Not everyone with hip joint pain needs a total hip replacement, but when your quality of life is affected by painful osteoarthritis, you may be advised by your doctor to consider hip replacement surgery.
It’s up to you to decide when you’ve had enough pain and are ready to seek a medical solution. Many people cope using pain killers before considering surgery.
If you cannot undertake your normal work due to pain in your hip joint, or if you find it difficult to sleep at night because your pain is so severe, then you should consider talking to a surgeon about whether hip replacement is right for you.
Hip pain can radiate from anywhere in or around the hip joint. In some cases, you may not be able to feel the pain directly over the hip; you may feel it in your thigh or in your knee.
Prosthetic hip joints can wear out over time, so if you have a hip replacement when you are still young and active, you may need a second hip replacement after 10-15 years.
Alternatives to Hip Replacement:
Non-surgical treatments, include weight loss, physiotherapy, taking painkillers (eg paracetamol) or anti-inflammatories (eg ibuprofen), or using physical aids like a walking stick.
A major issue in joint replacement surgery is the choice of artificial joint used.
You should discuss the prosthesis to be used with your orthopaedic surgeon.
There are two issues – cost and reliability.
The Commonwealth Government has developed a list of artificial joint types and the minimum benefit (and sometimes a maximum benefit) that should be paid by your health insurer. Normally, if the selected joint is on “The Prosthesis List” your health fund should cover the full cost of the prosthesis. However, sometimes the hospital charges a fee higher than the minimum and then you will have an out of pocket expense.
You should confirm that your health insurer will pay for the type chosen.
Some surgeons choose a prosthesis that is not on this list and THIS CAN ADD SUBSTANTIAL EXTRA OUT OF POCKET COSTS for the procedure. If it is not on this list, your PHI may not pay and the Private Hospital may charge you instead, sometimes many thousands of dollars. This should be discussed with your surgeon as to why they are choosing one not on the list and if you are not satisfied, you should seek a second opinion.
In addition to the Prostheses List, the Australian Orthopaedic Association maintains a National Joint Replacement Registry (AOANJRR) which assesses the evidence for each type of prosthesis as to how long it lasts, and how often it needs to be replaced.
You should ask your surgeon how the type of joint he/she is recommending rates on this registry. If it is too new to have been rated, it may be worth asking for one that has been in use for longer and its reliability is well tested.
There is an Annual Report available from the Registry, but it is very large and technical. If you want to peruse the list we recommend you read the Lay Summary first.
There are several complications which you should discuss with your surgeon.
The complication following hip replacement surgery is low. Serious complications, such as joint infection, occur in less than 2% of patients.
Infection may occur superficially in the wound or deep around the prosthesis. It may happen while in the hospital or after you go home. It may even occur years later.
Minor infections of the wound are generally treated with antibiotics. Major or deep infections may require more surgery and removal of the prosthesis. Any infection in your body can spread to your joint replacement, particularly in the first years after surgery. You should remind your treating doctors and dentists that you have Joint Replacement .
Blood clots in the leg veins or pelvis are one of the most common complications of hip replacement surgery. These clots can be life-threatening. Your orthopaedic surgeon will outline a prevention program which may include blood thinning medications, support stockings, inflatable leg coverings, ankle pump exercises, and early mobilization.
Sometimes after a hip replacement, one leg may feel longer or shorter than the other. Your orthopaedic surgeon will make every effort to make your leg lengths even, but may lengthen or shorten your leg slightly in order to maximize the stability and biomechanics of the hip. Some patients may feel more comfortable with a shoe lift after surgery.
Hip implant dislocation.
This occurs when the ball comes out of the socket. The risk for dislocation is greatest in the first few months after surgery while the tissues are healing. Dislocation is uncommon. If the ball does come out of the socket, a closed reduction usually can put it back into place without the need for more surgery. In situations in which the hip continues to dislocate, further surgery may be necessary.
Loosening and Implant Wear
Over years, the hip prosthesis may wear out or loosen. This is most often due to everyday activity. It can also result from a biologic thinning of the bone called osteolysis. If loosening is painful, a revision may be necessary.
Other complications including nerve and blood vessel injury, bleeding, fracture, and stiffness can occur.
Following joint replacement surgery there is a need for ongoing physiotherapy to restore full function.
This can be done by visits to a physiotherapist or patients may be offered the chance to be admitted to a Rehabilitation Hospital for a period or it can be provided in your own home.
This is an area where the health insurers are encouraging patients to have rehabilitation outside a hospital setting. Check with your health fund whether they will pay for inpatient rehabilitation if you need it.
The preferred choice depends on cost and circumstances.
If you have no one to support you at home, then a period as an inpatient can be very convenient. However, inpatient rehabilitation can add significantly to the cost of the procedure.
If you have good support at home, then regular visits to a physiotherapist either in the public or private sector or if offered, having a physio come to your home are just as effective.
The issues here are very similar to those for Knee Replacement. A recent article discussed Knee Replacement rehabilitation, the figures may be different, but the principal is the same.