Hip replacement

For more information, see also Anterior Approach and Hip Resurfacing

What is a Total Hip Replacement?

Total Hip Replacement (THR) involves replacing the damaged and worn hip with an artificial joint (prosthesis). Hip replacements may be manufactured using a combination of materials, including metals, ceramics, wear resistant polyethylenes and acrylic polymer cements. My recommendations for the type of hip replacement device used and the surgical technique employed for the conduct your procedure are made after assessment of your specific requirements.

What are the benefits of hip replacement?

For people with hip arthritis, joint replacement is an effective and reliable method of providing exceptional pain relief. Hip replacements are very durable, with bearing surfaces that are highly wear resistant. The chance of a hip replacement failing before 10 years is less than 5%. Many hip replacement devices are lasting longer than 20 years in greater than 80% of patients.

What sort of anaesthetic will be used?

Hip replacement may be performed using general anaesthetic (put to sleep), regional anaesthetic (epidural or spinal nerve blocks), or a combination of these techniques. Most patients under my care recieve a general anaesthetic togther with a combination of techniques using  long acting local anaesthetics introduced directly into the wound. Typically these techniques provide good pain relief, allowing patients to walk within 4-6 hours of their procedure.

Our anaesthetists are Dr Steven Cook, Dr Patricia Tucker and Dr Nathan Peters. Your anaesthetist will be allocated when your procedure date and theatre times are confirmed - we can provide you with provisional details when you initially book your procedure.

What is the best type of hip replacement for me?

Choosing an implant is a little like choosing a motor vehicle - there are many hundreds of different models to choose from. Not all people wth osteoarthritis have the same requirements in terms of joint replacement design. The decision regarding what type of joint replacement is best suited to your needs is determined by many factors, including bone anatomy (shape/ size/ density), anticipated activity levels (nature/ volume), the pattern of arthritis wear and your age. In my opinion, selection of the type of hip replacement used should not be a "one size fits all" approach. Prosthesis implant selection is an individualised decision that takes into consideration the specific requirements of the person being treated.

How can the hip replacement implant be individualised to my requirements?

At the time of booking your procedure, I will recommend a preferred implant design to best suit your requirements. When conducting your hip replacement, a large selection of different implants of the chosen design are made available (Figure 1). The multiple options of size, shape and other features within any one implant design allows the construction of literally thousands of combinations to individually enable accurate restoration of leg length, muscle tension, dislocation resistance and joint mechanics. 

I have created a short video that explains how a hip surgeon can customise joint replacements using modern implant instrumentation and implants (link).

In situations where very abnormal bone shape or bone deficiency is present (for example due to severe trauma, childhood deformity or previous surgery) custom patient matched implants can be manufactured using processes such as 3D printing.

Figure 1: Implant inventory for the conduct of a Total Hip Replacement. A large number of individual parts with different shape, size and material options allow the surgeon to assemble an implant specific to the individual requirements of each patient. The vast majorty of people with hip osteoarthritis are suitable for management with modular hip hip replacement designs such as this.

How long will it take to recover?

Typically you are permitted to place your whole body weight onto the hip and walk with assistance within 4-6 hours of your operation. Physiotherapy will be conducted twice daily while in hospital. Prior to discharge, you will be given ample instruction and practice on how to best perform daily functional activities (for example stair climbing and getting into the passenger seat of a car) (Figure 2). Hospital stay is usually 2-3 nights.

Crutches are recommended for comfort for 2 weeks after the procedure and can be discarded when you are confident. Many people like to use a single crutch or cane in the opposite hand for a few weeks longer. Depending on your occupation, you will require 2-6 weeks off work. You can be driven in a car as a passenger immediately on discharge from hospital. Patients managed by anterior approach techniques can drive a car when they feel confident, but no earlier than 2 weeks after their procedure (4 weeks for posterior approach procedures).

Aeroplane travel of less than 6 hours in duration can be undertaken immediately. For regional or interstate patients I recommend staying 1-2 nights longer in hospital (or alternatively staying in a hotel in Brisbane) prior to flying back home. Many patients leave for the airport directly from hospital. 

Figure 2: Before leaving hospital, you will be receive instruction in how to easily manage every day functional activities such as stair use and and getting into and out of the passenger side of a car.

