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Hip Replacement Surgery FAQ – Page 2

Does Dr Martin use a prosthesis with good results?

Dr Martin uses well-established hip replacement prostheses with reliable long term results confirmed in the Australian Joint Registry. He has taken extra steps to track his own results by choosing to be identified in the registry. Dr Martin also requests detailed registry reports regarding hip replacements in different situations and different patients to minimise the possibility of failure for each patient.

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How much physio will I need after the operation?

The recovery after hip replacement surgery is generally much easier than it used to be and Dr Martin is continually fine-tuning his practice to make it as easy as it can be. For many people, intense physiotherapy is no longer necessary after the joint replacement. This is especially the case for people who have done a course of physiotherapy prior to the surgery.

Often it is, now, simply a matter of doing some post-operative exercises, as advised by a physiotherapist,and getting on with life. Some patients will require specific attention to some aspect of their recovery and this is something that is dealt with on a case-by-case basis.

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Can I have both at once?

It is certainly possible to do both hips at once. That is called bilateral simultaneous hip replacement. This is reasonable in a healthy patient in their 70s or younger who has equally bad hips. The recovery is not much more difficult than one at a time. In general, patients having both done at once might stay in hospital 1 day longer.

Having both done at once is a bigger operation, but for the right patient it is probably about as safe as having one side done and the other at some later time. More people are choosing to have bilateral hip replacement surgery, as the recovery from the operation becomes easier.

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What is the anterior approach/ hip replacement from the front?

There are different ways of getting into a hip joint. It is possible to do a hip replacement from the back, side, front or even top. The main thing is to get the internal components in properly and the approach doesn’t matter too much. It is certainly possible to get an excellent result via any of the available approaches. There are pros and cons to the different approaches, which you could consider as fine tuning.

Dr Martin has decided to use the anterior approach as it lends itself to navigation and accurate component position, which probably helps achieve long term reliability. It has a low dislocation rate and achieving equal leg lengths is more accurate. As a side effect, it also has the benefit of less pain and a quicker recovery. In addition it is excellent for “both sides at once” hip replacement surgery, is a simple position for the anaesthetist, and is appropriate for redo hip replacement too.

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What about the bearing? Is metal, plastic or ceramic better?

There are lots of different options for lining the artificial joint. You may have heard of the problems associated with metal poisoning from some large metal hip replacements. Dr Martin does not use such linings. The other choices are mainly between a metal or ceramic head and a plastic or ceramic socket liner.

All these materials have improved a lot in the last decade or so. This has probably been the biggest single recent improvement in hip replacement surgery. There are pros and cons of the different materials can be discussed with Doctor Martin. Because of the “across the board” improvement, it is a much less critical decision than it used to be. It is nearly to the point where which of the good bearings are used hardly matters.

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Will I need a blood transfusion?

Blood transfusions after hip replacements are exceedingly rare these days. However, it is important to tell your doctor if you have a bleeding problem. It is also important to discuss all your medications, including over-the-counter medications and alternative treatments, as some of these have a blood-thinning effect. Pre-operative self-to-self blood donation is not offered any more, as blood transfusions are so rare there is no benefit.

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What is like to have an artificial hip?

It is very important to be realistic about what to expect from a total joint replacement. About 50% of people who have a hip replacement will have a normal-feeling hip afterwards. This is called a forgotten hip: when the hip feels normal to the point that you forget you have had the operation.

For other people the hip will not feel quite so normal and some will experience on-going aches or pains after the surgery. This should be manageable minor pain, not the severe dreadful pain experienced before the operation.

Numb patches on the skin, relating to the surgery, are also common. These usually diminish with time, but some permanent numbness often persists.

Some people have the idea that an artificial joint will be a super hip: better than it ever was. Unfortunately this isn’t the case. However, while an artificial hip is not as good as the healthy hip of a young person it should be much better than a painful, worn-out one.

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Will I trigger an alarm at the airport?

This depends on what sort of metal you have implanted and at what sensitivity the security equipment is set. People often ask if they should carry a card or certificate for the joint replacement, but such a document could easily be forged. The airport security staff are used to processing people who have had joint replacement surgery. Enjoy your trip!

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What can go wrong after hip replacement?

