including the stability and biomechanics of the hip. Some patients may feel more comfortable with a shoe lift after surgery.

Dislocation

Wear and Tear. Over years, the hip prosthesis may wear out or loosen. This problem will likely be less common with newer materials and techniques. When the prosthesis wears, bone loss may occur because of the small particles produced at the wearing surface. This process is called osteolysis.

Revision surgery – having the operation done again.

Complications | How to help avoid problems after a Total Hip Replacement

Blood Clots | Deep Vein Thrombosis | DVT

One of the main risks of having a total hip replacement is a blood clot formation in the legs called a Deep Vein Thrombosis (DVT). The danger with a DVT is that it may move to your lungs and cause severe and sometimes life-threatening breathing problems called a Pulmonary Embolism (PE).

This threat is present anytime after your operation and last for several weeks after your surgery.

To reduce this risk as much as possible

Whilst in hospital, you will:

• wear special compression stockings
• be given daily injections of blood thinners called anticoagulants
• walking and exercise everyday to help circulate your blood

Whilst at home

Look for the warning signs.

These include:

• Pain in your calf

Warning signs that a blood clot has traveled to your lung include:

• Shortness of breath
• Chest pain, particularly with breathing

Notify Dr Phong Tran immediately if you develop any of these signs.

Preventing Infection

The most common causes of infection following hip replacement surgery are from bacteria that enter the bloodstream during dental procedures, urinary tract infections, or skin infections. These bacteria can lodge around your prosthesis.

Following your surgery, you may need to take antibiotics prior to dental work, including dental cleanings, or any surgical procedure that could allow bacteria to enter your bloodstream.

Warning signs of a possible hip replacement infection are:

• Persistent fever (higher than 37.5°C orally)
• Shaking chills
• Increasing redness, tenderness, or swelling of the hip wound
• Drainage from the hip wound
• Increasing hip pain with both activity and rest

Notify Dr Phong Tran immediately if you develop any of these signs.

Admission

Most people are admitted to hospital on the day of surgery.

Anaesthesia

The anaesthetic team will see you and decide the type of anaesthetic that’s best for you.

The different types of anaesthesia include:

• General Anaesthetic. This type of anaesthetic puts you asleep during the whole procedure and a machine controls your breathing.
• Spinal Anaesthetic. An injection is placed into your back to numb your hip and legs. You will be awake during the procedure, however a sedative can be given to you to help you doze off.
• Nerve Blocks. This special injection is used to help with your pain after the operation and often used  in conjunction with a general anaesthetic.

The Hip Replacement Operation

The operation usually takes between 1 to 2 hours, however can occasionally take a few hours.

The damaged cartilage and bone and replace it with a new hip replacement.

Your wound is usually between 10-15 cms long, depending on your shape and your hip anatomy, and is located directly in front of your hip.

Your muscles are then carefully separated until your hip joint is found.

The arthritic femoral head (ball) is removed. This allows access to your acetabulum (socket) which is prepared for the new implant.

The acetabular implant is then secured into your hip joint socket.

Your thigh bone (femur) is then prepared and your new femoral stem and ball is inserted.

Your hip joint is then tested for stability, flexibility and size.

What is the Hip Replacement made of?

Hip replacements are made of surgical grade metal (often chromium cobalt, stainless steel or titanium), highly wear resistant plastic or ceramic.

A hip joint is basically a ball and socket joint, and a hip replacement is designed to replace this normal anatomy.

A hip replacement is composed of a:

• Socket: Medically called the Acetabular Component. It can be made of highly wear resistant plastic, metal or ceramic.
• Liner: The liner fits snugly into the socket to provide an ultra-smooth surface for the hip joint. It can be also be made of plastic, ceramic or metal.
• Ball: The artificial ball component is smaller than your normal hip ball. It is incredibly polished and perfectly round and smooth. It is usually made of metal or ceramic.
• Stem: The stem fits snugly into your thigh bone (femur) to provide a stable structure for the ball. It is made of metal.

There are types of hip replacements available, and Dr Tran will decide which one is best for you.

Recovery Room

After the operation, you will be resting in the recovery room, where specially trained nurses will closely monitor to. This usually takes 1 to 2 hours. After which, you will be taken to your hospital room.

Taking care of your new hip

Long term care of your total hip

Follow your orthopaedic surgeon’s instructions carefully to minimize any potential complications which can affect your recovery and your implant lifetime. These complications, however, are quite infrequent and some simple rules can dramatically reduce their likelihood.

DON’T FORGET:

• Lead a healthy and active life.
• In case of fever, throat inflammation, pulmonary inflammation or any infection, tell Dr Phong Tran that you have a hip implant.
• Undergo regular general check-ups.

If you have any concerns about your new hip don’t hesitate to contact Dr Phong Tran and, finally, …enjoy your new hip!

Wound Care | How do I look after my wound?

It is importatnt to keep your wound as dry as possible.

Most patients are discharged home with a waterproof dressing, which can be left on for showering.

During the first 24 hours, it is normal to have some minor bleeding. After being discharded home, there should be no discharge, redness or bleeding around the wound.

