When you hip arthritis is severe and is limiting your daily function, hip replacement surgery can restore your quality of life. Around 95% of patients who undergo this surgery report a good or excellent result, with over 95% of replacement still working after 15 years. Newer technology and designs will hopefully yield even longer lasting results.
A large volume review of all surgical procedures available to patients was performed, with patients asked to rate them based on outcomes. Eye sight restoring cataract surgery understandably took first place in terms of patient satisfaction, but a total hip replacement came in second – the improvement in pain and function is that good. Reduction in pain is more reliable, with restoration of range of motion and function dependent on the activity required. A hip replacement is not as stable as a native hip, and particular positions need to be avoided. Being man-made, they do not have the capacity to heal themselves, and will eventually wear out. The more you do, the heavier the load you place on it, the quicker the wear will be. With appropriate rehabilitation and time, the odds are in your favour for a long-lasting good or excellent outcome.
How do I know if I need a hip replacement?
If you suspect you have hip arthritis, seek review with your local doctor. If they agree, you will be sent for a plain X-ray of your hip, and be given a referral to an orthopaedic surgeon. Generally hip arthritis presents with pain in the groin, worse with activity and relieved with rest. However, hip arthritis can present as thigh pain, buttock pain, and even knee pain. If you are concerned, seek review.
What surgical approach does Dr Host use?
Dr Host uses either the Anterior or Posterior Approach to the hip joint for elective primary hip replacements. The Anterior Minimally Invasive Approach has received popular press as it utilises an interval between muscles in the upper thigh/groin, whereas the posterior and anterolateral approaches require release and repair of muscles. The reported advantage of the Anterior Approach is a quicker recovery with earlier return to activity and no reduced restrictions in the recovery period. Regardless of the surgical approach utilised, the literature suggests similar patient outcomes at 12 weeks regardless of the approach used. Not all patients are suitable for the Anterior Minimally Invasive approach, but it is Dr Host’s preferred technique due to the earlier improvement in function. Dr Host will choose the technique that has the best chance of helping you return to the function and quality of life that you desire.
If you are concerned regarding the approach that will be used, please discuss this with Dr Host during your review with him.
Will my hip be metal-on-metal?
No – Dr Host does not use implants that have a metal-on-metal bearing surface for a total hip replacement. These have understandably received bad press with some designs showing increased and early failures. Dr Host has never used such implants, instead preferring ceramic on plastic, metal on plastic or ceramic on ceramic bearings, as dictated by each individual’s functional requirements.
How long does the surgery take?
A total hip replacement takes between around 1 hour to complete, though frequently the whole trip through theatres will take 3-4 hours. You will be moved to a ward following your surgery, and once you have awoken from your anaesthetic, you will begin your rehabilitation.
When will I be able to walk after surgery?
The ideal situation is that you are helped to walk the same day as your surgery – the sooner we have you up and about, the quicker we can get you going and home. Your rehabilitation will start as soon as you are medically able to tolerate it.
How long will I be in hospital for?
The average length of stay is 3 days, with some home sooner, and others requiring longer periods in rehabilitation before being able to function independently at home. You will not be discharged from hospital until you have been cleared by a physiotherapist – they will only let you go when you can safely perform the daily activities you would need to do at home. The fitter and more active you are before surgery, the easier you tend to find your recovery after surgery. For those who find the going a bit slow, that is ok too. You will usually be transferred to a specific rehabilitation unit for more intense treatment prior to your discharge home.
When will I be able to do full activity following surgery?
A hip replacement tends to be tolerated much better than a knee replacement, and most people find that by 6-12 weeks they are able to function with minimal problems. Again this depends on your function prior to surgery – if you were severely limited before surgery, it will take longer to rebuild muscle and motion of the joint. Most people find that the pain side of the arthritis fades rapidly, with the function showing ongoing improvement over the first 12-24 months. There are particular activities which will need to be avoided, some in the short term, and some indefinitely. These will be discussed with you prior to any surgery, but most find they do not stop them from doing activities they would like to do.
When can I drive after my procedure?
You are not allowed to drive for at least 6 weeks following surgery, and may require longer periods depending on your surgical outcome and rehabilitation progress. Most cars have quite deep seats, and the motion you put your hip through in getting in and out is the exact motion that can lead to dislocation of the prosthetic joint. Your physio will show you an altered way of entering and exiting a vehicle that will protect the hip, but waiting for 6-12 weeks before driving allows the tissues around the hip to heal and help with stability.
What should I look out for following surgery?
If you experience an increase in pain or swelling, and if the wound becomes red and hot to touch, you should seek urgent review with Dr Host or your local GP. You may be developing an infection, and the earlier treatment is started, the better your result.
If you develop any lower leg/calf swelling or pain, or any shortness of breath, chest pain or rapid breathing and pulse, seek urgent review at your closest hospital.