Hip Replacement

What is hip replacement surgery?

Hip replacement surgery describes a procedure where the damaged ball and socket of the hip joint are removed and replaced with new synthetic materials (prosthesis). Also called total hip arthroplasty, this procedure is needed when all other treatments for arthritis related hip pain fail to give adequate relief.

Hip replacement surgery has been performed for over 50 years. Today, it’s one of the most common procedures performed by orthopaedic surgeons – around 40,000 hip replacements are performed every year in Australia. There have been great advances in techniques and implant design and fabrication, which have improved the quality and reproducibility of the surgery. Hip replacement surgery has an excellent success rate.

Our Specialists in Orthopaedic Clinics Gold Coast specialises in total hip replacement surgery.

Do I need a hip replacement?

The decision to have this treatment should be made after assessment and discussion with your orthopaedic surgeon. The decision will always be yours to make and you need to carefully consider all of the information you have received including what the expected benefits are, what the risks are and what the alternatives are.

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How does hip replacement surgery work?

During hip replacement, the worn hip joint is removed and replaced with an artificial implant (prosthesis). There are two components to a hip replacement: the ball and the socket.

Replacement of the ball

The ball of the hip joint is removed and then bone from inside the thigh bone is hollowed out so that a metal stem. A new highly polished and smooth femoral head ball is attached to this. The ball is composed of either highly polished chrome and cobalt alloy or highly polished ceramic.

Replacement of the socket

The hip socket is prepared for a new implant by removing the damaged arthritic layer of worn cartilage and bone. A new socket comprised of a titanium metal shell with highly wear resistant plastic is inserted to replace the hip socket.

Bearing surfaces

There are many options available to make up the moving parts of a hip replacement. The decision to use one bearing over another depends on durability, level of performance, wear resistance, and your personal needs. The bearing itself is not just a single part, but the point where the ball and socket of the hip replacement meet. So the bearing can involve joining of a different combinations of materials.

Materials include:

  • Polyethylene – this is a durable, non-toxic and versatile plastic that is commonly used in hip replacement for the socket side or ‘cup’. The current generation of this polyethylene has increased toughness by creating extra chemical ‘crosslinks’, reducing the level of wear compared to earlier generations of polyethylene
  • Ceramic – the currently-used fourth generation ceramic bearings are made up of a mix of zirconia and alumina. The ceramic is tough, smooth, has a low-wear rate and is non-toxic. Ceramic bearings are used in two configurations – a ceramic ball with a ceramic socket (ceramic on ceramic) or a ceramic ball with a polyethylene socket (ceramic on poly). Both configurations give very low-wear rates
  • Metal – this can be used for the ball of bearing surface. It may be made of either highly polished surgical stainless steel or an alloy of chromium, cobalt and molybdenum.Metal heads are the most commonly used femoral head bearing. In conventional hip replacements, metal heads are combined with polyethylene sockets to make the bearing surface (metal on poly).

How long does hip replacement surgery take?

Each operation is unique, but in general terms, hip replacement surgery takes around 90 minutes.

Where and how big is the scar?

Depending on which approach your surgeon takes, the scar may be at the front, at the side or at the back of your hip. The length of the scar depends on many factors that cannot be predicted.

What to expect after surgery?

It is common to have discomfort after a hip replacement for at least a few weeks. Although it will be very different from the pain from arthritis. Every day your pain, mobility and strength should improve. It is not uncommon to only require simple paracetamol within a few weeks after a hip replacement.

By the time you come for review around 6 weeks following your surgery, you should have minimal pain and be able to walk a reasonable distance with the aid of a walking stick. At this stage joint stiffness, weakness and occasional aching discomfort is common.

Some people experience lower leg swelling after hip surgery. If this occurs, it may take 8 weeks or more to resolve.

What happens during your hospital stay?

The first few days in hospital are a busy time. A team of doctors, nurses, physiotherapists, occupational therapists and other hospital staff will work with you to help you recover. You will also be given medication to treat any pain. Whilst each person has a different timeline our goal is to get you home 2–5 days after surgery.

Your therapists will teach you how to get around safely, give you exercises to strengthen your hip and monitor your progress. Typically, you can expect to take the first steps on your new hip on the afternoon of or morning after the surgery.

Some people do need more intensive therapy than can be done at home. If this is the case, there is an option of going to a rehabilitation unit before going home.

By the time you leave hospital or rehabilitation unit, you should be progressing well in regaining your mobility and can get around safely.

Hip replacement recovery timeframe

The usual hospital stay is 2–5 days, but full recovery typically takes 3–6 months.

To protect your hip in the first 6 weeks, there will be specific do and don’t list that your physiotherapist will go through with you. Sometimes it is necessary to have certain aids to assist you during the early days.