If there is redness, discharge or a foul odour, please seek medical attention as soon as possible.

Wound Care | When will my stitches be removed?

There are a number of ways your wounds may be closed.

You may have either have

• nonabsolvable stitches
• absolvable stitches
• surgical staples.

The stitches or staples are usually removed 10-14 days after surgery.

Diet | What should I eat and drink?

There are usually no specific diet or extra vitamins / nutrients needed to recover from a total hip operation.

It is important to have a normal healthy balanced diet and plenty of nonalcoholic fluids.

Activity | What exercises should I do at home?

Physiotherapy and the exercises that you perform at home are extremely important to achieve the best results after a hip replacement.

After returning home, you should gradually be able to do more and more. It is important to look after your new hip and follow Dr Tran ‘s and physiotherapy instructions.

Your program may include exerises that work on your:

• walking
• sitting
• stair climbing
• muscle strength

Avoiding Falls

A fall during the first few weeks after surgery can damage your new hip and may result in a need for more surgery.

Be careful on Stairs. Stairs are a particular hazard until your hip is strong and mobile, and you’ve regained your balance. You should use a walking aid such as cane, crutches, a walker. Use the handrails on your stairs or ask for someone to help you., or handrails or have someone help you.

Special Precautions

One of possible complications of hip replacement surgery is dislocation. Dislocation is most common during the first year after surgery, but can also occur at any time. There are certain positions and precautions that must be avoided.

• Do not cross your legs.
• Do not bend your hips more than a right angle (90°).
• Do not turn your feet excessively inward or outward.

Taking care of your new hip

Long term care of your total hip

DON’T FORGET:

• Lead a healthy and active life.
• In case of fever, throat inflammation, pulmonary inflammation or any infection, tell Dr Phong Tran that you have a hip implant.
• Undergo regular general check-ups.

If you have any concerns about your new hip don’t hesitate to contact Dr Phong Tran and, finally, …enjoy your new hip!

Are there important things I need to tell my doctors?

• Redness, swelling or warmth around the cut
• Leakage from the cut
• Fever and chills.
• Severe knee pain that is not relieved by prescribed painkillers.
• Sudden sharp pain and clicking or popping sound in the knee joint
• Loss of control over leg movement
• Loss of leg movement
• Further surgery planned for the future i.e. dental work, bladder catheterisation, examinations of the bowel, bladder, rectum or stomach.

What causes hip pain?

There are many causes of hip pain. Some of the common causes include:

• Osteoarthritis
• Fractures/dislocations
• Femoroacetabular Impingement
• Labral Tears
• Ligamentum Teres Tears
• Hip Bursitis
• Rheumatoid arthritis
• Aseptic bone necrosis / Avascular necrosis

Is there a cure to a damaged hip joint?

If your hip pain is as a results of osteoarthitis, there is no “cure”. However there are a variety of treatment options available, ranging from physiotherapy to total hip replacement surgery.

If your hip pain is due to FAI (femoroacetabular impingement), labral tear or ligamentum teres tear, than it could be treated with hip arthroscopy.

What is a Total Hip Replacement?

Total hip replacement surgery substitutes the painful damaged bone and cartilage of the joint with artifical hip parts called a prosthesis, a device that substitues or supplements a joint.

The total hip replacement prosthesis is composed of polyethylene (a plastic material), ceramic or metallic components.

The artificial joint is made of a socket, a ball, and a stem.

The socket (called the acetabular component) is made of an outer shell made of metal and an inner shell which can be made of plastic, ceramic or metal.

The ball can be made of metal or ceramic.

The stem is usually made of metal.

Together, these components provide smooth, nearly frictionless movement.

What is a Total Hip Replacement made of?

• The femoral stem is made of metal (usually a Titanium or Cobalt Chrome alloy or stainless steel)
• The femoral head is made of ceramic or metal.
• The cup is made of polyethylene or metal with a porous surface
• A cup liner, made of ceramic or polyethylene, assures a long life for the artificial joint, even when loaded under stresses.

Anatomy | What is the hip joint?

The hip is one of the body’s largest weight-bearing joints. It consists of two main parts: a ball (femoral head) at the top of your thighbone (femur) that fits into a rounded socket (acetabulum) in your pelvis. Bands of tissue called ligaments (hip capsule) connect the ball to the socket and provide stability to the joint.

The bone surfaces of the ball and socket have a smooth durable cover of articular cartilage that cushions the ends of the bones and enables them to move easily.

A thin, smooth tissue called synovial membrane covers all remaining surfaces of the hip joint. In a healthy hip, this membrane makes a small amount of fluid that lubricates and almost eliminates friction in your hip joint.

Normally, all of these parts of your hip work in harmony, allowing you to move easily and without pain.

Can I treat my hip pain without an operation?

Hip pain can be improved by many different methods.

These include:

• Medications. Such as paracetamol or anti-inflammatories.
• Changes to Activities. Modify the activites that cause you the pain.
• Walking aids. Such as a walking stick or cane can help off-load the weight on your painful hip and should be used on the opposite side to the painful hip. For example, if you have a painful right hip, you should use the walking stick in your left hand.
• Weigth Loss. Losing weight can make you more mobile and help you with your symptoms.
• Change your house. Modifications to your house may help you cope with your symptoms.

