Hip Arthritis

Overview

Hip arthritis is a very painful and disabling condition. Typically the smooth lining of the hip joint (the cartilage) is lost, resulting in the painful rubbing of bone on bone. A Total Hip Replacement is when both the socket of the hip joint (the acetabulum) and the top of the femur (the femoral head) are replaced with a new socket and a new head (a ball in socket joint). By replacing the bone rubbing on bone, this should alleviate your pain.

Non-Surgical Treatments

The non-surgical treatments for hip arthritis are limited. Weight loss is very important. Glucosamine and Chondroitin Sulphate which are available over the counter in your chemist, can often dampen down soreness and stiffness. Please chat to your pharmacist regarding this ‘over the counter’ medication. Physiotherapy to strengthen your hip joint and maintain range of motion is helpful. Appropriate use of painkillers is vital; starting with Paracetamol on an “as needed” basis, increasing to a “regular” basis, with the addition of an anti-inflammatory with the guidance of your GP.

Hip replacement is only indicated when pain is affecting your Quality of Life, despite taking appropriate painkillers and having tried the non-surgical treatments.

Surgical Treatments

1. Total Hip Replacement

 The hip joint is a “ball in socket” joint. A total hip replacement is when the socket of the hip joint (the acetabulum of the pelvis) and the top of the thigh bone (the femoral head or ball) are replaced with a new socket and head (a new ball in socket joint). By replacing the bone rubbing on bone, the pain should be alleviated.Thankfully, 95% of patients are satisfied with their hip replacement operation. However, there is a 5% (or 1 in 20) risk of a complication with hip replacement surgery, so surgery needs to be considered very carefully.

Complications of Total Hip Replacement Surgery

Infection is a potentially very serious complication and occurs in 1 – 2% of patients. We will take all the possible steps to limit your infection risk.  It is important to tell us of any infections you may have, such as urinary tract infections, a tooth abscess or painful in-growing toe nails. All infections need to be treated prior to having your surgery.

Dislocation occurs in 1-2% of patients – this is when the ball pops out of the socket. We spend lots of time showing you the correct way to move, dress, etc. Crutches are very important for the initial six weeks, to help your balance and to avoid putting all your weight through the new hip.

Venous thrombosis (leg clots) which can travel to your lungs (pulmonary embolus) occur in <1% of patients. We will prescribe Aspirin 150mg daily for 4 weeks, we encourage early active mobilization and ankle exercises to reduce the risk of a clot.

Leg Length Discrepancy (one leg longer than the other) can occur after hip replacement. Typically the arthritic hip shortens the affected leg length and on occasions restoration of equal leg lengths can be difficult. Occasionally heel lifts on shoes may be necessary to rebalance your leg lengths.

Sciatic nerve injury The sciatic nerve can be stretched or injured during hip replacement surgery.

Wear of your new mechanical hip joint slowly happens over time, at a rate of 1% per annum. The world literature suggests that 90% of hip replacement will survive for 20 years.

2. Revision Hip Replacement

Revision hip replacement is when part or all of your prosthetic hip needs to be revised or replaced. Failure typically arises from normal wear and tear of the implant over time. Other reasons for revision surgery are if the hip replacement was unstable (causing recurrent dislocations), loose in the bone secondary to infection (causing residual ongoing pain) or if the implant became infected causing pain and needed to be removed.

Surgery – What to expect?

Before Surgery

Joint School:

This is a free educational programme run by UPMC/Whitfield, aimed at preoperative education and answering any and all the questions you may have. Patient satisfaction rates improve, when patients understand more about their surgery and have set realistic expectations.

Pre-Assessment Unit:

All patients need to attend the pre-assessment unit prior to their surgery, for routine pre-operative blood workup and risk assessment.

Showering:

Prior to admission, I recommend you shower twice a day for three days, cleaning the skin about your groin gently with normal soap. We also advise a shower when admitted to Whitfield Clinic.

Hospital Stay

Patients are typically admitted on the morning of their surgery and the majority of patients are in hospital for 2-5 days, while working with physiotherapy. Before theatre, you will be fasting, so we may give you a sugar drink. You will also receive some pain-killers (pre-emptive analgesia) before coming to theatre. Most patients will have a spinal anaesthetic and sedation so don’t worry – you will not hear any noise in theatre!

We will start you walking the next day, using 2 crutches, with the assistance of our physiotherapist and nurses – partial weight bearing through your new hip joint. Please bring loose comfortable clothes that you can wear about the ward, with appropriate safe footwear (avoid loose slippers!)

Upon Discharge

You can be discharged once your pain is controlled and you have reached our physiotherapy targets including safe use of crutches on stairs. You will be given a prescription for pain relief and Aspirin and we will see you 10-12 days after the surgery for wound inspection. Once your wound is healed, you can exercise in a pool or on a stationary bicycle.  It is okay to sleep on either side with pillows between your knees. Everyone is sore initially, but in general the pain is very manageable with routine painkillers.

You must use your two crutches, until I see you again at 6 weeks with new radiographs. I suggest it is best to have someone at home with you for the first two weeks and I do not recommend driving until you are off both crutches.

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