5 Questions you should ask your Orthopaedic surgeon before hip replacement

1.Why did I develop hip arthritis?

Many people think that they developed hip arthritis either because they were unlucky or because they overused the joint during a sporting activity. This is usually not the case. If hip arthritis develops before the age of 65 there is usually a structural reason. The most common reasons include:

  • Hip dysplasia-where the hip socket has not fully formed and a small part of the joint is overloaded and wears out prematurely.

  • Osteonecrosis-where a part of the hip bone loses its blood supply and the bone dies and softens and this gives rise to a rapidly progressive arthritis.

  • Inflammatory arthritis developed-inflammatory arthritis is usually treated medically without surgery before severe joint damage has taken place which would necessitate a hip replacement.

It is important that the cause of the hip arthritis is identified before surgery as different causes change the structure of the natural hip joint and may require a different surgical technique to compensate for the structural problem.

2.How long should my hip replacement last?

This depends on many factors which include:

  • The age and activity level of the patient

  • The patients weight and technical factors such as the material from which the implant and its bearing surfaces are manufactured.

  • Generally we recommend that younger patients have porous titanium hips with ceramic bearings as these are more durable and are highly unlikely to ever dislocate. Conventional hip replacements should last 15 years or more unless there is a technical problem such as infection. However ceramic bearing hips are likely to last far longer. Hip implants which are fixed to bone using porous titanium technology are likely to last longer and to preserve more bone to facilitate easy removal in the event that they do wear out and need to be exchanged.

    How long will I be in the hospital?

In the past, it was felt that patients who had had undergone hip replacement should rest in bed for a few days afterwards. We now know that this is actually harmful and promotes the development of blood clots and weakens muscle and stiffens joints. The rapid recovery process which was introduced to Ireland by Mr Bennett 5 years ago allows patients to walk a few hours after their hip replacement. Patients can go home as soon as they are proficient in the use of crutches, usually two or three days after the operation.

3.How likely am I to have a complication?

At the Mayo Clinic we use multiple layers of protection against all possible complications and the risk of getting any of the complications is extremely low.

Blood Clots

We use early mobilization, low blood pressure epidural anaesthesia, pharmecutical blood thinning medications, compressive anti thrombosis stockings, and pneumatic foot pumps to prevent clots. Taken together these techniques have reduced the risk of clotting to less than 1 in 1000.

Infection

There are multiple layers of protection against infection and these include preoperative screening against protection, prophylactic antibiotics, an ultra clean air filtration system for the operating theatre, double layer antiseptic skin preparation, antiseptic impregnated surgical drapes and space suits for the entire operating team. Taken together these techniques have reduced the risk of getting an infection to less than 1 in 200, far less than the risk of infection with most types of surgery.

Dislocation

Dislocations are prevented by a direct lateral surgical approach, avoiding high flexion movements for 12 weeks after the operation and use of high performance ceramic bearings. None of Mr Bennetts patients with high performance ceramic bearings has ever dislocated their hip.

Nerve Injuries

Nerve injuries are less likely with a direct lateral surgical approach. Apart from this, there are no other specific precautions against nerve injury and the risk is approximately 1 in 400.

4. Is this the same type of hip as you put into an 80 year old?

Conventional cemented steel and plastic hip replacements work extremely well for elderly patients. In many cases a conventional hip replacement will result in a life long resolution of pain and symptoms. For younger patients it is important that increased activity levels and life expectancy are taken into account. For younger patients we recommend that hips with ceramic bearings should last longer, have a reduced dislocation risk, and permit a greater range of movement. We also recommend modern porous titanium cementless technology for fixation of implants in young patients as this preserves bone, facilitates easier removal in the event of the implant wearing out and allows easier revision of the implant in future years.

5. If my hip implant fails or has a technical problem can you fix it?

Most general Orthopaedic surgeons will do first time (primary) hip replacements. If a hip replacement develops a technical problem such as infection, dislocation, or loosening from the bone most general Orthopaedic surgeons will refer the patient to a specialist joint replacement surgeon like Mr Bennett. Mr Bennett receives referrals of complex joint replacement patients from many of his colleagues both in Ireland and internationally. He believes that the possibility of technical problems and implant failures should always be considered when performing the primary surgery so that, in the event of a problem a revision procedure will be relatively straight forward.