How do I best prepare for surgery?

Generally, people who are better prepared for surgery have a lower risk of developing complications and enjoy a easier recovery process. There are many ways in which a patient can better prepare themselves for surgery. The following is a short list of the common recommendation I make in preparation for undertaking surgery (but by no means exhastive):

- Make an appointment with your physiotherapist for a pre-surgery exercise program ("pre-hab")

- Ask your physiotherapist to show you how to use crutches over stairs

- Reduce of quit smoking (even just for a short time makes a difference)

- Weight loss (consider professional assistance from your GP or weight management centre)

- Well balanced diet with reduction in alcohol consumption

- Wash in Phisohex 1% (or chlorhexidine) for 5 days prior to surgery

In addition, many of our patients are managed with an online health education resource and therapy program known as HealthLnx. Typically the Brisbane Hip Clinic Joint Replacement Carepac on HealthLnx starts 3 weeks prior to surgery and outlines a number of pre-surgery health initiatives that will assist in your recovery.

What medications do I cease before hip replacement surgery?

I typically recommend you continue all your usual medications, with the exception of blood thinning agents or medications that may increase the risk of clot formation (DVT). Please note that many over the counter (non prescription) and complementary/ herbal preparations may also cause strong blood thinning effects. If you have any questions about any particular medication or preparation, please contact the clinic. The following is a list of medications that should usually be ceased before surgery (but not exhaustive):

Warfarin (contact office for instructions)

Plavix/ CoPlavix (contact office for instructions)

Xarelto (contact office for instructions)

Fish Oil/ Omega 3 (cease 3 weeks prior)

Supplements - Ginko, Ginsing, Garlic (cease 3 weeks prior)

Hormone Replacement Therapy (HRT) (cease 3 weeks prior)

Oral Contraceptive Pill (OCP) (cease 3 weeks prior)

Please note: Aspirin 100mg tablets, taken on advice from your doctor, for the management of a known heart condition or after stroke SHOULD BE CONTINUED.

Is a rehabilitation unit available for after the surgery?

For people who require greater than 2-3 nights hospital admission, a rehabilitation unit admission at St Andrews War Memorial Hospital. Alteratively a rehabilitation unit closer to your home can be arranged with advance notice. Most people do not require rehabilitation unit services, but they can be easily arranged if required.

Does Dr Weinrauch perform Direct Anterior Approach (DAA) Hip Replacement?

Yes. In suitable patients, Direct Anterior Approach hip replacement provides advantages in terms of accelerated recovery and a lower dislocation rate. Further information is available by following this link. Anterior Hip Replacement

What are the risks of hip replacement?  

Hip replacement surgery is very safe, and serious complications are uncommon. Serious wound infection occurs in less than 1%. Dislocation occurs in less than 1% of people managed by direct anterior approach hip replacement (3% for posterior approach). Clots can form in the veins of the leg (deep venous thrombosis 'DVT'), which on rare occasions may dislodge and travel to the lungs causing breathing difficulty. Many patients with hip arthritis have a short leg on the effected side, which is corrected during surgery. Occasionally it is not possible to make the leg lengths equal, particularly if very large length discrepency is present before surgery. I will discuss the risks of the procedure with you in detail prior to the operation.

Longer term, what activities can I perform after hip replacement ?

Once you have recovered, there are very few restrictions on activity after hip joint replacement. Impact pursuits such as running cannot be performed for 6 months after surgery. Actvities such as walking, cycling, skiiing, tennis & tennis may be conducted without limitation. Your suitability for returning to running activities depends on the nature and volume of the sport you are undertaking and the type of prosthetic implant selected. Some activities may place the joint replacement at risk (for example extremes of joint flexion and rotation in some advanced yoga postures) - if you are unsure please check with us prior to re-commencing. 

Is long term surveillence required ?

I usually recommend life-time surveillence of your hip joint replacement is conducted by intermittent X-Ray evaluation and clinical review. A standard surveillence program typically involves clinical assessment every 5 years. 

Related publications

This information handout has been written by A/Prof Patrick Weinrauch for the purposes of patient education. The details provided are of general nature only and do not substitute for professional recommendations based an individual clinical assessment. © A/Prof Patrick Weinrauch. Brisbane Hip Clinic. 11/16.