The decision to undergo a total hip replacement (THR) is a major one, and a comprehensive understanding of the risks and benefits is necessary to make an informed decision. There are several variables in the surgery that are important to understand as they may affect your rehabilitation and long-term outcome.

Surgical Approach

There are many described surgical approaches used for THR surgery. Dr Spelman utilises both the direct anterior approach (DAA) and the posterior approach. Long term results from either approach are both excellent, with very little difference seen in patients after 6-12 months.

The direct anterior approach utilises a muscle sparing approach where the muscles in the front of the hip are moved in order to gain access to the joint. The DAA uses an incision approximately 8-10cm long in the front of the thigh. Advantages of the DAA are faster short-term recovery and lower dislocation rates. Disadvantages are limited access for complex cases and an increased rate of fracture compared with other approaches. It is ideally suited to slimmer patients without major deformity around the hip joint.

The posterior approach is the most common approach used for THR surgery. It provides excellent surgical access and can be extended down the thigh for complex cases or revision surgery. The initial rehabilitation is slightly slower than the DA approach, requiring hip precautions for 3 months. It is ideally suited to complex cases and larger, more muscular patients.

Bearing Surface

There are several options available with regards to bearing surface for THR. The ball of the hip joint can be made of either ceramic or metal. The liner that is placed in the socket can be made of ceramic or highly cross linked polyethylene (XLPE). Another bearing surface which has gained popularity in recent years is a dual mobility bearing, which has 2 balls within a metal liner.

The recent advances in the manufacturing of the polyethylene means that the longevity has vastly increased compared to previous generations. It has excellent results in the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR). Dr Spelman generally recommends ceramic on highly cross linked polyethylene bearing surface for patients over 65 years of age

Ceramic on ceramic bearing may provide even better long-term results in terms of wear rate, as the ceramic liner effectively does not wear out. The downside of a ceramic/ceramic bearing surface is the potential for the hip to squeak, and a very small rate of fracture of the ceramic liner. Dr Spelman generally recommends this bearing for patients under 55 years of age.

Dual mobility bearings have been heavily marketed overseas as an option that provided greater range of motion and more stability for hip replacements. While it does improve stability in THR, it is generally reserved for patients with an increased risk of dislocation such as those with previous spinal surgery. Recent analysis by the AOANJRR has shown a significantly higher revision rate with the use of this bearing surface for primary THR, and as such Dr Spelman does not recommend it for standard hip replacements.

Implant choice

There are many different designs of implants for use in THR. The AOANJRR tracks all joint replacements done in Australia and provides data on revision rates for all the commonly used implants. The most important decision when choosing the implant is one with a long track record of excellent performance. Patients over 75 have been shown to have a higher revision rate with the use of uncemented femoral implants, and as such Dr Spelman uses cemented implants for all patients over 75.

Risks of Total Hip Replacement

Undergoing a hip replacement is a lifestyle choice that should be decided by the patient at a time when they feel the benefits of surgery outweigh the risks. Dr Spelman will discuss all of the available management options for hip osteoarthritis including both surgical and non-surgical. He will discuss in detail the risks of total hip arthroplasty which include but are not limited to infection, bleeding, neurological or vascular injury, leg length inequality, dislocation, component failure, component malposition, need for revision surgery, periprosthetic fracture, AMI, CVA, DVT, PE and death. You will have time to ask questions which Dr Spelman will answer for you.

What to expect from your total hip replacement?

Initial consultation

Dr Spelman will see you for a consultation to determine your suitability for a hip replacement. The initial consultation will include details about you pain, function, past medical history, allergies and current medications. Examination of your hip will assess your range of motion, leg lengths and assess any contractures around your hip. He will discuss the risks and benefits of THR and give you time to ask any questions you have about the surgery or recovery. He will ensure you have optimised your non-surgical management.

7 days prior to surgery

You will need to stop any over the counter medications such as fish oil. If Dr Spelman has asked you to stop taking your blood thinning or anti-inflammatory medication this will normally be at this time. You will be contacted by the anaesthetist who will review your medical history and current medications. You must inform Dr Spelman and the anaesthetist of any medication used for diabetes to arrange a plan around the time of surgery.

Day of Surgery

You must bring all of your relevant XRs to the hospital on the day of your surgery. You will be given a fasting time by Dr Spelman’s rooms. It is important not to eat or drink after this time as it may result in a delay or cancellation to your surgery. You will present to the hospital at which your surgery is being performed and go through a check in process to ensure everything is in order. After this you will change into a hospital gown and be taken to the anaesthetic bay. Total hip replacement surgery takes approximately 90 minutes, after which you will be taken to the recovery area of the theatre complex and monitored for approximately one hour prior to going to the ward.

Day 1

Dr Spelman will review you and check on your progress overnight. You will be encouraged to walk with the aid of physio and your urinary catheter will be removed once you are mobile. You will be given medication to prevent blood clots (DVT). You will have compression stocking on your legs to assist with DVT prevention.

Day 2-5

You will increase the amount of walking each day. You will require pain relief and may require ice packs for you operated leg. Discharge date is patient dependent, with most patients going home between day 2 and 5. Older patients, patients with difficult access to their house and patients with more complex medical conditions may require a period of rehabilitation after their inpatient stay.

Week 2

You will see Dr Spelman approximately 10-14 days after the surgery to check on the surgical incision and to ensure you have adequate pain relief and are progressing well. Remember to ask any questions you may have at this visit about the expectations for the upcoming weeks. Most patients will be down to a walking stick or single crutch by this point, with some patients walking independently.

Week 6-8

You will see Dr Spelman with an x-ray of your hip to check on the prosthesis. By this appointment most patients are walking independently and are off all pain medication. You will be able to drive a car again from 6 weeks post operatively.

Ongoing follow-up

Dr Spelman will continue to your follow-up with x-rays at regular intervals into the future. This will usually occur every 2-5 years depending on patient and surgical factors.