Hip replacement surgery is a safe and effective reconstructive procedure that may be suitable for patients with hip pain who have responded poorly to conservative treatments. It aims to relieve pain and improve mobility in patients who have sustained a traumatic injury or have advanced arthritis in the hip joint.

If your hip joint has been damaged by progressive arthritis, a fracture, or an underlying condition, the information found below will help you understand the benefits of hip replacement surgery, and allow you to recognise its limitations.

When is a hip replacement recommended?

Hip replacement surgery may be recommended when presenting with any of the following:

  • Hip pain that stops you from carrying out typical daily activities
  • X-rays displaying hip joint degeneration
  • Overnight stiffness and pain
  • Failed non-surgical therapy
total hip replacement procedure

 This metal or ceramic ball is attached to the top of your femur.

What are the
types of hip
replacements?

Total hip replacement surgery involves replacement of the portions of your thigh bone and pelvis that form your hip joint. There are various types of hip replacements, each of which are used in patient-specific cases.

Total Hip Replacement

The most common hip replacement surgery is a total hip replacement or total hip arthroplasty. During the total hip replacement procedure, your surgeon will replace the damaged parts of your hip joint with prosthetic implants.

The femoral head will be removed and replaced by a metal stem which is placed into the femur. Your surgeon will either cement the metal stem in place or apply a “press-fit” technique to precisely fit the stem to your femur size. A prosthetic ball made out of metal or ceramic is then placed on the upper part of the stem and replaces the femoral head. 

The damaged hip socket, known as acetabulum, will be replaced by a metal socket. A prosthetic liner is then inserted between the new hip components to allow for smoother, stable movements.

Hip Resurfacing

Hip resurfacing is an alternative to total hip replacement. Rather than removing the arthritic head of the femur completely, the surface of femoral head is covered with a metal cap. The bone of the femoral neck is largely preserved, and the prosthesis does not need to be placed in the femoral canal. The arthritic socket of the hip joint is replaced in a similar way to a total hip replacement. The metal cap on the femoral head moves inside the metal acetabular component. The potential benefits of hip resurfacing are preserved bone, improved range of motion and increased stability of the resurfaced joint.

Not all patients are suitable for hip resurfacing. The procedure is largely limited to male patients under the age of 55 with a larger body frame and good bone quality.

Anterior Approach Hip Replacement

The anterior approach hip replacement surgery is a muscle-sparing approach that exposes the arthritic hip joint from the front. The anterior approach utilises the hip’s natural intermuscular planes, going between muscles, rather than cutting through muscles. Due to the less invasive and muscle-sparing nature of this approach, patients may experience a quicker short-term recovery and return to usual level of activity. The medical literature suggests that this benefit is limited to the first 6-12 months. In the longer term, however, there is no functional difference between the two approaches and the long term outcomes are the same.

In 2019, the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) reported on approaches in total hip replacement surgery for the first time. This was based on data from hip replacements performed in Australia between 2015 – 2019. The primary finding was that there was no difference in overall rate of early revision between posterior approach and direct anterior approach. However, when revisions were required, the reason for revision was different between approaches. Posterior approach total hip replacements were more commonly revised for infection and dislocation, while anterior approach total hip replacements were more commonly revised for loosening or fracture.

hip replacement

What is the hip replacement made of and how is it fixed in place?

There are many different designs of total hip replacement prostheses. The main differences between prostheses are the way in which the prosthesis is fixed to the bone and the prosthesis bearing surfaces.

Hip replacement prostheses may be classified as:

  1. Uncemented – both femoral and acetabular components rely on a tight fit for initial bone fixation. The bone grows onto the components for long term fixation.
  2. Hybrid – the femoral component is fixed inside the femur with bone cement and the acetabular component relies on bone growth for fixation.
  3. Cemented – both the femoral and acetabular components are fixed in place with bone cement.

The Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) provides some guidance on how to choose a particular prosthesis for a particular patient. Generally speaking, for patients over the age of 65, a hybrid total hip replacement has the lowest revision rate. Uncemented prostheses may be used for younger patients. The best prosthesis choice is determined for each individual patient.

The bearing surfaces are the femoral head and the acetabular liner. These may be made from metal alloy, ceramic or polyethylene (plastic). The most commonly used bearing surfaces are metal alloy heads and polyethylene liners. Ceramic heads and liners may be used in younger patients. Metal on metal hip prostheses (with the exception of hip resurfacing) are not currently used.

How long will the hip replacement last?

