In FY2021-22, over 35000 total hip replacements were performed in Australia
HIP OSTEOARTHRITIS
Hip osteoarthritis is a degenerative joint condition that commonly occurs with age and involves the gradual breakdown of the cartilage in the hip joint. The primary cause is wear and tear over time, leading to the loss of cartilage, which cushions and protects the hip joint. Other causes include inflammatory joint diseases such as rheumatoid arthritis and osteonecrotic phenomenon such as avascular necrosis of the hip.
Factors such as aging, genetics, joint overuse, and previous hip injuries can contribute to the development of hip osteoarthritis. The natural history of the condition involves the progressive deterioration of the hip joint, leading to pain, stiffness, and reduced mobility. Symptoms typically include deep-seated joint pain, especially during weight-bearing activities, stiffness that worsens after periods of inactivity, and decreased range of motion.
Treatment options for hip osteoarthritis aim to alleviate symptoms and improve joint function. Conservative measures include pain medications, physical therapy, lifestyle modifications, and the use of assistive devices. In more advanced cases, surgical interventions such as hip joint replacement may be considered to relieve pain and restore function. Early diagnosis and a comprehensive treatment approach are essential for managing hip osteoarthritis effectively and maintaining an optimal quality of life.
Around 2.1 million Australians (1 in 11 people) have osteoarthritis, with a 58% increase expected by 2032 due to population ageing and rising obesity rates
Total hip replacement aims to relieve pain, improve joint function, and enhance the patient's quality of life. Postoperatively, patients undergo a period of rehabilitation and physical therapy to regain strength, flexibility, and mobility in the hip. Total hip replacement is a highly successful procedure with a high rate of patient satisfaction, particularly in relieving pain and restoring function to individuals with hip joint disorders.
When symptoms of osteoarthritis deteriorate, total hip replacement is one of the most successful and effective treatment options. Data from the British National Joint Registry (NJR), which has been collecting patient-reported outcomes since 2009, show that 97.5% of patients reported an improvement in hip pain and function (increase of 153% from a median of 17 to 43 points as measured by the Oxford Hip Score).
Dr Jason Hockings utilises a direct anterior approach for the majority of his hip replacements, although he is also trained and proficient in the traditional posterior approach which is occasionally more appropriate depending on the patient and the pathology.
“The direct anterior approach for total hip replacement is a way to make an already great operation even better.” Dr Jason Hockings
The direct anterior approach for total hip replacement surgery offers several benefits compared to traditional surgical approaches. One notable advantage is the potential for a faster recovery and shorter hospital stay. This is attributed to the fact that the surgery is performed through a smaller incision at the front of the hip, avoiding disruption of key muscles and tendons. The approach allows for a more tissue-sparing technique, reducing trauma to surrounding structures and minimizing postoperative pain. Patients undergoing direct anterior hip replacement often experience improved early postoperative mobility and reduced muscle damage, contributing to a quicker return to activities of daily living. Additionally, the reduced muscle trauma may lead to a lower risk of dislocation after surgery. While not suitable for all patients, the direct anterior approach represents an innovative and minimally invasive option for total hip replacement, providing potential advantages in terms of recovery time, postoperative pain, and overall patient satisfaction.
Dr Jason Hockings has been trained in the use of robotic assistance to perform hip replacements in order to achieve the best possible outcomes using the most advanced technology available. During your consultation, Jason will discuss whether robotic assisted hip replacement is appropriate for you.
The typical recovery following total hip replacement through a direct anterior approach is often faster compared to traditional approaches. However, it’s important to note that individual recovery experiences can vary based on factors such as the patient’s overall health, preoperative fitness, and adherence to rehabilitation protocols. Here is a general overview of the recovery process:
Immediate Postoperative Period (Days 1-3)
Patients are encouraged to start moving and walking with assistance on the day of surgery.
Pain management is a priority to ensure comfort during the initial recovery phase.
Physical therapy may begin soon after surgery to facilitate early mobilization and teach proper movement techniques.
Weeks 1-6
Patients continue with physical therapy to improve strength, flexibility, and walking abilities.
Gradual resumption of daily activities with precautions to avoid certain movements that may stress the hip joint.
Most patients are able to walk with a cane or walker, gradually transitioning to walking without assistance.
Weeks 6-12
Continued improvement in mobility and strength.
Transition to more independent daily activities, including driving (if approved by the surgeon) and light recreational activities.
Follow-up appointments with the surgeon to monitor progress.
Months 3-6
Further gains in strength and mobility.
Patients often resume more normal activities, including low-impact exercises and recreational pursuits.
Full recovery may take several months, and patients are advised to avoid high-impact activities.
Months 6 and Beyond
Continued improvement in strength and endurance.
Patients can often return to more demanding activities, including sports, under the guidance of the surgeon.
The direct anterior approach is associated with reduced muscle trauma, potentially allowing for a quicker recovery and a faster return to normal activities. However, it’s essential for patients to follow the prescribed rehabilitation plan, including physical therapy exercises, to optimize outcomes and ensure a successful recovery.
