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Hip Replacement

Total hip replacement is a very successful operation. It is widely regarded as being the most effectively successful operation that orthopaedic surgeons perform. In fact, the World Health Organisation has rated total hip replacement as second only to cataract surgery in terms of cost effectiveness and quality of outcome.

The hip is a joint made of a ball and a socket. The ball is called the femoral head, which is the upper part of the thighbone. The socket is called the acetabulum, which is part of the bony pelvis.

The hip joint allows us to walk and to sit and to climb stairs. It is used when getting in and out of cars. Normally the ball and the socket are perfectly smooth and have very little friction so that there is no pain associated with movement.

The ball and socket of the hip joint can become painful for a number of reasons. The most common cause is osteoarthritis. This is wear and tear type degeneration of the lining of the joint. The hip joint then becomes painful with pain often felt in the groin region. Walking becomes more difficult. Getting in and out of the car becomes troublesome. A walking stick may be needed and pain killers may become necessary.

The hip joint can develop arthritis for a number of other reasons. Childhood disorders can lead to cartilage wear. Inflammation, such as rheumatoid arthritis can be problematic. Trauma, such as from an accident, can result in damage to the hip joint.

Mr Donohue will assess a patient with hip pain by taking a full history and doing an examination. Xrays will be performed. If the worn out hip joint is causing significant pain, which is not relieved by simple measures or a walking stick, then a total hip replacement may be recommended. Occasionally, a Hip Resurfacing procedure may be appropriate. A total hip replacement may also sometimes be necessary for a broken hip (fractured neck of femur).

The total hip replacement is performed under a general or spinal anaesthetic. Mr Donohue performs what is called an abductor sparing posterior approach to the hip joint. This has the significant advantage that it does not interfere with the abductor muscles that help to move and support the hip joint. With this approach the incidence of limp is minimised.

The operation involves the surgical dislocation of the hip joint. The acetabulum (socket) is then prepared and a metal acetabular component is then positioned. A liner is then inserted into that metal acetabular component, which can be made of plastic, metal or ceramic. A femoral component is then inserted into the femur. This may be pressed into the bone relying on the bone to grow into it, or cemented into position. A spherical femoral head component is then placed onto the femoral stem. The ball and the socket are then enlocated and the muscles and tendons and skin is then repaired.

Mr Donohue uses a number of modern modular implants and a number of different bearing surfaces for total hip replacement. This is decided by Mr Donohue in consultation with the patient. The patients age, activity level and the size and shape of the femur help to determine the best implant system. Patients normally start to mobilise on the day following the surgery, and normally return home, or go to rehabilitation, at around the fifth postoperative day.

Total hip replacement is a very successful procedure, but unfortunately complications can still occur. These can involve things such as infection, bleeding, nerve or vascular injury, fracture, dislocation, leg length inequality, and medical complications. All of these complications are rare. Patients receive 24 hours of intravenous antibiotics to prevent infection. Patients also receive blood thinning medication to help to prevent the development of blood clots (Deep Venous Thrombosis). Physiotherapists are involved in educating patients about postoperative precautions.

Mr Donohue would be very happy to see you at any stage should you have questions before or after total hip replacement surgery. He will discuss at length the risks as well as the benefits of the surgery. He will also give you an information pamphlet explaining the procedure and explaining the recovery and possible complications.


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