If your hip arthritis is not responding to non-operative measures and is significantly affecting your quality of life (eg due to pain or reduced mobility), you may benefit from total hip replacement. Total hip replacement works by surgically removing the worn and painful joint and replacing it with a new prosthetic hip.
Using modern surgical techniques (including the direct anterior approach), most patients can return to their normal quality of life within 6 weeks and sometimes less, and can begin walking on the day of surgery.
There are different ways of performing a hip replacement.
Dr Connon generally recommends the anterior approach for the majority of first time (“primary”) hip replacements. According to numerous research papers presented in Dr Connon’s book chapter on the topic, the direct anterior approach can result in a faster recovery time, less pain post-surgery, and a shorter stay in hospital. This is because it avoids cutting through any muscles to access your hip. It is called the anterior approach because the cut is at the front of the hip near the groin. In certain patients, Dr Connon can utilise a “bikini” style incision for better cosmesis but this is patient specific.
The direct anterior approach is a specialised technique and it is recommended that this procedure only be employed by a suitably trained and experienced surgeon. If your surgeon is not extensively trained and experienced in the direct anterior approach (minimum 100 cases) at this technique, it is generally safer that they perform your operation using a more traditional technique such as the posterior approach.
With posterior hip replacements, the surgeon enters through the back of the hip (though the cut is on the side). Unlike the direct anterior approach, posterior hip replacements require a surgeon to cut through several muscles.
The advantage of this surgical approach is that it provides a larger field of surgical view through a larger incision. This makes it useful for revision (“re-do”) surgery where more access is often required in order to remove existing implants and put new ones in, which sometimes cannot be done using the anterior approach.
The posterior approach is also easier for surgeons who don’t do many hip replacements or haven’t been trained in the anterior approach. Posterior hip replacements have a slightly longer recovery time than anterior approach approach hip replacements, and more initial restrictions on movement, but it is important to note that there is very little evidence of long-term differences between the two approaches.
Most studies demonstrate that although Anterior Approach Hip Replacements recover faster and with less pain than Posterior Approach Hip Replacements on average, by one year postoperatively, there is little if any difference in satisfaction. Both surgical approaches to the hip offer excellent long-term results and most implants last the rest of the patient’s lifetime, regardless of approach.
Hip resurfacing is much less common in Australia now than it was 15 years ago, when hip resurfacings accounted for over 10% of all hip replacements (down to only 1% now). According to the Australian Joint Registry, in most patients, a hip resurfacing wears out faster than a total hip replacement and then further surgery can be required. Newer materials such as ceramics are being trialled due to the well-publicised issues with some previous metal-on-metal bearings. Nevertheless, this is sometimes the best option for a small group of patients.
Anaesthaetic for hip replacement surgery usually involves spinal anaesthetic or general anaesthetic and many patients actually have some of each to optimise their pain relief and post-operative recovery. Dr Connon can discuss this further with you at your consultation.
To begin, your surgeon will make an incision over the hip (usually at the front for a minimally invasive anterior approach). The surgeon then removes the damaged bone and cartilage from the hip joint, including the socket (“acetabulum”) and the ball (“femoral head”). A metal stem is placed into the hollow of the femur, onto which a ball is fixed. This element of the prosthesis is the ball which fits with the socket.
The socket is replaced with a cup, which integrates with your natural bone over time. A liner is then added to the cup to provide a smooth surface.
The time spent in hospital following hip replacement surgery varies according to your needs and personal circumstances as a patient. To go home we need to ensure your pain is well controlled and you are able to safely get around your own home with the use of crutches or another gait aid to assist you as required. The majority of patients spend about 2 to 3 days in hospital, but some people are keen and suitable to go home on the day of surgery and some patients can stay for 4 days or more.
It is becoming less and less common for patients to need inpatient rehabilitation after a total hip replacement because various advances in recent years have ensured most patients are able to recover faster with less pain from their surgery and are hence able to safely return directly to their own home. Some patients still require inpatient rehabilitation and this is usually determined based on how the individual progresses with physiotherapy after surgery- we can’t always predict it beforehand.
After your anaesthetic has worn off, you should be able to place full weight on your hip, with crutches or a frame to aid you. It is preferable that if your operation is done earlier in the day, you stand up on the same day as surgery to get used to being upright again. Sometimes you will even be able to go for a short walk.
We will try to get you walking, sometimes with a frame, sometimes with crutches as an aid.
