Total hip joint replacement
Total hip joint replacement (THJR), also called Total Hip Arthroplasty, is a procedure where an artificial surface is used to replace the worn or damaged surfaces of the hip joint. The primary aim of the procedure is pain relief and to return an individual to pain free activities of daily living. The most common reason for a Total Hip Joint Replacement is osteoarthritis of the hip joint.
The procedure
An incision is made over the thigh and or buttock and muscles and other tissues retracted or detached in order to expose the hip joint. There are a variety of approaches that can be used to expose the joint. The femoral head (ball part of the thigh bone) is dislocated from the acetabulum (hip socket) and the femoral head is removed. The acetabulum is prepared in order to accommodate the prosthesis (implant). The prosthesis is made of two separate components, an acetabular component for the hip socket and a femoral component which replaces the head (ball) of the femur (thigh bone). The two components are implanted and the hip joint is then relocated. Implants that use bone cement and those that do not (cementless) are used.
The implants are generally made from a combination of metal and polyethylene plastic, however a variety of new implants are being used such as metal on metal, or ceramic on ceramic, and these implants all have different characteristics.
The surgery is usually performed under general anesthesia, but can also be performed with a spinal anaesthetic. A combination technique may be used in order to provide better pain relief.
The surgery usually takes between one to three hours, and you will usually stay in hospital for about five to seven days.
After your surgery
Initially after the surgery you will have a dressing over hip and incision, and may have drainage tubes coming from within the hip joint to drain any excess fluids. If present the drainage tubes will usually be removed the day after the surgery. Analgesia (pain relief) will be given to you from the time of surgery, and can come in a variety of forms from tablets through to an epidural catheter or a patient controlled analgesia (PCA) pump.
You will begin mobilising as early as the first day following surgery. This usually begins with transferring from a bed to a chair, and gradually progresses to walking with crutches. The specific post-operative regime will be managed by your orthopaedic surgeon, and you will be assisted by physiotherapy and nursing staff.
You will leave hospital when you are mobilising safely with crutches and will remain using crutches for up to six weeks. Pain following the procedure generally settles relatively quickly and has often resolved a few weeks after surgery. Your surgeon will follow you up post-operatively, initially at two to six weeks and then at regular intervals over the first two years.
You may be able to return to activities such as driving or golf as early as the six to twelve week stage depending on your progress.
The long term outcome
A hip joint replacement typically lasts for at least ten years, and many last for much longer. Occasionally there are complications such as dislocation, loosening, or wearing out early, and in these cases a revision procedure may be needed.
The vast majority of patients will have a straightforward surgical procedure and recovery course, with an outcome of a pain free and functional hip joint.
Risks
A hip joint replacement is a major surgical procedure which carries small but significant risks. These include dislocation of the hip joint, the possibility of blood clots or deep venous thrombosis (DVT) of the veins of the legs or pelvis, bleeding, post-operative infection, joint stiffness, implant loosening or failure, or injury to a major nerve. There are other risks associated with this procedure, and it is important that you have a thorough conversation with your surgeon about the possible complications prior to surgery.
Pre-existing medical conditions can alter the level of risk associated with any procedure, and it is important that you notify your surgeon and anaesthetist of any medical problems prior to surgery. It is also important to follow your surgeon's instructions both before, and after, surgery to ensure that these risks are minimised.
Costs
The components that determine the cost of the procedure are the surgical theatre costs, hospital costs, implant costs, anaesthetic fee and the surgeon's fee. Prices vary and may depend on; the extent/complexity of the procedure, the physical attributes of individual patients, and the surgeon performing the operation. A Total Hip Joint Replacement typically costs around $30,000.