Hip Replacement

Total Hip Replacement

Total hip replacement is considered to be one of the most successful operations in all of surgery.

It is a surgical procedure that involves replacing a damaged or diseased hip joint with an artificial joint, known as a prosthesis.

The aim of the surgery is to alleviate pain, improve mobility, and enhance the overall function of the hip joint.

Contact

Why would someone need a hip replacement?

There are several reasons why a patient may need a hip replacement, including:

Z

End-stage osteoarthritis (most common). This occurs when the cartilage of the hip joint wears away, resulting in pain, stiffness, and reduced mobility.

Z

Rheumatoid arthritis

Z

Avascular necrosis (disruption of blood supply to the hip)

Z

Hip dysplasia (abnormally shaped hip joint)

Z

Developmental issues with the hip, such as slipped upper femoral epiphysis, Perthes disease

Z

Trauma, such as hip fracture

Hip,,Back,And,Spinal,Problems,In,Young,Ages.

When is the right time to have a hip replacement?

Total hip replacement is a major operation, and the decision to undergo the surgery should be carefully considered. There is not a single right answer that can decide when is the right time to have the operation, and the decision is very individual for every patient. On the whole, however, hip replacement is recommended when you have exhausted all non-operative measures (see non-operative measures) and you feel that your symptoms are affecting your day-to-day activities and quality of life.

It is important to involve your loved ones in the decision-making process as they can provide an alternative perspective on how your symptoms impact your life. Often, you may not fully recognise the extent of the hip condition when you have lived with it for an extended period. They will also play a vital role in supporting you during and after the surgery, making their involvement important.

Mr. Costin-Brown will conduct a thorough assessment of your symptoms, perform a comprehensive examination, and take the time to discuss your options, as well as the benefits and risks of surgery, as part of a “joint decision-making process” between the patient and the surgeon.

What is involved with a hip replacement?

Essentially, total hip replacement involves removing the damaged joint and replacing it with an artificial joint (prosthesis).

A cut is made on the outside of the hip and the tissues incised to expose the joint. The damaged ball (head of the femur) is removed.

The socket (acetabulum) is prepared using a series of hemispherical “reamers” to remove the damaged cartilage and bone and leave a healthy bed of bone for the new cup. The new socket (cup), which is made of titanium, is then fitted into the bone, and a plastic (highly cross-linked polyethylene) liner is then inserted inside of the new shell.

A metal stem is inserted into the thigh bone (femur) which is attached to a ball (usually made of ceramic or metal) which fits into the new socket. Afterwards, the tissues are repaired and a dressing is applied to the wound.

What type of hip replacement will I have?

Mr Costin-Brown uses implants with an excellent track record and high-performance bearings to ensure optimal outcomes for patients.

The two main methods of securing the implants to bone are “uncemented” and “cemented” techniques. Uncemented implants rely on a tight fit that allows the bone to grow onto the implants over time, providing a biological fixation. Cemented implants, on the other hand, are bonded to the bone using orthopaedic cement, similar to a superglue. These approaches have different risks and benefits, and Mr Costin-Brown will determine the most suitable option for you on an individual basis.

What approach will Mr Costin-Brown use?

There are various approaches to accessing the hip joint, including from the front, side, and back. There is a lot of interest regarding which is the best approach, and a huge amount of information online.

Mr Costin-Brown has experience performing hip replacement using all of the approaches. He currently uses the “posterior approach” which he finds to be the most reliable and best for his patients.

Top,View,(flat,Lay),Of,Turmeric,(curcuma,Longa,Linn),Rhizome

What anaesthetic will I have for the surgery?

Whenever possible, Mr Costin-Brown and his team recommend having your hip replacement performed under “spinal anaesthetic” (like an epidural). This has many benefits over a general anaesthetic (where you have to be put to sleep and have a tube to help you breathe), including a quicker recovery, reduced side effects, etc…

Some patients may be apprehensive about being awake during the procedure, but additional sedation can be administered alongside the spinal anaesthesia to induce sleepiness and unawareness of the surgery. The anaesthetist will discuss these options with you beforehand to ensure your comfort and understanding.

