Hip Replacement - Everything you need to know

I'm holding in my hands here a total hip replacement prosthesis and shortly I'll explain exactly what a hip replacement is and answer all the common questions that you and your family might have about hip replacement surgery now the aim of this video is to give you and your family a more realistic and practical understanding about hip replacement so that you can make the best possible decisions for your hip now this is a very comprehensive educational video and as a result it is quite long but I do encourage you to watch it all the way through it is vital that you understand as much as possible before considering hip replacement surgery we also know that most patients will not remember all the information they are told by a doctor during the average consultation the beauty of an educational product like this video is that if you do forget something you can always come back and watch the video again to refresh your memory I'd also suggest sharing this video with your family and friends it will help them understand more about the decisions you are making and why you're making them just use this video as a guide and at the end jot down any remaining questions you have so that you can discuss them with your surgeon the more you know and understand about hip replacement before you even see a surgeon the more you'll take out of your consultation with them I'm sure you can all relate to walking out of a doctor's office and thinking I just knew there was something else I wanted to ask and I forgot about it if you just write down the key questions you want answers to before you see your surgeon then this point happened [Music] your hip is a simple ball and socket joint the socket of a joint is called the acetabulum the top of your fire bone or femur has a bowl on top of it it fits perfectly inside the socket now many patients think that their hip joint is on the outside but that's not actually true the femur or thigh bone has a bony bump on the outside called the greater trochanter and this is what you can feel on the outside of your hip but that is not actually part of the hip joint the ball and socket of your hip joint is actually located beneath your groin if you push the pin through the skin of your groin it would eventually pop into your hip joint and this is why hip pain is commonly felt in the groin or the buttocks hip pain can also be referred down your thigh and even into your knee joint both surfaces of the ball and socket are covered in a smooth substance called articular cartilage now my grandpa back in the day would have referred to this as gristle you may have seen cartilage or gristle stuck to the end of a bone such as a chicken wing it's exactly the same substance that's in your joints now this smooth articular cartilage allows your hip to glide around and move without any pain a normal hip joint lets you move your leg in pretty much any direction forwards backwards and also from side to side these hip movements are essential for everyday activities like doing the shopping riding a bike getting into and out of a car and even putting on your shoes and socks they all require your hip joint to move freely the hip joint is right at the top of your entire low limb so every joint below also relies upon it otherwise these joints have to compensate because your hip is not doing its usual job the hip joint takes a huge amount of pressure off your lower back or lumbar spine so if your hip is stiff and not moving properly you may also experience worsening back pain when the smooth articular cartilage of your hip joint wears away it exposes the bare bone beneath your hip literally begins to grind bone on bone a bit like a mortar and pestle that a chef would use to grind up spices to very hard surfaces grinding together now this process is what we commonly call arthritis now arthritis is quite a complex and interesting topic in itself so if you'd like to learn more about what causes arthritis and how to fix your joints then take a look at my arthritis video on the education section of my website [Music] we're looking at an x-ray of a normal hip joint we can see a clear dark space between the ball and socket now that dark space is the cartilage inside the joint which is invisible on an x-ray when looking at an x-ray of an arthritic hip joint we can see there is no longer any space between the ball and socket the nice smooth contour of the joint has also changed this is because all the cartilage has worn away and the ball and socket are now grinding together the more bone and cartilage that grinds away the more the ball will move deeper into the socket this makes the entire leg shorter on that side it's not uncommon for a patient's leg to actually be one to two centimeters shorter due to their hip arthritis because this shortening happens slowly over many years most patients don't actually notice it and they can be quite surprised when I point this out to them an arthritic hip can be very painful but that's only half the problem as arthritis progresses the hip joint also becomes very stiff and this has a big impact on your function remember you need your hip to move freely to let your lumbar spine and other joints in your lower limb do their jobs properly and that's why hip arthritis can be so disabling it's not just pain the stiffness of your hip prevents you from doing a large number of activities some of the common problems patients report include difficulty bending down to pick things off the floor getting into and out of a car and especially getting dressed and pulling on their shoes and socks hobbies like playing golf or going for a walk