Hip Problems

Hip Replacements

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There are various reasons that a hip replacement may be necessary. The most common reasons for a hip replacement are hip fractures and Arthritis, including Osteoarthritis and Rheumatoid Arthritis.


Hip Surgery

I use a frontal approach to the hip as I believe that this results in a lower complication rate in that the dislocation rate is significantly lower. 
 
A total hip replacement usually takes between 1 and 2 hours. I always have an experienced assistant to help speed thing up and make the operation go smoothly. We have many different sizes and types of hips available in theatre and usually only make a final decision in theatre as to what hip will be used. The hip is custom fitted for you.
 
There are 4 main layers of stitches to close the wound and we apply a dry, waterproof dressing. We do not use wound drains.


 

Your Hospital stay

Usually a hip replacement will stay in hospital between 5 and 7 days. Patients usually need to see a physician before the procedure and are admitted the day before the surgery or the morning of the surgery. The physician checks all the medical systems to make sure that the patient is as strong as possible for the procedure.
 
After the operation you will go to the High Care Unit as a routine way of monitoring your progress. The physician is the doctor who is in charge in the HCU, but there is input from the anaethetist and the orthopaedic surgeon.
 
Your pain will be controlled using a local anaesthetic infusion into the groin area and this stays in for 3 days.
 
After 1 night in the HCU we usually transfer you to the orthopaedic ward - C ward. Here the physiotherapists will see you and begin doing your exercises. Usually you will do exercises in bed until day 2 and then they will start getting you up and walking with the walking frame. You will have elasticized stockings which need to be worn for 6 weeks and calf pumps to reduce the chance of getting a Deep Vein Thrombosis (DVT). You will also receive injections to thin your blood.
 
Usually you will be walking reasonably pain free by the 4th day after surgery but will still need support. You will be ready for discharge between day 5 and day 7 after the operation. Depending on your personal circumstances and progress you could either go straight home to your family, get nursing help or go to a Step Down facility for further training in walking etc. Please speak to Sr. Val to help you with arrangements for discharge.


 

Recovering From Hip Surgery

The recovery following a Total Hip Arthroscopy is initially very quick and one rapidly achieves milestones.

Once you have achieved mobility time seems to stop and the progress slows drastically. Your hip will continue improving for up to 18 months after the operation. There are always good and bad days and you may find that the weather becomes very predictable for a while after the operation.

You will need to visit the physiotherapist weekly and when the wound has healed at 2 - 3 weeks you should consider joining the rehab classes run by Marcelle Piennaar and her team.

Due to the type of surgery, you will have weak muscles for a couple of months and tend to limp a bit. This will improve as your muscle strength improves.


Possible Complications

Hip complications
 

The most common complications are infection and dislocation.I am not too concerned about dislocation and although the physios have a generic rehab for all surgeons, I am not as strict when it comes to sitting, raised toilet seats or bending over. Your body will usually let you know when it is uncomfortable and you will need to listen to it and not get yourself into positions where it is uncomfortable.

Infection is a rare complication and we have a far lower rate at Constantiaberg than what is regarded as an acceptable rate. Infection is an extremely difficult condition to treat. Usually by analyzing the bacteria causing the infection we can tell where the infection came from. It almost always happens at the time of the operation and can be either from your own normal bacteria on your skin or from resistant hospital bacteria.

Every attempt is made to avoid the chance of getting an infection by giving antibiotics and cleaning the skin properly, but it is not a risk that can be completely eliminated.
 

Medical complications

The most common medical complications following THA are electrolyte disturbances, cardiovascular complications and DVT with or without pulmonary embolus and chest or bladder infections. The physician looking after you will treat all these conditions if they arise.

If you have any questions on hip replacement surgery or would like to book a consulation please contact us.