Hip Replacement

• Hip replacements are categorised into two common approaches: DAA (Direct Anterior Approach) and Posterior Approach. Both can be performed through smaller incisions in suitable patients.
• Minimally invasive hip replacement aims to minimise the impact of the surgery on healthy tissues such as muscles and blood vessels.
•  The DAA approach is gaining popularity in Australia due to less post-operative pain and a quicker recovery.
  The DAA is a different approach to the longer established hip replacement approaches through the side (lateral approach) or the back (posterior approach).
• Your age, weight, health level and other factors will help Dr Markham decide which procedure is best suited for you.

• Hip replacement is an operation to replace a damaged part of the hip joint with an artificial component.
• This procedure can help reduce hip pain and improve your mobility.
• Dr Markham may recommend a hip replacement if your hip damage is severe enough to affect your life and other treatments have not worked.
• In a total hip replacement (also called a total hip arthroplasty), a surgeon removes the damaged part of the hip joint and replaces it with a metal, ceramic, and rigid plastic component. This artificial joint (prosthesis) helps relieve pain and improves the function of the hip.
• Hip replacement can be completed in less than two hours.
• After surgery, you will be moved to a recovery area to wait for a few hours until the effects of the anaesthetic wear off.
• The medical staff will monitor your blood pressure, pulse, acuity, pain or comfort level and the need for medication.

• In 2021–22, 53,500 knee replacements (210 per 100,000 population) and 35,500 hip replacements (140 per 100,000 population) were performed to treat osteoarthritis. (AIHW, 2024)
• People across the world of sport and beyond have chosen to have hip surgery to prolong their careers and improve their quality of life. These include wrestler Hulk Hogan, gold medal-winning Olympic gymnast Mary-Lou Retton, and Team GB triathlete Michael Rix.
• While over $3.5 billion per year is spent on osteoarthritis, overwhelmingly for hip and knee replacements, escalating pain and disability from arthritis will have a major impact on the workforce – particularly where people engage in active or standing roles – such as teachers, construction workers, nurses and carers.
• “Osteoarthritis is a major cause of disability and chronic pain in Australia. The findings in this study are significant, as these risk factors can be screened for in a biomechanics lab and are modifiable through certain therapies.” says PhD candidate Ms Nicole D’Souza.

If your quality of life is affected by hip pain, a hip replacement may be necessary.
Signs of reduced quality of life include:

• Severe hip pain that cannot be relieved with medication and that interferes with your work, sleep, daily activities or quality of life.
• Hip stiffness that restricts movement, making it difficult to walk or perform other daily activities such as putting on shoes and socks.
• Inability to participate fully in your favourite activities.

• After surgery, you will be encouraged to get up and walk around as soon as possible. Patients with no other health problems can go home as soon as they can walk, climb stairs and get in and out of a car.
• Some patients may need to stay in the hospital for a few days. You can go home after 3 to 5 days, sometimes sooner. Most people are encouraged to walk with the help of a walking brace soon after surgery. You will be advised on how to care for your new hip and avoid dislocation of the hip.
• Everyone’s recovery is different, and you will need rehabilitation, including physiotherapy and occupational therapy, to strengthen the new joint and improve mobility.

• Most people can resume normal activities after about 6 weeks, although some patients report ongoing improvement up to 12 months after surgery.
• The new hip joint can eliminate all pain and significantly improve mobility. Many patients report forgetting they’ve had a hip replacement once they have fully recovered.

Hip replacement surgery is considered safe and effective with common side effects including pain for a few weeks.

However less common complications include:

• Infection
• blood clots (deep vein thrombosis, or DVT)
• Hip dislocation

Leg Length discrepancy (Feeling one leg is shorter than the other)

• Swelling and stiffness
• Persistent pain from trochanteric bursitis

Very rarely Nerve or blood vessel damage

• After 10 yrs only 2.5% of patients have required a revision operation (Australian National Joint Replacement Registry data), with superior longevity outcomes noted than for knee or shoulder replacement. There are patients with joints exceeding 30yrs of survivorship.
• The joint replacement may eventually need to be replaced (revision surgery). The younger you are, the more likely you are to require revision surgery.
• The artificial hip joint may eventually wear out, especially in patients with hip replacement surgery at a relatively young age.
• If this happens, you may need to undergo a second hip replacement. However, new materials are extending the life of the implant.

Before surgery, your orthopaedic surgeon will perform an examination.
The surgeon may:

• Ask about your medical history and current medications.
• Examine your hip, looking at your joint mobility and the strength of the surrounding muscles.
• Order blood tests and X-rays. In some cases, an MRI may be needed.
• Be sure to determine what medications you should avoid or continue to take the week before surgery.
• Tobacco use can affect healing, so it is best to stop smoking.

• Long distance running is best avoided after hip replacement surgery as it will lead to premature implant wear.
  High intensity contact sports such as rugby or martial arts are high risk for injury or dislocation.
• However, at the end of the recuperation period from surgery, most people can engage in low-intensity activities such as swimming, golfing, cycling and long distance walking. Medium-intensity activities such as tennis, skiing and recreational soccer are also possible.