Serious problems after a hip replacement are very unusual and the team led by Dr Martin go to great lengths to prevent them. Despite this there are risks associated with the operation and these include infection, which can cause early failure or ongoing pain. An infection can also spread to the hip later to cause failure,but that is also very unusual. The overall risk of failure due to infection is less than 1%.

Failure can also occur due to wear, loosening or breakage of the bones or for other reasons, including dislocation. Dislocation usually only occurs in unusual positions that are easily avoided and the anterior surgical approach also diminishes the risk of dislocation.

Normally a dislocation can be fixed with a redo operation, but if in the extreme case that that wasn’t successul, it is possible to end up with no hip.

Sometimes a patient can have a post-operative difference in the lengths of their legs. Usually a new hip would be less stiff than an arthritic hip, but, very occasionally, a new hip can be very stiff with bone growth.

Usually a limp would also be much improved after hip replacement surgery, but sometimes a limp could persist and very rarely even be worse. It is also possible to still have severe on-going pain after a hip replacement, but that would indicate a failure of the operation. This is very unusual or we wouldn’t perform the procedure in the first place.

Other risks of the surgery include nerve injury and other problems like heart attack, stroke or blood clots. It is possible to die from the surgery. It is important to talk through the risks and benefits of the procedure, and any specific concerns you have, when making decisions about the surgery.

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Are blood clots a worry?

There are different types of blood clots you can get after a hip replacement and there are good steps that can be taken to protect against them.

A clot in the wound is called a haematoma. That can’t spread to the lungs so it isn’t dangerous in that respect, but it is an infection risk. Very occasionally a hip replacement might need a haematoma cleaned out in the operating theatre. With current techniques, the risk of a bad wound haematoma is very low.

The other sort of blood clots are ones in the leg veins (DVT) that can clog up the lungs (PE). A PE can be life threatening,but there are a lot of effective measures that the team of people caring for hip replacement patients always take to minimise the risk.

Bruising colours up and down the leg after surgery are most likely not a clot. They are usually from some blood that has leaked out of the hip and tracked along the skin.

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Is infection a worry?

Infection can be a major problem, so the surgical team takes many steps before, during and after the surgery to minimise the risk of infection spreading to a hip replacement.

An example of this is careful pre-operative screening and treatment of people who carry golden staph, whether it is the superbug or more common “garden variety” type. About a third of people carry the “garden variety” golden staph on their skin and special treatment to clear it, or the worse bug, before surgery, decreases the risk of infection.

Pre-operative screening of infections, pre-operative skin preparation, careful technique and great team work in the operating theatre, as well as careful post-operative wound care, are also very important.

With these and other steps the infection rate is less than 1%.

Something that patients are not always aware of is that it is also possible for infection to spread to a new hip years after surgery via bloodstream poisoning. This is very unusual, but it is still worth taking steps to protect against it. It is important to check with your doctor if you need antibiotics before future operations or procedures. If you are getting a recurrent infection somewhere such as a kidney infection from a stone, then it is very important to treat the infection and fix the underlying issue to minimise the risk of spread to your hip on each occasion.

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Do injections work for arthritis?

There are different types of injections available. Any injection has a small risk of infection. Cortisone injections can give temporary relief. These would be used to help pinpoint which pain was from where in cases where it is unclear, rather than for on-going treatment.

There are some lubrication-type injections. However, these are expensive and current research to support them is inconclusive. Their success can be a bit “hit or miss”.

Other injections include platelet-rich plasma or stems cells. These treatments are not yet at the point where they are useful in terms of making cartilage grow back.

It is possible that stem cells may be useful in the future, but realistically that is a long way off. There are a lot of things wrong in a worn-out hip that would need fixing (probably also with an operation) for cartilage cells to take.

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How long will I need off work?

This is different from person to person and depends on the Job. Office type work may be possible 4 weeks after the surgery. Heavier work might be possible 6-8 weeks after the surgery. Some people will recover even more quickly and be able to return sooner, and some more slowly and need longer. It is also important to remember that in general driving isn’t recommended for 6 weeks, although some people may be able to drive earlier after discussion with the Doctor. Within 2-3 weeks after the surgery, you will be able to get a feel for whether an early return to work is feasible. Patients having both hips replaced would typically neeed a week longer than single sided surgery.

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