When you are comfortable and once you are able to walk independently and tackle stairs, that’s when you are safe to head home. Everybody is a little different and this timeframe is tailored to you as an individual.
After 2-3 weeks, your wound will be checked (usually by a specialist wound nurse). Your surgeon will probably use dissolving suture and glue so no suture removal is likely to be required. After your wound review you should arrange to see your physiotherapist to begin post-operative exercises. We recommend against doing aggressive physiotherapy exercises before the wound review to allow the wound to settle first.
By two weeks you are probably down to using a single crutch in the opposite hand to your hip replacement. You will use this for longer walks and balance but can actually often get short distances around home without a gait aid. You will gradually disband this remaining crutch over the next few weeks depending on your stability.
From 6 weeks post-surgery, you should be able to return to normal activities if you haven’t already. Some patients may be able to drive earlier, notably following a left hip replacement if you have an automatic car.
Dr Connon will always put your health first and will discuss the potential risks of surgery with you before you book in for any procedure. Before surgery, Dr Connon will assess any risks involved with your current medications, medical history, and require your skin to be healthy.
He will also organise a review by a perioperative doctor to optimise your general medical health and monitor you postoperatively.
Some risks present themselves only after surgery, such as infection and DVT. Please don’t hesitate to call Dr Connon’s rooms if you have any postoperative concerns.
You should be able to do most normal activities after 6 weeks, if not before. Please note that time frames differ for each patient.
Physiotherapy is important to your recovery but you should avoid strenuous physio exercises for the first 2-4 weeks and stick mainly to gentle walking to allow the wound to settle first. You can then progress to more strenuous physiotherapy exercises to build your strength.
Advances in surgical techniques and prosthetics mean that you can expect hip replacement surgery to last for much longer than previously. Many people still recall that older style prostheses would last “about 10 or 15 years” but this is because those older implants used plastics that wore away much faster. Australian Joint Replacement Registry data shows that using modern implants, about 90% of hip replacements last for 20 years or more. The vast majority of patients therefore only need their hip replacement done once. Whilst the need for revision hip replacement (re-do surgery to replace a worn-out replacement) is more likely in younger patients, there is no specific age-limit on hip replacement surgery.
From being admitted to hospital to returning to the ward, the entire process of hip replacement surgery will take several hours. This includes preparation for surgery and recovering (waking up) afterwards. The surgery itself usually takes approximately one hour when performed by an experienced surgeon but is dependent on how complex your anatomy is.
While every individual is different, and recovery can be affected by many factors, you should expect to resume normal life by or before 6 weeks of surgery.
Most of the cost of your hip replacement will be covered by your health insurance. We can advise you of any remaining likely out-of-pocket costs for after your consultation which is dependent on which health fund you are with. These vary based on your fund and type of cover but will be itemised for you in detail after your pre-operative consultation. Dr Connon has arrangements with many health funds that limit your out-of-pocket costs.
Due to Dr Connon’s expertise in performing day surgery hip replacement, he is particularly experienced at treating patients seeking to “self-fund” their hip replacement. This is because one of the main costs of total hip replacement is the hospital stay and the total cost can therefore be lowered by shortening your hospital stay where it is safe to do so. Utilising the direct anterior approach, some patients are able to go home on the day of surgery.
Rough total costs are generally around $21,000 – 25,000 depending on your length of stay. Please note that Dr Connon will never agree to lower the cost of your operation by using substandard implants or compromising on safety so some costs are unavoidable and corners will not be cut.
If you have had a Direct Anterior Approach Hip Replacement, you can do all these movements straight away. There are essentially no major restrictions on your movement after a direct anterior approach hip replacement.
After a Posterior Approach hip replacement, it is generally necessary to avoid bending your hip past 90 degrees/crossing your legs for the first 6 weeks in order to reduce your risk of dislocation. This means you may need a special toilet seat and a grasping device to pick up objects from the floor.
You can start driving once you regain full motor control of your leg and are no longer on prescription strength pain killers. You can often start driving after 4 weeks but sometimes less in patients who have had a left hip replacement and drive an automatic car.
For the first few weeks after your operation we recommend gentle walking only in order to allow the wound the opportunity to heal. Please avoid aggressive physiotherapy exercises during this phase.
After the first few weeks, you can resume most normal activities and should discuss progressing your exercises with your physiotherapist.
