Hip pain can be caused by many conditions. When pain is caused by a diseased hip joint, hip replacement can be an effective treatment to cure pain, restore function, and return you to the activities you want to do. Arthritis can be a debilitating condition and is becoming increasingly prevalent as our population ages. Our ability to manage conditions of the hip has been refined over decades and improved by modern technologies. Utilising these technologies we are now able to more effectively and accurately deliver patient specific surgical solutions to cure pain and stiffness.
What is arthritis?
Arthritis is simply inflammation of the joint and can be caused by a number of diseases. The most common is osteoarthritis, or wear and tear of the joint. The symptoms of arthritis are pain and stiffness. While arthritis may be visible on x-rays, treatment is only required when your symptoms demand it. When these symptoms stop responding to non-surgical measures, and are sufficiently debilitating, surgical measures should be discussed. Determining when surgery is appropriate is the focus of assessment by Dr Franks and discussion with you.
What is a hip replacement?
Hip replacement is a surgical procedure in which the ball and socket joint of the hip is replaced by an artificial ball and socket. This is designed to remove the pain generating joint surfaces. The artificial parts of the hip replacement are held onto the bone of the pelvis and thigh bone with either a surgical cement or special bone ingrowth surfaces. The hip replacement prostheses are combinations of cobalt chrome, stainless steel, titanium, ceramic and polyethylene.
Do I need surgery?
Just because you have arthritis it does not mean you need an operation. In addition, nobody can simply tell you when you need a hip replacement. It is a decision you make with the help of your surgeon. Like all surgery, hip replacement has risks and should only be considered when those risks are outweighed by the benefits of pain relief and improved function.
What are the risks of surgery?
Like every surgical procedure, hip replacement presents some risks. These risks include infection, fracture, tendon/vessel/nerve damage, instability of the hip joint, leg length discrepancy, blood clots, prosthesis loosening, tendonitis, bleeding, and the risks of undertaking an anaesthetic. The likelihood of any of these occurring remains very low but they are important for you to know about and Dr Franks will discuss these with you at your consultation.
What can I do to delay or prevent Surgery?
There are many treatment modalities available to us that should be undertaken before considering surgery. In many cases, especially in early arthritis, these treatments can delay or even prevent the need for surgery. Non operative measures include: weight loss, pain killers, joint injections, activity modification, physiotherapy, and job retraining. Such treatments aim to reduce the symptoms you have from the arthritis rather than modifying or reversing the arthritis itself.
What approach do I use?
There has been much discussion about the ‘approach’ used for hip replacement. The approach is simply where the incision is made and the anatomical pathway the surgeon takes to get to the hip joint to replace it. The main approaches are posterior, anterior, and anterolateral. Over the many years of medical literature comparing how patients do with each of these approaches, no single approach has proven to be best. Due to differences in anatomy some patients will be better suited to one approach over another.
Dr Franks is trained in all 3 approaches and routinely uses anterior and anterolateral approaches for hip replacement. The best option for you will be discussed with you at your consultation.
What happens after I decide on surgery?
The next step is to get a date for your surgery and this will be discussed at your consultation. You should plan for your family and other supports to be available around the time of your surgery to ease your return home after your operation. We will need to do some planning scans to plan your prosthesis and fabricate your custom guides where necessary. You will also be required to perform some routine pre-operative tests and to see our anaesthetists before your operation. These appointments and tests will be arranged for you.
What to expect on the day of surgery?
On the day of surgery you must be fasted, this means you should not eat or drink from midnight the night before surgery. You will be given a time and a place to attend for admission to hospital and be checked in. Dr Franks will see you before the operation to answer any questions. You will see your anaesthetist to discuss the type of anaesthetic and pain relief plan with you again. After your surgery you go to the recovery ward for usually around 30 minutes and then to the ward where your family may visit.
What happens after surgery?
Immediately following your surgery, the focus of care is to ensure the effects of the anaesthetic wear off completely, and that your post-operative pain is well controlled. You will also get formal post-operative xrays of your new hip and blood tests on the first day after surgery. Once you have recovered from the anaesthetic, and your pain is well controlled, physiotherapy is the next important step. This will start in earnest as soon as possible, usually on the day of surgery or first day following surgery. Your normal hospital stay will last as long as it takes for you to be comfortable on tablet pain killers only, and to be safe to mobilise at home. This usually takes around 4 to 5 days. Occasionally some time in a rehab facility will be required and this will be determined by Dr Franks and your physiotherapists and arranged if necessary. Upon discharge you will be given your medications, including necessary pain relief, and you will be given details of your follow-up appointments. You will be seen at 2 and 6 weeks after your operation to ensure you are progressing well.
Where can I get more Information?
Please bring any questions you may have about the procedure to your appointment with Dr Franks and they can be discussed in detail. If you would like more information, please contact my rooms on 02 9998 8255.
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