Authors

Dr Keran Sundaraj MBBS, MSc (Trauma), FRACS, FAOA

With age, the weight-bearing surfaces of the hip joint become worn away. They are no longer smooth and free running, and this leads to stiffness and pain. Eventually, the joint wears away to such an extent that the bone of the acetabulum (pelvis) rubs on the head of the femur. A total hip replacement replaces these surfaces with a new ball-and-socket joint. The femoral replacement is a metal stem that fits snugly inside the femur (thigh-bone), with a metal head (ball) on the top. The acetabular component (socket) is a metal shell with a polyethylene liner. Thus the hip is ‘replaced’ by a metal and plastic joint. 

What is Involved in Total Hip Replacement

To be able to replace the hip joint, a 20cm incision is made down the side of your hip. Muscles are released to gain access to the arthritic joint. Specialised instruments are used for shaping of the bone so that the joint replacement components sit snugly in the bone. Bone cement may be used to hold the components in place.

Laboratoires Servier, CC BY-SA 3.0 <https://creativecommons.org/licenses/by-sa/3.0>, via Wikimedia Commons

What is involved for you as a patient

Before admission into hospital: You will need to book your surgery in our rooms. You will receive a package of information from us containing your admission, consent and questionnaire forms, which need to be completed and sent to the hospital. You will need to attend a preadmission hospital clinic before your surgery. At this time, you will be assessed by an Anaesthetist. You should also inform Dr Sundaraj and the Anaesthetist of any medical conditions or previous treatments as this may affect your operation. You will also meet the nursing staff and physiotherapists to discuss your admission and treatment. Before the operation, any allergies you may have to medications, bandages and ointments should be brought to the attention of the Surgeon. You should stop arthritis tablets (anti-inflammatories) for one week before surgery as they increase bleeding. Please notify your Surgeon and Anaesthetist in advance if you are taking any anticoagulants (blood thinners), hormone tablets or suffer from diabetes. You should inform your Surgeon, and your Anaesthetist of any medical conditions or previous treatment as this may affect your operation. You must contact our office before you go into hospital if there is any evidence of pimples, ulcers, or broken skin around the area to be operated on OR if you have a cold, cough or infection evident. You must check with the doctor whether you need to stop taking any of the medication before your surgery. 

Admission into Hospital: 

You are admitted to the hospital on the morning of the surgery. The staff at the hospital will call you and let you know your admission time. You will need to take all relevant x-rays, current medications and their prescriptions. When you wake after surgery, you will be in the recovery ward. From here, you will be transferred back to your ward. Your hip will have a waterproof dressing on it, and a drip will be in your arm. The drip makes up for the lost fluid, which may have occurred in your operation and is used to dispense blood or drugs that you may require. The drip is usually removed 48 hours after surgery. You will be given regular pain relief in the form of an injection or tablet as needed. 

After Surgery

The recovery from the operation requires about 2-4 days in the hospital. On the evening of your surgery, your physiotherapist will begin to assist you to get out of bed and walk a small distance. Early mobilisation will help with your recovery. This will be progressed over the following days until you are independently mobile. You will be taught exercises to improve the strength of the muscles and regain the range of motion of the hip. The exercising and mobilising of the hip will cause some discomfort and swelling; however, this is normal and is just part of the healing process. If pain is preventing you from exercising effectively, you should discuss this with Dr Sundaraj. The swelling takes typically a few weeks to subside.

After your hospital stay

The hospital staff will organise your rehabilitation to continue after being discharged from the hospital, either staying in a rehabilitation unit or going home. You will generally be able to leave with the aid of a single walking stick or crutches. If you are located close to the Mater hospital, they may arrange for you to return there for treatment during the day. While at home you should continue your exercises, as well as walking regularly. If you develop a fever or the wound becomes red or painful at any stage, you should bring this to the attention of our rooms immediately. It is usual to be reviewed by Dr Sundaraj at 6-8 weeks after surgery, with new x-rays.  

Potential Complications Related To Surgery

• Dislocation: As muscles are released to gain access into the hip, there is a risk of the hip dislocating. This risk reduces significantly over time as scar tissue forms. ‘Hip precautions’ will be explained by your physiotherapist. These are safe positions that allow you to return to everyday life and prevent your hip from dislocating.

• Deep vein thrombosis and pulmonary embolus: A combination of immobilisation of the limb, smoking and the oral contraceptive pill or hormonal replacement therapy multiply to increase the risk of a blood clot. Any past history of blood clots should be brought to the Surgeon's attention prior to your operation. Prevention of deep vein thrombosis involves a rapid recovery program, with patients getting out of bed within 24 hours following the surgery and the administration of anticoagulants which are continued for weeks following your surgery.

• Bleeding: Excessive bleeding resulting in a haematoma can occur following total hip replacement surgery. This sometimes results in wound breakdown and the need for re-suturing of the wounds. This happens in less than 1% of total hip replacements.

• Infection: Surgery is carried out under strict germ-free conditions in an operating theatre. Antibiotics are administered intravenously at the time of your surgery. Despite these measures, following surgery, there is a less than 3% chance of developing an infection. Most commonly, these are superficial wound infections that resolve with a course of antibiotics. More severe infections may require further hospitalisation with surgical and prolonged antibiotic therapy.

Frequently Asked Questions

Q. How long will the new hip last? 

A. New materials and techniques in the past 10-15 years make it difficult to forecast; current models have an excellent chance of lasting more than 20 years. This is dependant on age, level of activity and a complication-free post-operative period. 

Q. What is the prosthesis made of? 

A. The metal component of the prosthesis is made from cobalt-chromium and the lining from high-density polyethylene. 

Q. How long do I need off work? 

A. This depends mainly on the type of work you do. After the time in hospital, you may need a few weeks to recover and settle down before returning to light duties. You should not attempt work requiring a great deal of moving around for 6-8 weeks. 

Q. When can I travel? 

A. You can travel from the 6-week mark following review. 

Q. Can I play sport following my total hip replacement? 

A. Sporting activities following total hip replacement surgery do put increased loads through the total hip replacement. More vigorous sports that involve running and pivoting apply increased loads than walking. Taking up sports following a total hip replacement that have not been performed for many years is usually not recommended. Following a total hip replacement, resuming sports that have been performed in the days leading up to the total hip replacement surgery should be allowed within reason. You should discuss these sports with Dr Sundaraj to establish a reasonable time frame for them to occur. Returning to golf, doubles tennis, sailing, or lawn bowling usually can be managed after 8 weeks, and an appropriate rehabilitation program has been completed. 

Q. Do I need antibiotics before going to the dentist after a total knee replacement? 

A. Antibiotic prophylaxis is not usually necessary before dental treatment unless advised by your dentist. Patients are strongly recommended to undergo a comprehensive dental examination (including radiographs) before undergoing joint replacement surgery. Postoperatively, early recognition and treatment of any infection are important to prevent infection to the prosthesis.

As with all operations, if at any stage anything seems amiss, it is better to call for advice rather than wait and worry. A fever, redness or swelling around the line of the wound or an unexplained increase in pain should all be brought to the Surgeon's attention. You can contact Dr Sundaraj by telephoning his staff during business hours or the Mater Hospital after hours. For any questions, please do not hesitate to contact our staff (02) 9437 5999 For after-hour assistance contact Mater Hospital (02) 9900 7300 Further information is available on our website