All these methods should be tried before considering an operation.

Will my hip replacement activate the metal detectors at airports?

Some hip replacements may activate metal detectors at airports and some buildings.

Patients have reported mixed experiences at airports: some detectors go off and some don’t.

You will be provided with a special card to keep in your wallet explaining that you have a hip implant.

Do I need to tell my dentist that I have a hip replacement?

Yes, it is important to let your dentist know that you have a hip replacement. You will need to take antibiotics before any dental procedure to prevent the possibility of a blood borne infection of your hip replacement.

How do I know if I need a hip replacement?

If you have difficulty walking or performing everyday activities such as getting dressed, it may be time to consider hip replacement surgery.

It is usually wise to delay total hip replacement for as long as possible in favor of less invasive treatments like medications, exercises and walking aids. However in patients with advanced joint disease, hip replacement offers the chance for relief from pain and a return to normal activities.

How do I prepare for hip replacement surgery?

Several things may be necessary to prepare for surgery.

These may include:

• a review by a medical physician. This will help to ensure that other health problems such as diabetes, high blood pressure or medications, are identified, optimised and treated before surgery.
• weight loss
• exercise program
• stop or decrease smoking. Smoking can dangerously increase surgical risks and slow down the healing process.
• see your dentist. You should finish any dental work that may be underway to prevent germs in your mouth from entering the bloodstream and infecting the joint. If you have any teeth, dental or gum problems, these should be treated well ahead of having a hip replacement.
• blood test. It is quite common to require a blood transfusion are a hip replacement, so you will need your blood type tested before the operation.

What happens during hip replacement surgery?

On the day of surgery, an intravenous tube will be inserted into your arm to administer necessary medications and fluids during surgery. You will then be taken to the operating room and given anesthesia.

The surgery usually takes two to four hours, although this is dependent upon the severity of the arthritis in your hip. Compression stockings and pneumatic sleeves will be put on both legs.

The procedure is performed through an incision over the front of the hip. The ball-end of the thighbone (femur) is cut and replaced with the new metal ball and stem component.

The damaged surface of the socket is smoothed in preparation for the insertion of the new socket. The ball and socket are then joined. A small drainage tube is left coming out of the hip so that local anaesthetic can be injected after the operation.

You will be sent to the recovery room and as the anesthesia wears off you will slowly regain consciousness. A nurse will be with you, and may encourage you to cough or breathe deeply to help clear your lungs. When you are fully conscious, you will be taken back to your hospital room.

What is the recovery time?

You will be encouraged to start walking on the day of your surgery. As no muscle is damaged in the anterior hip approach, you are safe to walk immediately and there are no hip precautions, unlike with the standard traditional methods of performing hip replacements.

Most patients stay in hospital 2-4 days.

How is the implant affixed in the body?

There are generally 2 methods to affix the implants to your body.

• Uncemented Press-Fit. In other cases, the implants may be “press-fit” into the bone. Press-fit components may have a special porous coating that allows tissue to grow up to it for fixation.
• Bone Cement. A special type of bone acrylic cement may be used to secure some or all of the implant components to the bone. If used, the bone cement takes about 10 minutes to set.

The decision as to whether to use a cemented or press-fit component depends upon many individual factors, including your age, the condition of your bone and your general health.

What can I expect after surgery?

When you are back in your hospital room you will begin a gentle rehabilitation program to help strengthen the muscles around your new hip and regain your range of motion.

As soon as possible, usually on the same day of the operation, your physiotherapist will help you start walking a few steps at a time. As you heal you will progress from walker to crutches and then a cane.

Before you are discharged from the hospital, an occupational therapist will also show you how to perform daily tasks at home with your new hip. For example, he or she will instruct you on how to go to the bathroom, how to dress yourself, how to sit or stand, how to pick up objects and many others.

After about two to four days, or when your surgeon determines that you have recovered sufficiently, you will be discharged. You may be transferred to a rehabilitation facility for a few more days, as determined by your surgeon.

Upon returning to your home, you will need to continue taking your regular medications and continue your exercises. Walking, remaining active and practicing the required exercise are the quickest ways to full recovery. Read the Surgery Calendar to learn more on what to expect after surgery.

How long will a joint replacement last?

How long a hip replacement lasts depends on quite a number of factors including:

• your general health
• activity level
• your weight
• the accuracy of implant placement during surgery.

It is useful to keep in mind that prosthetic joints are not as strong or durable as a natural, healthy joint, and there is no guarantee that a prosthetic joint will last the rest of a patient’s life.

At times, a hip replacement can last for 30 years.

How old is the average patient?

The average joint replacement patient is around 60 – 70 years old, however patients of all ages have received hip implants.

What activities can I do or not do after receiving a hip implant?

Safe activities include walking, golf, swimming, and bicycling.

It is best to avoid high impact sports such as jogging, basketball, racquetball, gymnastics, etc.

What about sex?

You may resume sexual activities as soon as they feel able.