In 2019, the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) reported the overall revision rate of primary total hip replacement as 11.7% at 18 years after surgery.

Recovery and Results

Whilst every patient has a different starting point prior to hip replacement, relief from arthritic hip pain is usually very rapid. Patients are encouraged to walk almost immediately following surgery under the supervision of a physiotherapist. It takes approximately 2 weeks for the skin wound to be well healed and it may be wet after that. Hip replacement patients will have returned to driving a car by 6 weeks.

After a rapid improvement in the first three months, progress will start to plateau, and you will return to normal activity levels. Depending on the approach taken for a hip replacement there may be restrictions in positioning for three months. Hip precautions are taken for posterior approach total hip replacement. There are less restrictions for anterior approach total hip replacement.

total hip replacement surgery

Physiotherapy allows you to get used to any new movements your new hip has to go through and increases your chances of returning to normal function.

ligamentum teres tear treatment in Melbourne

What are the
main risks of
hip replacement
surgery?

Deep venous thrombosis (DVT). A blood clot may form in the leg after surgery. This has the potential to propagate or break off, travelling to lung. This is potentially life threatening. Medications can be used to reduce the risk of DVT. Other things that you can do to prevent clots include remaining well hydrated, wearing TED stockings and mechanical calf pumps immediately after the operation. Also, moving around and walking early after surgery will lower your risk of DVT.

Infection. Infection can be either superficial or deep down at the hip prosthesis. This may occur soon after surgery or even many years down the track. The hip replacement may need to be removed while being treated with antibiotics. Infection is the complication that orthopaedic surgeons fear the most. On average the risk of deep infection is 1%. This means that 1 in 100 patients may develop an infection. We do everything we can to prevent this. This includes antiseptic body wash before the operation, antibiotics during and after the operation, and meticulous wound care after the operation. All joint replacements are performed in a laminar air flow operating theatre under sterile conditions.

Fracture. The bone supporting the hip prosthesis may fracture both during or after surgery. Small fractures may heal on their own. Larger, unstable fractures may require further operations.

Dislocation. Certain positions after hip replacement can cause the hip replacement to dislocate, particularly when a posterior approach has been used. For the first 3 months, precautions should be taken. Avoiding positions of high hip flexion to 90 degrees, avoiding low chairs and toilets, and avoiding bending to the ground to pick things up will help reduce this risk.

Change in leg length. The length of the leg being operated on can be altered during a hip replacement but not during a knee replacement. Patients with osteoarthritis may have a short leg without even noticing it. The aim of surgery is to restore leg length back to what is equal, and we use a number of tools to do this. We look at your x-rays and template the implant size before the operation. During the operation we may use a leg length guide which is inserted into the pelvis by a separate small incision. We also trial the implant, checking for stability and leg length before it is finally inserted. During a hip replacement, through a direct anterior approach, an x-ray is taken to confirm accurate leg length and implant size. We do not compromise leg length for stability. Very rarely if someone feels uneven, they may need to wear a shoe lift in the opposite shoe. More often than not with time you will not notice a difference in leg length. This is because you have gotten used to having a short leg and will need to get used to having equal leg lengths again.

Loosening. The femoral or acetabular component may become loose over time. This is rare with modern day techniques and prostheses. Further revision surgery may be required for this.

Hip replacement cost in Australia

The cost of total hip replacement in Australia varies widely, depending on whether treatment occurs in a public or private hospital, and the level of cover provided by private health insurance. Treatment at a public hospital is fully covered by Medicare. For treatment at a private hospital our staff will be able to provide you with a quotation, taking into account your level of health insurance coverage. If you do not have private health insurance but still wish to be treated in a private hospital, you will be provided a full fee estimate including fees for the surgeon, surgical assistant, anaesthetist, the private hospital and any required surgical implants or prostheses.

The Australian Medical Association (AMA) provides an annual list of medical services and the recommended fees for specialists. The fees are considered to be reasonable when taking into account the running costs of a medical practice and the level of training required. The Mid North Coast Hip & Knee Clinic uses the AMA recommended fee as a guide and aims to keep fees at an affordable level for patients.

knee replacement

Why choose us?

At the Mid North Coast Hip & Knee Clinic, we pride ourselves on providing patients with the highest standard of care in the treatment of all hip and knee disorders. We treat patients of all ages using a multi-disciplinary approach, working together to form a comprehensive and patient-specific treatment plan. We treat patients from all along the Mid North Coast and surrounding communities. This covers a large area from Yamba and Grafton in the north, to Coffs Harbour, Port Macquarie, Forster and Taree in the south.

