Total hip replacement is the operation performed for all types of hip arthritis. It is a reasonably big operation and many types of prostheses and surgical approaches are employed to achieve a good result.
A total hip replacement is recommended when your pain is due to hip joint arthrosis and has progressed to a level that your function and general well-being are so seriously affected by pain and limitation of hip movement.
When you have decided to have a total hip replacement, it is important that you maintain your mobility as best you can to keep fit, keep your chest clear and to take good care of your skin. Don’t let the cat scratch your or thorns from working in the garden. It is essential to practice on crutches or walking frame or whatever walking aid may suit you as you will need to use this in the early post-operative period.
Your hip replacement is done through what is called a direct lateral approach (DLA). There are many approaches to the hip to do a hip replacement. The advantage of the DLA is that it enables us to deal with any pathology of the hip tendons which are often worn (25% of cases) and if these tendons are not repaired, some pain may persist. As well, it is possible to effect a very good repair of these tendons during wound closure. It gives us excellent exposure of the joint enabling us to implant your new hip in the correct position. We use an Exeter/Trident prosthesis which is cemented into position on the femoral side. This implant has excellent long term follow-up and issues of metal toxicity and early implant failure have not been seen with this device and 30 year results have been published with up to 97% retention rate.
In the early post-operative period, you will be required to mobilise while avoiding putting any significant weight on your operated leg. No doubt some of your friends will say to you “my family member was able to walk on theirs straight after the operation how come you have to use crutches?” This is done for a very good reason. It is essential for the soft tissues around the hip to heal in their normal position to ensure good stability of the new hip. The strength of the muscles is greater than the strength of the repair and early weight-bearing can result in the repair failing. This leads to more pain and more importantly, increased risk of dislocation. Once the soft tissues have healed, no restrictions at all are required. You can treat your hip like it is a normal one.
In the immediate post-operative period, you will be using sequential calf compression to reduce the risk of a blood clot and be started on aspirin as well. Antibiotics are administered in the operating room. You will be given an incentive spirometer to exercise your lungs to keep your chest clear while you require strong pain medication. Your wound is closed with absorbable staples so after 10 – 14 days you may take your water proof dressing off, wash the wound in the shower and remove the steri-strips. After that you may leave the dressing off and let the wound dry out.
After leaving hospital, arrangements can be made for you to go to a specialist rehabilitation centre. Most patients are well enough to go straight home. While weight-bearing on the leg is not advised, it is desirable for you to move around as much as possible on the walking aid to maintain good muscle tone. After five weeks, weight-bearing commences by graduating to 25% weight and then at six weeks to one crutch on the opposite side of the operation, then onto a stick and finally full weight-bearing unsupported. The best exercise by far to train your hip muscles is walking on flat ground. However, physiotherapy, hydrotherapy and a dedicated home exercise programme will help to restore your normal tendon and muscle function more quickly. Initially the muscles become quite sore because they are weak and unfit but this improves with regular exercises.
All surgeries have risks and the bigger the operation the more is the risk. The important problems for which strenuous precautions are taken in the peri-operative period are blood clots in the legs and less frequently in the lungs (pulmonary embolus), infection of the implants, nerve injuries, leg length inequality and dislocations. This is not all that can happen but would be the problems that occur directly related to the surgery. Exacerbations of pre-existing health problems which affect you such as heart arrhythmias, diabetes, strokes or gout can be made worse. It is essential in your pre-operative visit to mention any of these problems you may have so all precautions can be taken to minimise any risks from them.
There are many treatment alternatives proposed to deal with the pain of an arthritic hip, including exercise, physiotherapy, medications, chiropractic, homeopathy, naturopathy and mindfulness but none of these has ever been shown to be as effective as an operation in dealing directly with the problem in your hip.