Hip replacement is a common operation in Australia and other developed countries around the world. It was pioneered by Sir John Charnley in England in the 1960s and can be hugely beneficial to people suffering with hip arthritis.
Hip replacement involves making an approach through the muscles and soft tissues around the hip and removing the head of the femur (thigh bone) and the surface of the socket of the hip joint. The socket is replaced with a new socket made of a combination of metal and specialised high-density plastic. The head of the thigh bone is replaced with a ball sitting on a stem fitting inside the shaft of the bone. The muscles and tendons are then carefully repaired and the skin closed. The operation takes a little over an hour.
Success rates of hip replacement surgery are very high and in general it provides excellent pain relief and functional outcomes.
In Australia the National Joint Replacement Registry stores the results of all hip replacement surgeries and their report can be accessed on the link here : Hip, Knee & Shoulder Arthroplasty Annual Report
Commonly Asked Questions About Hip Replacement:
- What approach is used to the hip?
There are a number of commonly used surgical approaches to the hip. These can be divided into direct anterior, anterolateral and posterior approaches. Each of these approaches have their own advantages and disadvantages. Anterior approaches have been heavily marketed but there is no convincing evidence that they lead to better results than the other approaches. My preference is to use the anterolateral approach which provides some of the advantages of the anterior approach in a very low risk of dislocation but also has the safety of a low risk of fracture or other complications which can occur with the anterior approach.
- Are there concerns with metal on metal hip replacements?
There were issues in the past with hip replacements requiring metal articulations. These are only very uncommonly used now in Australia. Personally, I have never implanted a metal on metal hip replacement and so the concerns about metal ion levels and metal poisoning should not be an issue for any of my patients.
- How long will I be in hospital?
Hospital stay can be quite short for people who are fit and motivated. The average stay for our patients is 3-4 days in hospital. Some patients choose to go to a rehabilitation unit after the surgery if they feel they will not be ready to go home after the first few days. This can be organised with the rehabilitation specialists we work with.
- Will I be very sore after the surgery?
The first day or two after surgery the hip can be quite sore. The anaesthetist will use local anaesthetic blocks to minimise the postoperative pain and a combination of different painkillers taken in hospital will also help. Pain after hip replacement generally settles quite quickly and we would not expect people to be taking strong painkillers for more than a few weeks after the surgery.
- What are the risks of surgery?
There are a number or surgical problems that can be encountered. Some of these include:
Difference in the leg lengths after surgery, fractures of the bone around the hip, dislocations of the joint and infection. It is also possible to have medial issues such as blood clots or issues with kidney or heart function. All of these issues are rare. The overall chance of needing a repeat surgery as documented by the National Joint Replacement Registry is approximately 0.5% per year after the surgery.
The gluteal muscles ("glutes") are major muscles attaching the pelvis to the thigh bone. They drive rotation of the hip, abduction (moving away from the midline) as well as extension and some flexion.
The largest gluteal muscle (gluteus maximus) is attached to the thigh bone through a very strong tendon and this is rarely damaged. The gluteus medius and minimus are two smaller muscles and the tendons attaching them to the thigh bone can tear. This often happens by a slow process without a specific injury.
The torn tendons can be very painful around the outer aspect of the hip.
Surgery to repair the torn tendons can be performed either with or without a tendon augmentation. The surgery involves an incision on the side of the hip and re-attaching the tendons to the bone. Normally we expect people to stay in hospital overnight after the surgery.
Post operatively we will recommend a single crutch in the opposite hand for 6 weeks to take the pressure of the tendon repair while it heals.