Consulting rooms:

  • Coffs Harbour Specialist Centre
    230 Pacific Highway, Coffs Harbour New South Wales 2450
  • Mayo Private Hospital
    Potoroo Drive, Taree New South Wales 2430
  • Forster Private Hospital
    29-41 South Street, Forster New South Wales 2428

Hospital affiliations:

  • Coffs Harbour Health Campus
    345 Pacific Highway, Coffs Harbour New South Wales 2450
  • Baringa Private Hospital
    Mackays Road, Coffs Harbour New South Wales 2450
  • Macksville District Hospital
    Boundary Street, Macksville New South Wales 2447
  • North Shore Private Hospital
    3 Westbourne Street, St Leonards NSW 2065
  • Prince Of Wales Private Hospital
    Barker Street, Randwick New South Wales 2031
  • Mayo Private Hospital
    Potoroo Drive, Taree New South Wales 2430
  • Forster Private Hospital
    29-41 South Street, Forster New South Wales 2428

FAQs

If you feel like we may have left some things unanswered, why don’t you check out the questions below?

Most hip replacement surgeries are performed on an outpatient basis, meaning that you typically have to stay in the hospital between 24 and 72 hours before your discharge.

Your ability to drive after your surgery depends on how quickly you recover. Some patients can begin driving after 2 weeks, whilst others have to wait up to 8 weeks before they feel comfortable doing so. Meeting the following requirements is necessary in order to drive safely:

  • You should have completed your course of narcotic pain killers, or any medication that can limit your driving ability
  • You should be able to hit the brake quickly
  • You should be able to get in and out of the car safely without injury

Total hip replacement is a surgical procedure that replaces the arthritic hip joint with an artificial joint (prosthesis). The main goals of total hip replacement are pain relief, improved mobility and quality of life. Total hip replacement is one of the most successful surgical procedures performed in the world today and was named by The Lancet as the “operation of the century” in 2007.

Common reasons for undergoing total hip replacement include:

  • Severe pain
  • Reduced mobility and independence
  • Difficulty performing job due to pain and stiffness
  • Inability to enjoy recreational activities due to pain and stiffness
  • Pain at night that interrupts sleep

459,265 primary total hip replacements have been performed in Australia since 1999. The ball (head of the femur) is removed and replaced with a femoral component that is fixed inside the femoral canal. The femoral component has a new ball on top. The arthritic socket of the hip joint is also replaced with a metal acetabular component. A liner is inserted into the acetabular component. The ball of the femoral component moves inside the liner of the acetabular component.

Hip resurfacing is an alternative to total hip replacement. Rather than removing the arthritic head of the femur completely, the surface of femoral head is covered with a metal cap. The bone of the femoral neck is largely preserved, and the prosthesis does not need to be placed in the femoral canal. The arthritic socket of the hip joint is replaced in a similar way to a total hip replacement. The metal cap on the femoral head moves inside the metal acetabular component. The potential benefits of hip resurfacing are preserved bone, improved range of motion and increased stability of the resurfaced joint.

Not all patients are suitable for hip resurfacing. The procedure is largely limited to male patients under the age of 55 with a larger body frame and good bone quality.

There are different ways or “approaches” to perform a total hip replacement. Irrespective of the approach used, total hip replacement can offer long-term pain relief and improved quality of life. The most common approaches used today are the “posterior approach” and the “direct anterior approach”.

The posterior approach is the most common approach utilised in Australia today. The arthritic hip joint is exposed through the back of the joint.  The posterior approach requires the large gluteus maximus muscle to be split and the detachment of some short external rotator muscles from the femur. It is generally a more invasive approach.

The minimally invasive direct anterior approach is a muscle-sparing approach that exposes the arthritic hip joint from the front. The anterior approach utilises the hip’s natural intermuscular planes, going between muscles, rather than cutting through muscles. Due to the less invasive and muscle-sparing nature of this approach, patients may experience a quicker short-term recovery and return to usual level of activity. The medical literature suggests that this benefit is limited to the first 6-12 months. In the longer term, however, there is no functional difference between the two approaches and the long term outcomes are the same.

In 2019, the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) reported on approaches in total hip replacement for the first time. This was based on data from hip replacements performed in Australia between 2015 – 2019. The primary finding was that there was no difference in overall rate of early revision between posterior approach and direct anterior approach. However, when revisions were required, the reason for revision was different between approaches. Posterior approach total hip replacements were more commonly revised for infection and dislocation, while anterior approach total hip replacements were more commonly revised for loosening or fracture.