are also very challenging pain is also a major symptom and if severe it can actually make everyday life quite miserable a loss of sleep and a need to take regular pain medications is very common [Music] a hip replacement really has two main goals number one to take away the pain and information from your bones grinding on each other by allowing your joint to glide smoothly and secondly to improve the range of motion of your hip so that you can perform the activities you need to so what actually is a hip replacement in simple terms it involves giving you a new ball and a new socket the first thing we do is to remove the old worn-out or rusty ball of the hip joint now this does require a surgeon to make a cut through the bone with a small saw we remove the ball and also a few millimeters of bone what we call the neck of the hip joint that's this bone in here so after we've removed the rusty ball and some of the neck of the hip joint your fire bone looks a little bit like this you can see how there's no longer a ball or neck on top of it now as you might know the inside of our bones are hollow and we take advantage of this hollow cavity inside the bone and we place a metal prosthesis down inside it just like that so now that metal prosthesis is sitting nice and securely inside the thigh bone now the prosthesis that goes down inside your fire bone is actually made of metal but on the outside it's got a very special rough coating and this does two things the first thing is it's very grippy and as it goes inside the fire bone it grips very tightly so as soon as your processes is inserted it's strong enough to walk on the second function of this rough coating which is very clever is it enables bone to grow into it it's exactly the same size and shape of natural bone and so by about six weeks after your surgery your human bone has grown into this prosthesis and securely glued it inside your thigh bone very naturally in some patients your surgeon may choose to use a special bone cement and that securely cements the prosthesis inside your thigh bone so now the prosthesis is securely fixed inside the fire bone the next thing we do is place a very smooth beautiful round ball on top of the prosthesis like that and it fits securely in place and this becomes the new ball of your ball and socket joint now this particular ball is made of ceramic but they can also be made of metal so now we've taken away your old rusty arthritic ball and giving you a nice shiny brand-new one now the socket of your hip joint which we called the acetabulum is located up here inside your pelvis so the next part of the procedure involves inserting this metal prosthetic socket into the arthritic socket of your pelvis now this artificial socket is made of a similar metal as your thigh bone prosthesis it also has the same rough coating on the outside that is very grippy and that makes it stick inside your pelvis as soon as we place it there your bone will also grow into this prosthesis and naturally heal it in place by about six weeks so after the metal socket is positioned we then place a very smooth shiny piece of plastic inside of a cup like that now what this does is act like the artificial cartilage inside your hip joint now this is a very hard-wearing medical grade plastic and the technical name is high molecular weight polyethylene but look don't worry too much about all the technical terms just think of this smooth lining inside the socket is acting like the nonstick Teflon in your frypan but sometimes this lining can also be made of ceramic just like the ball of the hip joint is so unlike before when you're after etiquette was bone grinding on bone you now have these two beautifully smooth surfaces that can glide over each other now this is what takes away your pain and also improves the range of motion of your hip joint [Music] when we look at an x-ray after a hip replacement you can see the new socket the new ball and the prosthesis inside the thigh bone of course what we can't see is all the muscles tendons and ligaments around the hip joint because they are all invisible on an x-ray because we are actually replacing the bone and cartilage that has worn away from arthritis a hip replacement is also able to lengthen your shortened leg and put it back to the same length as it was before arthritis shortened it [Music] some of my patients are confused about how their hip joint should actually be replaced there is a lot of information available about hip replacement surgery with varying opinions about what is best now each surgeon has a particular preference and skill set for the type of procedure they use to replace a hip joint this might be influenced by where in the world we completed our training what surgical techniques we've been exposed to and also what the evidence tells us works best for patients now every hip replacement technique does have pros and cons so talk to your surgeon about why they prefer the particular technique that they use it's also very important for me to highlight that no matter what technique a surgeon uses a hip replacement is an excellent operation with very high levels of patient satisfaction and function in fact a number of studies have shown that no other operation in the world improves a patient's quality of life as much as a hip replacement it's been an incredibly successful procedure for many years there are three main techniques that a surgeon can use to replace your hip joint we can replace your hip through the front or the anterior approach the back or the posterior approach or the side which is called the lateral approach now you can think of each of these three approaches as