HIP ARTHROSCOPY
Hip arthroscopy is a minimally invasive surgical procedure employed to diagnose and treat various conditions affecting the hip joint. It is commonly used to address problems such as femoroacetabular impingement (FAI), labral tears, hip dysplasia, synovitis, and loose bodies in the joint. Femoroacetabular impingement involves abnormal contact between the hip bones, while labral tears pertain to damage in the cartilage lining the hip socket. Arthroscopy is also effective in treating inflammatory conditions like synovitis and removing loose fragments or debris within the joint. The procedure involves the use of small incisions and a camera (arthroscope) to visualize and treat the hip joint, providing a less invasive alternative to traditional open surgery. Hip arthroscopy is instrumental in relieving pain, improving joint function, and addressing a range of hip-related pathologies, making it a valuable tool in modern orthopedic practice.
Femoroacetabular impingement (FAI) is a hip condition characterized by abnormal contact between the ball (femoral head) and socket (acetabulum) of the hip joint. The causes of FAI can be attributed to structural abnormalities in the hip joint, such as excess bone growth along the femoral head or acetabulum, leading to an altered joint anatomy. Over time, this abnormal contact can result in the natural wear and tear of the hip joint, potentially causing damage to the cartilage and leading to the progression of hip osteoarthritis. The natural history of FAI involves the gradual development of symptoms, including hip pain, stiffness, and limited range of motion. Individuals with FAI may experience pain during activities that involve hip flexion, rotation, or prolonged sitting.
Treatment for FAI often begins with conservative measures such as physical therapy, anti-inflammatory medications, and activity modification. In cases where conservative methods are insufficient, surgical intervention, such as arthroscopic hip surgery, may be considered to address the structural abnormalities and alleviate impingement. Early diagnosis and appropriate management are crucial for preventing further hip joint damage and preserving long-term joint function in individuals with femoroacetabular impingement.
Labral tears of the hip involve damage to the labrum, a ring of cartilage that lines the hip socket and adds stability to the joint. The causes of labral tears can vary and may include traumatic injuries, structural abnormalities like femoroacetabular impingement (FAI), hip dysplasia, or repetitive motions that strain the hip joint. The natural history of labral tears often involves a gradual progression of symptoms. Individuals may experience hip pain, especially during activities like walking, running, or pivoting. Patients may also report a catching or locking sensation in the hip and reduced range of motion. Treatment options for labral tears depend on the severity of the tear and the individual’s symptoms. Conservative approaches include rest, physical therapy, and anti-inflammatory medications. In cases of persistent or severe symptoms, arthroscopic hip surgery may be considered to repair or remove the torn portion of the labrum. Early diagnosis and intervention are essential for optimal outcomes in managing labral tears of the hip and preventing long-term joint damage.
Hip microinstability is a condition characterized by subtle, abnormal movement or laxity in the hip joint that is not easily detectable through standard clinical examinations or imaging. Unlike more obvious hip instability, microinstability involves subtle shifts in the position of the hip joint components, often occurring during specific movements. It can be caused by factors such as ligamentous laxity, muscle imbalances, or structural abnormalities in the hip joint. Individuals with hip microinstability may experience symptoms such as hip pain, clicking or snapping sensations, and feelings of instability, particularly during activities that involve repetitive or extreme hip motion. Diagnosis can be challenging, often requiring specialized imaging studies and dynamic assessments. Treatment may involve a combination of physical therapy to strengthen supporting muscles, activity modification, and in some cases, surgical intervention to address underlying structural issues. Early recognition and management of hip microinstability are crucial to prevent long-term joint damage and improve overall hip function.
The recovery following hip arthroscopy can vary based on the specific procedure performed, the extent of joint damage, and individual factors such as the patient’s overall health and adherence to rehabilitation protocols. However, here is a general overview of the recovery stages:
Immediate Postoperative Period (Days 1-2)
Patients typically experience some discomfort and swelling after surgery.
Pain management is a priority, and prescribed medications are often used.
Early mobilization with the help of crutches or a walker may be initiated.
Weeks 1-6
Physical therapy is usually initiated to improve joint mobility and strength.
Weight-bearing restrictions and activity modifications are often recommended.
Patients gradually transition from using crutches to walking without assistance.
Weeks 6-12
Continued physical therapy focuses on strengthening exercises and improving functional range of motion.
Introduction of low-impact activities and controlled exercises.
Gradual return to normal daily activities with caution.
Months 3-6
Progressive strengthening exercises and functional activities.
Gradual return to higher-impact or sports-specific activities.
Regular follow-up appointments with the surgeon to assess progress.
Months 6 and Beyond
Continued improvement in strength and endurance.
Patients may resume normal activities, including sports, under the guidance of the surgeon.
Ongoing monitoring for any signs of persistent symptoms or complications.
It’s important for patients to follow the prescribed rehabilitation program diligently, including physical therapy exercises and activity restrictions, to optimize recovery and prevent complications. Returning to activities too quickly can increase the risk of re-injury, so a gradual and systematic approach to rehabilitation is crucial for optimal outcomes. Patients should communicate any concerns or difficulties with their healthcare team throughout the recovery process.