There are many different designs of total hip replacement prostheses. The main differences between prostheses are the way in which the prosthesis is fixed to the bone and the prosthesis bearing surfaces.

Hip replacement prostheses may be classified as:

  1. Uncemented – both femoral and acetabular components rely on a tight fit for initial bone fixation. The bone grows onto the components for long term fixation.
  2. Hybrid – the femoral component is fixed inside the femur with bone cement and the acetabular component relies on bone growth for fixation.
  3. Cemented – both the femoral and acetabular components are fixed in place with bone cement.

The Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) provides some guidance on how to choose a particular prosthesis for a particular patient. Generally speaking, for patients over the age of 65, a hybrid total hip replacement has the lowest revision rate. Uncemented prostheses may be used for younger patients. The best prosthesis choice is determined for each individual patient.

The bearing surfaces are the femoral head and the acetabular liner. These may be made from metal alloy, ceramic or polyethylene (plastic). The most commonly used bearing surfaces are metal alloy heads and polyethylene liners. Ceramic heads and liners may be used in younger patients. Metal on metal hip prostheses (with the exception of hip resurfacing) are not currently used.

In 2019, the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) reported the overall revision rate of primary total hip replacement as 11.7% at 18 years after surgery.

Whilst every patient has a different starting point prior to hip replacement, relief from arthritic hip pain is usually very rapid. Patients are encouraged to walk almost immediately following surgery under the supervision of a physiotherapist. It takes approximately 2 weeks for the skin wound to be well healed and it may be wet after that. Hip replacement patients will have returned to driving a car by 6 weeks. After a rapid improvement in the first three months, progress will start to plateau, and you will return to normal activity levels. Depending on the approach taken for a hip replacement there may be restrictions in positioning for three months. Hip precautions are taken for posterior approach total hip replacement. There are less restrictions for anterior approach total hip replacement.

Deep venous thrombosis (DVT). A blood clot may form in the leg after surgery. This has the potential to propagate or break off, travelling to lung. This is potentially life threatening. Medications can be used to reduce the risk of DVT. Other things that you can do to prevent clots include remaining well hydrated, wearing TED stockings and mechanical calf pumps immediately after the operation. Also, moving around and walking early after surgery will lower your risk of DVT.

Infection. Infection can be either superficial or deep down at the hip prosthesis. This may occur soon after surgery or even many years down the track. The hip replacement may need to be removed while being treated with antibiotics. Infection is the complication that orthopaedic surgeons fear the most. On average the risk of deep infection is 1%. This means that 1 in 100 patients may develop an infection. We do everything we can to prevent this. This includes antiseptic body wash before the operation, antibiotics during and after the operation, and meticulous wound care after the operation. All joint replacements are performed in a laminar air flow operating theatre under sterile conditions.

Fracture. The bone supporting the hip prosthesis may fracture both during or after surgery. Small fractures may heal on their own. Larger, unstable fractures may require further operations.

Dislocation. Certain positions after hip replacement can cause the hip replacement to dislocate, particularly when a posterior approach has been used. For the first 3 months, precautions should be taken. Avoiding positions of high hip flexion to 90 degrees, avoiding low chairs and toilets, and avoiding bending to the ground to pick things up will help reduce this risk.

Change in leg length. The length of the leg being operated on can be altered during a hip replacement but not during a knee replacement. Patients with osteoarthritis may have a short leg without even noticing it. The aim of surgery is to restore leg length back to what is equal, and we use a number of tools to do this. We look at your x-rays and template the implant size before the operation. During the operation we may use a leg length guide which is inserted into the pelvis by a separate small incision. We also trial the implant, checking for stability and leg length before it is finally inserted. During a hip replacement, through a direct anterior approach, an x-ray is taken to confirm accurate leg length and implant size. We do not compromise leg length for stability. Very rarely if someone feels uneven, they may need to wear a shoe lift in the opposite shoe. More often than not with time you will not notice a difference in leg length. This is because you have gotten used to having a short leg and will need to get used to having equal leg lengths again.

Loosening. The femoral or acetabular component may become loose over time. This is rare with modern day techniques and prostheses. Further revision surgery may be required for this.

If you suffer from a knee or hip condition,
we can help you get back to life.

Pain and discomfort caused by orthopaedic conditions affect our patients negatively every day.
Which is why we work so hard to provide relief for every one of our patients. Our team is highly
trained in the diagnosis, treatment and management of all musculoskeletal conditions and injuries.

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