Dr Ray Randle: 07 5598 0094
Dr David Liu: 07 5598 0205
Dr Haig Lennox: 07 5598 0531

Total Hip Replacement

Total hip replacement (THR) is a surgical procedure in which the damaged cartilage and bone is removed from the hip joint and replaced with artificial components. The hip joint is one of the body’s largest weight-bearing joints located between the thigh bone (femur) and the pelvis (acetabulum). It is a ball and socket joint in which the head of the femur is the ball and the pelvic acetabulum forms the socket. The joint surface is covered by a smooth articular cartilage which acts as a cushion and enables smooth movements of the joint. Injury and diseases such as arthritis can cause damage to the articular cartilage, making the bones rub painfully against each other.

Total hip replacement surgery is an option to relieve hip pain that limits daily activities. It involves the replacement of the damaged parts with prostheses and is recommended if conservative treatment options such as analgesic medications, activity modification and physical therapy do not relieve the symptoms.

Procedure

  • THR surgery is performed under anaesthesia
  • A surgical cut is made over the hip (anterior, lateral or posterior) to expose the hip joint
  • The femoral head is dislocated from the socket (acetabulum). The head is removed
  • The surface of the socket and the damaged or arthritic bone is removed using a reamer
  • The acetabular component is fixed into the socket (cemented or un-cemented)
  • In un-cemented shells, a liner made of plastic, ceramic or metal is placed inside the acetabular component
  • The femur or thighbone is then prepared by removing the medullary bone using special rasps, to allow for the exact fit of the new metal femoral component
  • The femoral component is then inserted into the femur either by a press fit (un-cemented) or using bone cement
  • The femoral head component, made of metal or ceramic, is placed on the femoral stem
  • The hip is reduced and evaluated for stability, range of movement and leg length
  • The muscles and tendons around the new joint are repaired and the incision is closed

Goals and outcome

Total hip replacement is one of the most successful Orthopaedic procedures performed for patients with hip arthritis and other painful hip conditions. The procedure can relieve pain, restore function, improve movements at work and play, and provide patients with a much-improvedquality of life.

As part of the preparation for surgery, the better informed and prepared the patient is, the better the likely outcome. Signing an informed consent is a vital part of preparing for surgery. Attending a preadmission clinic is helpful. Many steps and actions are taken to reduce the risks of surgery and to aid in an uneventful full post-operative recovery.

Post-operative care

Post-operative pathway usually include:

  • The patient will be monitored regularly
  • Pain will be managed in a multi-modal style
  • Drugs will be administered to avoid blood clots, prevent infections and prevent bleeding
  • Urinary catheters usually stay in 1-2 days
  • Patients usually stay 3-5 days in the acute care ward
  • Patients will be given specific instructions regarding exercises and activity. Starting on the day of surgery. The physiotherapist will guide mobility
  • Leg swelling is common after hip surgery. Ice and elevation of the leg are recommended to minimize swelling and pain
  • Foot or calf pumps, early mobilising and hydration will be utilised to prevent calf and lung clots
  • If progress is slow, a referred to in or out patient rehabilitation will be arranged
  • Eating a healthy diet and not smoking will promote healing

After undergoing total hip replacement, patients must take special care to prevent the new joint from dislocating and ensure proper tissue and bone healing.

Some of the common precautions to be taken (for at least the first 6 weeks) include:

  • Avoiding combined movement of bending the hip and rotating the leg excessively
  • Never crossing the legs and bending the hips past a right angle (90°)
  • Avoiding sitting on low chairs
  • Avoiding bending down to pick up things; instead using a grabber
  • Using an elevated toilet seat
  • Protected weight bearing with crutches or a walking frame ‘til confident

Complications

As with any major surgical procedure, there are certain potential risks and complications involved with total hip replacement surgery. These may include but are not limited to:

  • Infection (superficial or deep)
  • Wound breakdown or drainage
  • Formation of blood clots in the leg veins and lungs
  • Hip dislocation
  • Fracture of the femur or pelvis
  • Injury to nerves or blood vessels
  • Leg length inequality
  • Limping and weakness
  • Loosening of the prosthesis
  • Wear out of prosthesis and surrounding bone destruction
  • Failure to relieve pain
  • Scar formation
  • Pressure sores
  • Bone formation in the soft tissues

The patient is a very important part of the pathway pre and post surgery. Patients need to be responsiblefor there own health and follow instructions. Informing the doctor or appropriate professional if there is a concern. Early diagnosis and treatment of complications will improve the success of treatment.

Total Hip Replacement

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