Hip replacement surgery is performed for a number of conditions but the commonest is osteoarthritis. Osteoarthritis is often thought of as age related wear and tear. It is a disease which affects the whole joint including bone, ligament, muscle and of course cartilage. Other conditions which may require hip replacement include hip dysplasia, avascular necrosis, and hip fracture.
Hip arthritis causes pain and stiffness. It often comes on gradually. Typically pain is felt in the groin or thigh. It sometimes causes knee pain. Pain can be worse with activity but may also be present at rest including in bed at night. Pain may limit how far you can walk and make it difficult to perform your normal activities such as golf, bowls, tennis or surf. Joint stiffness may cause you to walk stooped over which can secondarily affect your lower back. It may become difficult to bend over to put on a shoe and sock.
The aim of hip replacement surgery is to relieve pain and restore function to enable you to walk, sit, sleep and perform your activities of daily living and leisure activities more comfortably. The surgery aims to improve your quality of life.
The procedure can be done through a number of “approaches” including anterior, posterior or anterolateral. Each approach carries it’s own risks and benefits. Although surgeons like to take credit for it, early mobility depends more on the anaesthesia than the surgery. The Australian National Joint Replacement Registry has been collecting data for over 20 years on every hip and knee replacement performed in Australia. The evidence now shows that hip replacements done through an anterior approach have a significantly higher rate of the hip failing and requiring a major revision compared to a posterior or lateral approach (see fig. HT50). As can be seen in the graph, the higher the line rises, the higher the revision (failure) rate.
Once the joint is opened the worn ball and socket are replaced. Many different types of prostheses and bearing surfaces are available and the Australian National Joint Replacement Registry data also helps guide your surgeon in selecting the most appropriate components for your hip.
Dr Freihaut, along with his anaesthetic team, pioneered the use of rapid recovery joint replacement in Northern New South Wales, a technique now used in various forms throughout the country. Early mobilisation reduces your risk of complication and allows faster return of function.
If you have significant pain which is no longer responding to other forms of treatment such as exercise and medications, or you are struggling to work or look after people who depend on you, you may need to consider a hip replacement.