Ballarat OSM are specialists in hip surgeries. These include replacement and resurfacing for a number of conditions. Hip surgery is a common orthopaedic procedure and, as the population ages, it is expected to become even more common.
This guide to common surgical options can help you have an informed discussion with your doctor about which type is best for you.
Hip replacement surgery is a great operation in terms of relief of pain, stiffness and disability caused by hip arthritis. Non-operative treatment including weight loss, paracetamol, anti-inflammatory tablets, activity modification and a walking stick, is all some people may need.
Why have a hip replacement?
Hip replacement surgery is performed to relieve pain, stiffness, and disability caused by hip arthritis. The most common reason is osteoarthritis. The pain is most commonly felt in the groin, but some people get the pain in the thigh, knee, buttock, or a combination. The diagnosis is usually confirmed on an x-ray. Most patients come to us having tried non operative treatments such as tablets (anti-inflammatories, paracetamol, glucosamine), and may have tried a walking stick. A cortisone injection into the hip joint may sometimes be appropriate. Some young patients may have other operations that should be considered.
Hip replacement is a commonly performed surgical procedure, many hundreds a year here in Ballarat. The ball and socket joint is replaced with a new artificial joint, implanted into the pelvis, and down the inside of the femur.
We use rapid recovery techniques such as injections placed around the hip joint during the surgery. As a result, our patients are able to mobilise on the day of surgery, and often go home the following day.
Resurfacing of the hip joint represents the fusion of technologies, allowing a thin metal cap to be placed over the head of the femur, and a thin metal socket inserted in the pelvis.
Current technology (used since 1993) allows these to be solidly fixed to bone, show minimal wear, and avoid many of the complications of traditional hip replacement. Many other brands of resurfacing have gone by the wayside, but in our practice we have only use the Birmingham, The preferred patients have good bone quality, are of normal weight, and typically over 170cm in order to fit the preferred sizes.
In well selected patients, advantages include a low incidence of dislocation, and a low incidence of blood clots.
Whilst metal allergy and fractures are rare, patients with risk factors for these are better to have traditional hip replacements.
Advantages of Hip Resurfacing
Some conditions in the hip joint can be improved or rectified under camera control. These are typically younger patients with labral tears, “Cam” or “Pincer” lesions, or loose bodies.
The surgery is undertaken under general anaesthesia, and usually involves an overnight stay in hospital and usually requires time on crutches afterward.
Hip replacements may fail in the long term for a wide variety of reasons, based on the design of the original implant and technique of implanting it. Whilst the revision rate of modern hip replacements is approach 0.5% per year, there are still older style replacements more likely to need re-operation.
Our practice over the last decade has performed over 200 revision operations.
Infection adds a large number of difficulties to fixing a joint replacement that has gone wrong. Some patients are not suitable for single stage surgery, and are better treated with two operations six weeks or more apart.
An infected hip replacement can be like having an infected splinter. It is almost impossible to eradicate the infection without removing the foreign material.
A traditional viewpoint is that the foreign material is removed at one operation, and some weeks/months later, a second operation undertaken to re-implant a new hip replacement (a so called two stage operation).
A single stage operation does it all in one go. The theory is that a new implant and antibiotic bone cement will restore function faster, although six months of antibiotics by mouth are usually necessary as well.
Our practice offers both single and two stage operations based on the individual patient’s circumstances.
Sometimes bone is weakened by tumour. This can cause severe pain and even fracture of the bone. The diagnosis may be obvious on x-ray, or it can be difficult to diagnose. Different surgeons will solve this problem in different ways, often more complex than traditional hip replacement.
The stem down the femur needs to be longer to avoid unexpected failure by the bone breaking, or giving way at the tip of the stem. The pelvis side sometimes needs a reinforcing cage or screws. Both components are usually cemented.