What happens after surgery?

Following the operation, you will be taken to recovery for a period of observation before being moved back to the ward. If all goes to plan, you will be encouraged to mobilise with the physiotherapist the same day (or following day if not possible) with the aid of crutches or a frame. The physiotherapists will teach you how to use the crutches and manage activities following your surgery.

You will undergo routine blood tests and a check XR of your hip to ensure that there are no issues. You will have your vital signs (blood pressure, heart rate, etc…) monitored regularly.

When all of the above is satisfactory, you will be discharged home. Usually this is day 1 following your operation. Some patients will be suitable for discharge the same day (if you are suitable for this service, arrangements will be made in advance). Some patients, however, take longer to recover or to be safe on their crutches, and therefore stay longer. You will not be discharged before you are ready.

Four,Healthcare,Workers,In,Scrubs,Walking,In,Corridor

What precautions do I need to do after the operation?

One of the big risks of hip replacement surgery is dislocation (where the ball comes out of the socket). This is particularly relevant in the first few months following surgery – after this, the body lays down scar tissue and the risk becomes less. Dislocation can occur when the hip gets put beyond certain positions.

You will be given instructions by the physiotherapy team prior to discharge about what movements to avoid to put you at risk of dislocation. In particular, avoid deep bending of your hip and also rotation. If you imagine a line down the middle of your thigh, try to avoid moving your knee inwards. When sitting down, move your legs away from each other rather than together.

What are the risks of surgery?

As with any surgery, there are inherent risks involved. It is important to be aware of these risks before proceeding with hip replacement. While some risks are small, it is crucial to understand them and their potential implications. The risks include:

Z

Bleeding, which may require a blood transfusion. If you have a personal or religious objection to receiving a blood transfusion, please inform Mr Costin-Brown.

Z

Scar. You will have a scar on the outside of your hip, which some patients can find sore, particularly within the first few months after surgery.

Z

Damage to surrounding structures, including nerves, blood vessels and tendons. If a nerve or blood vessel was to be damaged, this may result in weakness and numbness of your leg or loss of blood supply to the leg, respectively.

Z

Dislocation, where the ball comes out of the socket. This can occur in 1-2% of cases and it is important to be aware of positions to avoid following surgery.

Z

Wear / loosening. Over time, the implants can wear down or work loose from the bone. Modern day implants have excellent survival, but if they do wear down or work loose, you may require revision surgery. On average, the chance of your new hip lasting you at least 10 years is around 97%, and at least 15 years around 95%. However, individual circumstances (age, sex, weight, activity level, etc…) affect how long your hip may last.

Z

Blood clots (deep vein thrombosis or pulmonary embolus). You can develop a blood clot in the leg following surgery. This can break off and travel to the lungs / heart / brain and can be life threatening. Around the time of surgery, you will be given blood thinners to thin the blood and minimise the risk of this occurring.

Z

Infection. Infection of a joint replacement is significant. If bugs get around the new joint, they cling onto the metalwork, and are nearly impossible to remove with antibiotics alone, and often require further surgery to remove the implants and put new ones in (either at a single surgery, or over two separate surgeries). Mr Costin-Brown does his utmost to minimise the risk of infection, including clean theatres, sterile implants, meticulous technique, antibiotics, etc… but despite these measures, the average risk is around 1%. Some patients have a higher risks of infection (including patients with diabetes, patients on immune suppressing drugs, patients with obesity, etc…) and Mr Costin-Brown will discuss this risk with you.

Z

Leg length difference (i.e. your operated leg being longer or shorter than the other).

Z

Fracture. It is possible to break your bones when performing surgery, as the implants require a tight fit in order to be secured. If a fracture was to occur, this would be identified and dealt with, either at the time of surgery or soon afterwards.

Z

Further surgery. If you suffer a complication, you may require further surgery.

Z

Anaesthetic risks. There are risks associated with the anaesthetic, and your anaesthetist will discuss these with you prior to your operation.

Z

Death. Hip replacement surgery is by and large a safe procedure. However, there is a very small, but not insignificant risk of death (less than 1%).