What is hip replacement?

Hip replacement (also called hip arthroplasty) is a major surgical procedure where the worn out articulating surface of the hip joint is replaced by a prosthetic device. This device is implanted surgically and is designed to replicate the size, shape, and function of your native hip joint.

Who NEEDS a hip replacement?

Hip joints may wear out and begin to cause pain and other symptoms (stiffness, weakness, clicking, limping, and inability to stand or walk for long periods), leading to dysfunction in day-to-day life. If the symptoms are not adequately controlled by simpler measures such as

• pain medications
• activity modification
• physiotherapy etc

then replacing your native joint with a prosthetic one is indicated, as long as there are no medical contra-indications to such surgery. Dr Ihsheish will be able to discuss these with you in detail.

Joints may develop arthritis from so called ‘wear-and-tear’ (also called primary arthritis) which happens over the many years of use, or from other causes such as trauma, infections, inflammation (so called secondary arthritis). Dr Ihsheish will be able to discuss in relevant detail with you the specific disease affecting your joint, and how it has resulted in your specific symptoms.

What is a hip replacement made of?

World-wide there is a very big number of hip replacement prostheses available for use by surgeons, and new ones are constantly coming on the market. The prosthesis has several components, generally with metallic and polyethylene (a type of plastic) or ceramic components.

The metal part is generally an alloy – a mix of different metals that produce a highly smooth surface that has good wear characteristics. The Polyethylene is likewise designed to have similar characteristics, while ceramic is also very smooth and has excellent wear properties. Dr Ihsheish will measure the dimensions of your bones/joint before and during the operation and implant prosthetic components that fit your bones, with the aim of reconstituting your normal hip dimensions, range of movement, and stability, and thereby allowing you to regain normal function.

Dr Ihsheish chooses prosthetic components with the patient foremost in mind, the other consideration is to choose a prosthesis with excellent theoretical and scientific evidence for its clinical performance and constituent parts. Scientific evidence for the latter is constantly being updated which prompts surgeons to keep abreast of the current data and adapt accordingly with regard to their techniques and implant/prosthesis choices. Your prosthesis will be chosen with your specific anatomy and disease in mind, in combination with current evidence and best practice, Dr Ihsheish can take you through these during our consultations.

How TO PREPARE FOR HIP REPLACEMENT SURGERY?

Firstly, it is important that you are clear in your mind about the reasons for your painful symptomatic hip joint, and the indications for such operation in your case specifically. You should talk to Dr Ihsheish about any concerns or questions you have before the surgery, it may also be helpful to read about the condition or operation, and talk to anyone you know who may have had the procedure.

Dr Ihsheish will discuss with you relevant detail at the time of booking your surgery.

You must have radiographs (x-rays) of the joint affected which your surgeon can organise, and you will be required to have blood and other tests before the day of your surgery.

If you have other medical illnesses or are taking any medications, it is important to bring these up during the consultations as certain disease conditions may need  optimisation and certain medications may need to be ceased or adjusted prior to surgery. Please bring a list of these if they are hard to remember.

Please look after your skin, make sure there are no scratches or breaks in your skin and look after your health in general. Try to keep your joint mobile and strong as that will help you have a smoother recovery.

The hospital will contact you before your surgery and provide you with information about fasting (generally you will be asked to fast for six hours before your operation) and medication, when and where to come, and what to bring with you.

Finally, Dr Ihsheish recommends that you keep a written list of questions and bring that with you to the consultation, to make sure you don't miss any important information.

How is HIP REPLACEMENT surgery done?

The anaesthestist will discuss with you the details of your anaesthetic before the operation.

Your surgical team will prepare your hip in the operating room. You will be given antibiotics to reduce the chance of infections. Your skin will be cleaned and sterile surgical drapes used to cover the skin. The operation is performed through an incision over the hip joint. The surgeon will remove the damaged surface of the joint and replace it with a suitably sized prosthesis. At the end of the operation the skin is closed and a dressing applied.

There are different surgical approaches to hip replacement surgery, and you may have heard of "anterior approach", "posterior approach", "anterolateral approach", "posterolateral approach", "two incision approach", and minimally "invasive approach"....The details of these approaches are beyond the scope of this summary, however Dr Ihsheish will be able to discuss with you any questions or concerns you may have and explain to you the differet meanings. Dr Ihsheish is able to use a number of techniques, and will choose one that has excellent long term results world-wide, with the patients long-term outcome foremost in mind.

Dr Ihsheish does not usually use visible skin sutures or wound drains, as he has found them unnecessary, and without good scientific evidence to support their routine use.

The team in charge of your care following the operation, which includes Dr Ihsheish, junior medical staff, nursing staff, physiotherapists, and other allied health staff will guide you and monitor your progress in hospital. You will be encouraged to commence standing and mobilising with assistance on the day of your surgery, and will have physiotherapy daily.

What happens after the HIP REPALCEMENT operation?

From the operating room you will be moved to the recovery room where you will slowly wake up under the supervision of specialised nursing staff. From there you will be moved to the ward where you may spend 3-5 days. During your stay on the ward you will be continually monitored and will commence physiotherapy. You will have various blood tests and radiographs (xrays) as monitoring in this early recovery phase.

When you wake you may notice that you have a small urinary catheter. It is Dr Ihsheish’s preference not to use these tubes routinely, as he believes they have no proven advantage in the current literature, however in certain cases exceptions may be made. If these tubes are present they will generally be removed in the first 1-2 day after the operation.