being a different door to your hip joint each door leads to the very same place just through a different path the posterior approach as the name suggests replaces your hip through your bottom muscles a surgeon separates the largest muscle in your body called the gluteus maximus and that is located just under the skin of your buttocks the surgeon then detaches some tendons around the bone of your hip to expose and replace the joint at the end of the operation these tendons are repaired back to the bone with suture material the gluteus maximus muscle is also repaired back together with sutures personally I only use a posterior approach in a small number of specific patients however many surgeons do use this approach for all their patients and the outcomes are very good the lateral approach involves detaching part of a tendon called the gluteus medius tendon from the fire bone now gluteus medius is one of the most important muscles and tendons around your hip joint once the hip is replaced the gluteus medius tendon is then repaired back to the bone with suture material I don't use a lateral approach in any of my patients the direct anterior approach which is a technique I prefer to use for the vast majority of my patients takes place through the front of your hip joint the size of the incision depends a little bit on the size of a patient but in general it's quite small about six to ten centimeters in length rather than splitting muscles or cutting through tendons we move in between the muscles on the front of the hip to gain access and replace the joint at the end of the procedure no muscles or tendons require a pairing with suture because they have not been cut during the operation the principal of the anterior approach is to allow patients to mobilize more quickly with less pain and weakness early after the operation temporary weakness is created when a muscle or tendon is cut until they heal and recover it's for these reasons that I'm so passionate about the anterior approach for my patients because it avoids cutting muscles and tendons but again I would stress that all hip replacement approaches give excellent results in the longer term the most important thing isn't what approach your surgeon uses it's their skill and experience with whatever technique they are comfortable with so you need to make a choice about what is best for you and your hip [Music] most patients will spend three to five nights in hospital after hip replacement the higher majority of my patients choose to go straight home after their stay in hospital and actually the safest place for most patients to recover from their surgery is in their own home if you have specific health needs or just require a little bit more support then you have the option of an extended period of rehabilitation within a hospital now our nursing and physiotherapy staff and sportsmen are absolutely incredible everyone is specifically trained and very experienced in helping you to recover from joint surgery every patient has a private room ensuite and free Wi-Fi and patients also tell me they love the food there is a reason sportsman is twice been rated the number one private hospital in Australia and so many of my patients tell me about the really positive experience they had at sportsman you're allowed to stand up and walk on your new hip as soon as your pain control and strength allows you to do so most patients will aim to sit out of bed and stand on their new hip the very same day of surgery our physiotherapists will work with you every day in hospital to get you up and moving and also to provide a basic game plan for your rehabilitation in the weeks after you leave hospital rehabilitation begins from the very same day as your surgery unlike a knee replacement where patients have to work quite hard to recover entry hip replacement is easier to recover from and in general you don't have to do a huge amount of exercises I tell my patients the best thing they can do for the first six weeks after surgery is just gently increase their activity levels as they feel comfortable more elderly patients will require the use of a frame for the first few days after surgery but younger patients will typically just require a walking stick it is uncommon for a patient to be using more than a walking stick on discharge from hospital but occasionally this is required after entering hip replacement surgery most patients are actually in less overall pain when they leave hospital than they were prior to surgery of course they still do have some pain and swelling from the operation but the severe groin and buttocks pain goes away very quickly patients will also notice more freedom of movement in their hip joint quite quickly many patients will describe a woody or bruise feeling in their fire for the first two to four weeks after surgery it can feel tight swollen and a little bit like having a Corky from a bad knock playing sport now this is very normal even though no muscles have been cut you've still had a significant operation which involve removing the bole of your hip joint there will be some ongoing bleeding and swelling within your hip for several days and when you stand up gravity allows this swelling to drain into your thigh and it feels swollen your body will absorb this over the next few weeks the Golden Rule that I tell all of my patients is just to be sensible for the first six weeks after surgery some patients feel so good so quickly after answering hip replacement that they can push things a little too far too soon it does take six weeks for the prosthesis to heal securely into your bones so there is no running jumping or high-risk activities