Hip Surgery

Hip arthritis refers to the degenerative changes within the hip joint. This results in the loss of cartilage that lines the femur and acetabular bones which make up the hip joint. The causes for hip arthritis are varied and can include natural aging, post-traumatic changes, inflammatory arthritis, as well as developmental issues such as hip dysplasia.

Typically, hip arthritis can cause groin pain, which may even radiate down the leg to the knee. The pain usually begins with activity-related discomfort, such as that experienced during prolonged walking or deep flexion (for example, getting in and out of a car). As the disease progresses, it may cause pain at night and rest pain.

TREATMENT

Treatment for hip arthritis in its early stages includes non-operative interventions such as the judicious use of anti-inflammatory medications, Panadol-Osteo, as well as targeted physiotherapy and hydrotherapy. Corticosteroid injections can also be utilised to help with short-term pain relief and may last up to six months. When non-operative interventions have failed or when patients are in the advanced stages of hip arthritis, surgical intervention may be warranted. The most reliable result for hip arthritis surgery is in the form of a total hip replacement. This includes replacement of both the ball and socket components of the hip joint.

The recovery period for hip replacement surgery is typically six weeks to recover most pre surgery function with reduced pain; however, full recovery may take up to four to six months post-surgery. Patients are encouraged to immediately weight bear on the day after surgery and will see a physiotherapist. However, it is important to note that there are risks associated with hip replacement surgery. Whilst infrequent, these include infection, dislocation, leg length difference, and damage to surrounding vascular structures.

Hip revision surgery may be required following a hip replacement for various reasons including infection, loosening, liner wear, and dislocation. This is major surgery and necessitates various investigations to pinpoint the exact reason for issues with the original hip replacement.

Infections can be broadly divided into acute (within six weeks of the original surgery) or chronic infections. Loosening may occur following a hip replacement if the prosthesis has not integrated into the bone surrounding it. This may be a consequence of the liner wearing out over time, or may occur when the bone surrounding the hip replacement has not integrated. Dislocation can occur following total hip replacements due to various factors; however, when the components have been malpositioned, a full hip revision may be required. Your treatment plan will be tailored to you, taking into account your investigations.

Treatment

As mentioned above, hip revision surgery is major surgery and preparation will often include blood tests, x-rays and CT scans. Once the problem has been identified, the treatment will be tailored accordingly. In the case of an infection, the prosthesis may be able to be salvaged with multiple washouts and change of the head and liner of the prosthesis, if the infection is detected sufficiently early. Antibiotic therapy will also be initiated in consultation with an infectious diseases specialist. In more chronic circumstances or where there is an uncontrolled infection, a full revision may be required. This may involve a two-stage operation, with the first stage being a removal of the prosthesis and insertion of a temporary hip replacement, in conjunction with antibiotic therapy. Once the infection has been controlled, a more definitive second stage hip replacement will be inserted.

Where a hip replacement has become loose, specialised revision instruments and implants may be required to utilise more healthy bone. When recurrent hip dislocations are an issue, revision surgery may be undertaken to reposition the components or change the liner to a specialised 'dual mobility' or 'constrained liner'. Revision surgery carries significant risks. These include bleeding, damage to the nerves and vessels in the area, infection, requirements for further surgery, and leg length differences.

Neck of femur fractures refer to fractures of the femur just below the femoral head. A significant problem with these fractures is that they can interrupt the blood supply and usually lead to avascular necrosis (death) of the femoral head. Typically, these injuries occur in elderly patients with osteoporosis. Due to the location of these injuries, they usually render patients unable to weight bear without significant pain. Therefore, they require prompt surgical treatment to improve patient outcomes. Neck of femur fractures can also occur in younger patients who are involved in high velocity injuries. This is typically an orthopaedic emergency.

Treatment  

Treatment for neck of femur fractures depends on the degree of displacement of the fracture as well as its location. In the event the blood supply to the femoral head is unaffected, typically a nail or a plate and screw device is used to stabilise the hip. This allows the patient to immediately weight bear following the surgery. In the event the blood supply to the femoral head is compromised, usually a hemi-arthroplasty (half a hip replacement) or a total hip replacement is recommended, depending on the patient's age and medical condition. This surgery will allow the patient to mobilise immediately afterwards.

The major risks involved with surgery for femoral neck fractures is the anaesthetic itself and complications surrounding this. Typically, as patients are more elderly and frail, they can succumb to medical issues following or prior to surgery, including heart attacks, strokes, clots, and pneumonia. Accordingly, Theepan will engage the use of a perioperative physician to help look after patients coming in for neck of femur surgery. Complications of surgery itself include infection, bleeding, damage to surrounding nerves, and implant failure such as dislocation; although it should be noted that these risks are relatively uncommon.