Total Hip Replacement

Introduction

Hip replacement is one of the great operations of the second half of the 20th century. It has given millions of people relief from the pain of osteoarthritis of their hip, pain that can be very debilitating. The cause of osteoarthritis of the hip is generally unknown, and recent theories about the shape of the hip joint are still to be tested in the long run. Other causes include childhood disorders, growth abnormalities, trauma (fracture) and osteonecrosis where there is loss of blood supply to the hip joint.

Diagnosis

Diagnosis is made based on patient history and physical examination, and is then confirmed by X-rays or other prescribed investigations. The decision to proceed with hip replacement surgery comes down to the degree of compromise of a person’s quality of life, and after all non-operative measures have been trialled and found to be unsuccessful.

There are seven indications that suggest a patient may need hip replacement surgery:

  • Severe pain from osteoarthritis of the hip that regularly disturbs sleep;
  • Severe pain from osteoarthritis of the hip that is not settling with medications, physiotherapy, or the use of a walking stick;
  • Pain from osteoarthritis of the hip that limits a person’s ability to work;
  • Pain from severe osteoarthritis of the hip that limits a person’s ability to enjoy hobbies and recreations;
  • Difficulties with activities of daily living such as reaching shoes and socks, or being able to clip one’s toenails;
  • The feeling that one’s quality of life is so compromised that almost anything beyond putting up with the current situation would be worthwhile;
  • The desire to do something to reduce symptoms while one is otherwise medically well.

Realistic expectations of hip replacement surgery

The longevity of hip replacements is outstanding. Currently, 90% of replacements are still functioning at 20 years following their insertion. In fact, with the availability of newer improved materials such as the widespread use of ceramic in hip replacements, we expect that these results will continue to improve over time.

Despite this, it is important to remember that a new hip is not the same as a biological joint, and as such is subject to wear. Patients can look forward to resuming most activities, but repetitive impact sports and running should be avoided.

The aim following hip replacement surgery is to return to as many activities of daily living that allow independence as possible, such as clipping toe nails, the ability to put on socks and shoes independently, getting into and out of trousers without assistance, driving a vehicle comfortably, walking around the shops confidently, and so on.

Following hip replacement surgery, patients can look forward to substantial, if not total, relief from pain, and markedly improved mobility and quality of life.