during this time however the movement restrictions that may apply for the first six to eight weeks with other hip replacement techniques are not needed after anterior hip replacement surgery so you don't need to sleep on your back for six weeks you can sleep on your side immediately if you wish you do not need to sleep with a pillow between your legs and you can usually drive a car within four weeks of surgery but this does vary from patient to patient you need to have good strength well controlled pain and no restriction of movement before driving your physiotherapist can help monitor this one of the risks of any hip replacement procedure is dislocation of the ball from the socket but the risk of dislocation is lowest with anterior hip replacement compared with other approaches that we discussed for this reason we can be more proactive with rehabilitation and get you moving quite quickly you will also require regular simple medication such as panadol and anti-inflammatories for a minimum of two weeks and possibly longer if you still have pain despite these simple medications you'll have a supply of stronger pain medication to take if and when required we call this breakthrough pain relief if your pain breaks through the simple medications you have a safety net of stronger medication ready to help most occupations will require four weeks off work completely but a return to light or office duties could potentially occur from two to four weeks depending on your job returning to manual duties would be a minimum of six to eight weeks after surgery and possibly longer depending on your occupation by six weeks after surgery the majority of patients are walking normally and not using a walking stick it is unusual for patients to be taking any pain medication at this time by three months the majority of patients will be over eighty percent recovered and back into all usual activities the final twenty percent of your recovery occurs slowly but gradually from three months after surgery you can have continued improvement for up to six or twelve months after surgery I tell my patients that during this period they'll become more accustomed to their new hip and most of the little niggles will slowly fade away don't forget we've only replaced the arthritic surfaces of your joint everything else in and around your hip joint is the same age as you are whilst we can expect a smooth and pain-free joint surface we can't expect all your muscles tendons and ligaments to feel like you're 18 again now I'll do everything I possibly can to give you the best result but sadly I can't make you or your hip muscles any younger I wouldn't recommend that a patient runs after having a hip replacement as this will make you a new hip wear out more quickly but you can walk swim hike ride a bike go to the gym and pretty much fall back into most of your regular activities playing golf lawn bowls and even a social hit of tennis is possible for most patients [Music] like all operations there are some risks that every patient needs to be aware of and understand serious complications are rare but some minor complications are more common and I'll point each of these out to you as we go along all patients will have some degree of mild ongoing bleeding and oozing inside the hip for several days after surgery this is one of the reasons your fire will be swollen it is unusual for a patient to require a blood transfusion but sometimes that is necessary injury to a major blood vessel is a very rare complication but if it did happen you may require additional surgery to repair that blood vessel damage to a major nerve is also very rare but if that occurred you could be left with some permanent weakness infection is thankfully a rare complication occurring in less than 1% of patients infection with the anterior approach is actually lower than with any other hip replacement approach if you do have a deep infection inside your joint it can be challenging to treat it will require further surgery to wash out the infection several weeks of antibiotics and sometimes a number of operations to remove the infected prosthesis and replace it with a new one you'll be given antibiotics via a drip before and after your surgery to reduce the risk of an infection you will also be given a scrub brush of antiseptic solution to wash your entire body with pride and the use of an antibacterial nasal augment in the five days before joint replacement surgery your nose is a major reservoir of bacteria that can cause joint infections by using the ointment will reduce the number of these bacteria and some studies indicate this may reduce the risk of an infection ever occurring in your hip replacement it is very common for patients to describe a feeling of numbness on the outside of their fire this is because there is a network of fine sensory nerves just beneath the skin very close to the location of your surgery now these nerves can be damaged by being cut or stretched or even just irritated from swelling this numbness usually resolves but it may take 3 to 6 months or more for this to occur in some patients numbness may be permanent this would not affect your movement but it may irritate your skin and some patients find the feeling uncomfortable you will be given medication after your surgery to gently thin your blood to reduce the risk of your forming a blood clot in your calf otherwise known as a DVT now blood clot in your calf in itself is not dangerous and your body will slowly dissolve the clot however if the blood clot traveled from your calf up into your lungs it could make you very unwell or even be fatal this situation is fortunately very uncommon we