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Total Hip Replacement

Updated: Mar 20

by Niamh Rafter, Physiotherapist and Pilates Instructor, bounceREHAB

co-Author Matthew Craig, Principal Physiotherapist, Director bounceREHAB


What is a hip replacement?


Total hip replacement is a common and effective surgical procedure, with >50,000 being performed each year in Australia. The number continues to rise each year, given that the life expectancy of the general population is continuing to rise.

The demand for these surgical procedures is rising as a result. Total hip replacement (total hip arthroplasty) has been around since the 1970’s and is regarded as a straightforward procedure which provides excellent outcomes.


Why are these operations done?

Osteoarthritis (OA) of the hip joint is the main indication for having a hip replacement. A healthy hip joint consists of a ball and socket shape, the femoral head and acetabulum.

When arthritis occurs, the joint space between the ball and socket will narrow and cause degenerative wear of cartilage. Evidence has shown that the an individual's natural joint shape is highly variable, and certain shapes may contribute to degenerative change over time. The mechanics vary on a spectrum for range and angles, and so the age at which each person may experience symptoms can vary significantly.



What are the symptoms of arthritis?

Common symptoms include:

  • Hip pain – common in the groin and buttock

  • Stiffness of the hip

  • Loss of movement with rotation type hip movements

  • Hip pain with sitting or walking

  • Limping

  • Struggling to put on shoes and socks

  • Difficulty with driving or getting in/out of the car


These symptoms can be investigated by your doctor, who can refer for scans and onwards to Physio and an Orthopaedic Surgeon.


Who should I see for an opinion on hip surgery?


Here at bounceREHAB, we work closely with A/Professor Nigel Hope, one of Sydney's leading knee and hip surgeons. His approach to the patient's orthopaedic journey offers excellent outcomes - he places huge emphasis on high quality rehabilitation from an early post op stage.

Associate Professor Hope is a leading hip specialist in Direct Anterior Approach (DAA) surgery and was one of the pioneering surgeons to perform the operation in Australia.

DAA enables the surgeon to enter the hip joint from the front of the thigh and travel between muscles. Once the hip joint has been replaced the retractors are removed from the area and the muscles fall back into position.


Here he is answering some common questions regarding hip surgery:


Everything you need to know about surgery:


How can I prepare for a hip replacement?


PRE-HAB at bounceREHAB ! Research has shown that those who have better lower limb and core strength will recover faster, tolerate early mobility and require shorter hospital stays. A high quality study has shown that high levels of knee extensor (quadriceps) strength prove superior outcomes for recovery. Simply put, the stronger you are when standing from a chair, the better research has found you can do in your surgical recovery!

PRE-HAB at bounceREHAB is called PHYSIO REHAB ! We use small group sessions to cater to the individual's recovery needs.



What will my recovery look like?

Early Phase

  • Early movement and pain relief.

  • Assistive walking device (e.g crutch(es) or frame).

  • Special home equipment (e.g. raised toilet seat, hand grabbers) may be of benefit

Mid Phase

  • Slowly building on walking tolerance, reducing the need for crutches over time.

  • Home exercises and group rehab sessions where appropriate.

Late Phase

  • Progressive rehabilitation - increasing challenge and complexity with exercises.

  • Return to general fitness activities and sport (as appropriate).

Long term outcomes


These surgeries are become more refined year by year, with the life-span of a prosthesis lasting sometimes >30 years. Timing of a hip replacement surgery is key and is topical in medicine these days due to the rise in life expectancy.

A common question we get asked is regarding this timing:


Am I too old / young to have a hip replacement?


The answer to this is dependent on many factors, outlined in the Talking with Docs video below:


An old school way of thinking suggests that >65 years would be a safe predictor of the patient only requiring one hip replacement surgery in their lifetime. As people age, the surgeries they undergo become more complex and take longer to recovery from.


These days, the number of people under 65 having hip replacements has increased, and is expected to rise consistently over the next decade. It is predicted that 50% of people having hip replacements will be younger than 65 by the year 2030.

In the past patients were very concerned about joint replacements wearing out. In fact this is not such an issue with a recent study indicating that hip replacements may last over 30 years. The failure rate is only 1% per year meaning that in 10 years 90% of implants are ok, in 20 years 80% of implants are ok and in 30 years 70% of implants are ok.

This is a phenomenal achievement in the discipline of orthopaedics, showing that the surgery is becoming more refined and these hips are robust and durable for our ageing, active population.


It is great news for all the patients we see in clinic here, meaning they can regain quality of life and remain healthy and strong into their later years.



Written by


Niamh Rafter BSc. (Hons) Physiotherapy

Physiotherapist

Pilates Instructor bounceREHAB


Co-Written by


Matthew Craig Pinc & Steel Cancer Rehab Physiotherapist B.App.Sci. (Physiotherapy) Masters. Musculoskeletal Physiotherapy (fy) CSCS (Strength & Conditioning Specialist), National Advisory Board Member (CPAA) DIRECTOR Bounce Rehab PTY LTD

References

https://edisciplinas.usp.br/pluginfile.php/5699216/mod_folder/content/0/Pivec%202012%20-%20Hip%20Arthroplasty.pdf

https://journals.sagepub.com/doi/full/10.1177/1120700020971314

https://www.nigelhope.com.au/


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