As mentioned above, you will be encouraged to mobilise and start using your new hip starting on the day of the operation.

All surgery entails some 'surgical pain' unfortunately, this occurs due to tissue damage and although unpleasant, it should be different to your arthritis pain, and should also be noticeably less each subsequent day. The team above, which includes the anaesthetist, will constantly monitor and tailor your regimen of pain medications to make you as comfortable as possible safely.

When do I go home AFTER HIP REPLACEMENT SURGERY?

In general, Dr Ihsheish allows his patients to leave hospital once they have fulfilled these three requirements

• you must be medically stable
• you must be comfortable, such that your pain is controlled with tablets (ie not requiring injections)

And,

• you must satisfy the physiotherapy and nursing staff that you are safely mobile in and out of bed.

Some patients may require more intensive physiotherpy and functional training in rehabilitation before going home (see below).

After leaving the hospital you will have physiotherapy arranged on an outpatient basis. This is a vital part of your recovery aimed at achieving a mobile, strong, and stable joint. A home visit may be arranged prior to your discharge to check your safety at home.

The risk of developing clots is still present after going home, and Dr Ihsheish's patients will be placed on the appropriate anticoagulant medication to reduce this risk. Most commonly Dr Ihsheish uses this in a tablet form that is cheaper and easier to administer than injections, with proven results in the published scientific literature. This treatment is usually for about a month after going home, but the type of medication and duration of treatment can vary depending on your medical background and your usual medications. Dr Ihsheish will discuss this with you accordingly.

Will I require a stay in the rehabilitation ward?

The average hospital stay for joint replacement for patients seen through our clinic is 3-5 days. Please note that there is no pre-determined length of stay for any of these patients, and that every patient’s recovery is different. Dr Ihsheish firmly believes that physiotherapy is a major factor in producing a good outcome, when your pain has improved and you are medically stable the team may determine that a short stint in the rehabilitation ward may be of benefit – rehabilitation aims to give you more intensive physiotherapy and functional recovery training than you would receive on the standard hospital ward.

As well as the usual team looking after you, there will also be a 'Rehabilitation Specialist Physician' in charge of co-ordinating  your rehab ward care.

What follow-up will I have with my surgeon?

Dr Ihsheish will see you while you are in the hospital, and you will need to make an appointment to see him at approximately 2 weeks after the surgery to have your wound reviewed. He generally does not use visible sutures and so there will be no sutures to remove. Follow-up down the line, including any relevant tests, will be arranged for you in due course through the clinic.

How long is the recovery following hip replacement?

In hospital stay is generally 3-5 days.

At two weeks most patients have discarded the crutches, but this is variable for each individual patient.

Physiotherapy will continue for 6 weeks.

Hydrotherapy may commence after 2-3 weeks if your surgeon is happy with the wound.

You are allowed to drive 3-4 weeks after the surgery if you are walking without a walking aid at that time.

You are allowed to sleep on the operated side after six weeks.

It is not unusual to experience some discomfort related to the surgery for several weeks, this should be different to your arthritis pain, and will gradually subside.

What precautions should I take after hip replacement Surgery?

Please note that any precautions you are given are aimed at improving your recovery, and minimising the chance of damage to your new joint.

You will be given precautions by the team looking after you through-out your stay in hospital, and these will be reinforced in the ensuing weeks with your ongoing outpatient rehabilitation/physiotherapy.

In summary, you will be restricted from  -

• bending your hip too far (such as when bending to put on your socks or getting off a low seat)
• crossing your legs over, running early, etc.

The details will be provided while you are in hospital, and please ask Dr Ihsheish if you need any clarification.

Impact loading (running, jumping etc) will be disallowed initially, but some patients are able to return to some form of this if they need to later on.

Dr Ihsheish allows his patients to commence driving once they have discarded their walking aids that they took up after the surgery (walking stick or crutches). For most of our patients this is about 3 weeks but can vary from 2-6 weeks.

What if I have any questions or concerns about my progress?

If you have any concerns it is important to bring them to our attention as soon as possible. Please call out clinic on 6109 0002, or email us on . If you have difficulty reaching us in reasonable time then please contact your family doctor or nearest hospital.

Arthroscopy is a surgical procedure that allows the operating surgeon to visually inspect the joint internally by the use of a small camera.

The surgeon makes small incisions in the skin near the joint (usually less that 1 cm) and inserts a small camera (the arthroscope) to view the joint. In the past the surgeon used to view the joint directly through a small eyepiece, but these days the arthroscope is a fibreoptic instrument that transmits the picture to a large screen in the operating theatre which can be viewed clearly and safely. Pictures or videos can be taken through this instrument and saved for later viewing or record keeping, and to allow the patient to also view the interior of their joint.

Dr Ihsheish can insert similarly small instruments through other incisions and perform many procedures without the need for large incisions.

Examples of what the surgeon can do include taking samples of fluid or tissues for examination, and removal of abnormal tissues and repair or reconstruction of ligaments or cartilage inside the joint.

The advantage of arthroscopy is that it can be performed through very small incisions in the skin, thus avoiding the need for a formal large incision. This should mean less pain and general discomfort, and cosmetically it means less scarring. Many arthroscopic procedures thus allow a more comfortable and faster recovery phase following surgical procedures.
Many joints can be approached arthroscopically these days, commonly these procedures can be done in such joints as the knee, ankle, shoulder, elbow etc.