monitor you closely for signs or symptoms of this during a recovery after surgery an artificial hip joint is not as stable as your natural hip joint and it is possible for a hip replacement to dislocate now this simply means that the ball pops out of the socket one of the many reasons that I prefer the anterior approach for my patients is the risk of dislocation is lower than with other approaches the risk of dislocation is about 1% if your hip did dislocate you would need have it manipulated back into place under anesthesia if they continue to dislocate you may require revision surgery to prevent this happening again a major fracture of the thigh bone or the bony socket of your hip joint is a rare complication occurring in about 1% of patients the risk of this occurring is slightly higher with the anterior approach and other approaches this can occur during the operation or in the weeks and months after surgery if this occurred you may require further surgery to fix the fracture and replace the hip joint or a slow recovery period to allow the fracture to heal a hip replacement can make your leg longer or shorter in general we aim to equalize your leg lengths so they're about the same on both sides but the most important factor is that your hip joint is stable and does not dislocate the muscles around your hip joint are a bit like elastic bands and when they are placed under some tension they keep the hip snugly in place sometimes a surgeon may need to make the leg slightly longer to increase the tension of these muscles and stabilize the joint if there is a one centimeter or less difference in your leg lengths then most patients are very unlikely to even notice the difference if it is greater than this you may notice it but wearing an orthotic within your shoe on the other side is usually enough to make a patient's leg lengths feel equal [Music] one of the most common questions patients ask me is how long will my hip replacement last the basic rule of thumb with a hip replacement is it will last most patients 20 years or more to put this into context if we looked at every patient in Australia who had a hip replacement 18 years ago over 90 percent have not required that hip to be replaced if and when your hip does wear out it can be replaced with a new one but that surgery is more complex and the functional results may not be as good as original procedure now there is no definitive line in the sand for how old you have to be before you can have a hip replacement some young patients are suitable candidates if non-operative management of their pain has failed and their symptoms are severe however hip replacements don't last as long in younger patients as they do in more elderly patients and this is because younger patients are more active and quite literally wear them out more quickly having said that hip replacement technology has improved significantly and the overall rate of hip replacements that are requiring revision surgery in Australia is continuing to decrease over time [Music] increasing pain and a lack of function are the two biggest reasons that you may need to consider having a hip replacement some patients will be able to manage quite well with pain relief physiotherapy and some natural supplements the glaad program for example is a specific physiotherapy program for patients with hip and knee arthritis symptoms it aims to help patients reduce their pain and increase strength and mobility it's worth speaking to your physiotherapist about this the decision about when is the right time for a hip replacement is a complex and personal one however I would strongly encourage you to make a decision based largely on your level of pain and loss of function or put simply how badly is your hip affecting your quality of life you simply do not need a hip replacement just because an x-ray or MRI scan shows that you have arthritis many patients have arthritis but their symptoms are quite mild there is also no rush to have a hip replacement you have plenty of time to think about your options and try alternative treatments however over time arthritis symptoms do worsen as your joint continues to wear out unfortunately we can't permanently cure arthritis without a joint replacement procedure getting a broad range of opinions from health care professionals is also helpful your general practitioner and physiotherapists are great sounding boards there are people you know and trust and they also know you and your health history in my experience most patients have told me that they eventually reached a point where they just knew it was the right time for them to have a hip replacement ultimately this is a personal decision for you to make so thanks for sticking with me through what I know was a long and information-rich video but I do hope that this has given you a comprehensive understanding about hip replacement surgery and that it helps you in your decision making remember if you have any specific questions arising from this video then please do write them down you can discuss them with your surgeon when you next meet with them if you would like to talk to me about your hip then pleasure in my room's at any time to make an appointment if you haven't already had appropriate scans I can arrange for these to occur before I see [Music]

Channel: Dr Matthew Hutchinson

Views: 669,589

Keywords: Matthew Hutchinson, hip replacement, direct anterior hip replacement, no muscles cut, anterior approach, Dr Matthew Hutchinson, minimally invasive hip replacement, total hip replacement, direct anterior approach hip replacement

Id: W-PHNGsDU-o

Length: 30min 39sec (1839 seconds)

Published: Tue Jul 14 2020