Orthopaedics at Melomed Hospitals

1. What does total hip replacement surgery entail?

The hip is a ball-and-socket joint that has a large range of movement. Total hip replacement (THR) surgery is undertaken when a patient's native hip has been problematic due to a number of possible causes, including arthritis, trauma or collapse of the femoral head (the ball). Surgery is recommended when there is constant pain and stiffness that limits daily activities and reduces your quality of life. The surgery involves replacing the worn or damaged ball (femoral head) with a new prosthetic ball, as well as lining the socket (acetabulum) with a prosthesis to restore motion in the hip and eliminate pain.

2. What are the results of Total Hip Replacement surgery:

Hip replacement surgery is usually very successful, second only to cataract surgery in the whole field of medicine. More than 95% of patients have relief from hip pain, and the success rate remains at 90 - 95% at 10 years post surgery.

3. What the risks involved in this kind of surgery?

Although hip replacement is an extremely successful procedure, there are possible risks associated with any surgery. The risks of complications are around 1-2%. The common ones in THR are:

Bleeding (intra-operative). This can be controlled in surgery using various techniques

Fracture of the femur or pelvis. These may be left to heal on their own or may need to stabilised during the surgery or soon thereafter

Blood clots. These can form in the leg veins during or after surgery and carry a risk of shooting to the lung or heart (embolization). Blood-thinning medication is used to reduce this risk.

Infections. This may be superficial, involving only the wound, which is treated with antibiotics, or deeper involving the joint, when further surgery may be needed to cure it. Our patients are all given antibiotics around the surgery to reduce this risk.

Other more rare complications include dislocation of the hip joint, loosening of the prostheses, leg length differences, and nerve damage, but these all occur very infrequently.
4. How soon after a hip-replacement surgery can the patient go home?

Modern surgical techniques aim to get our patients back home and returning to function as soon as possible. The usual hospital stay is between two and four days. Patients are discharged once they are mobile and it is safe for them to return home.

5. Will the patient need any assistive devices, for example, a walker or crutches?

Most patients will cope with crutches after their hip replacement, which they will use for between 4 and 6 weeks. A small number of patients may require a walking frame is they feel unsteady or are unable to use crutches.

6. How soon does rehabilitation therapy start after the hip surgery?

Ideally, patients will have "pre-habilitation" where they do exercises to strengthen them prior to surgery. Rehabilitation will start very soon after surgery, mostly the next day, or in some circumstances even on the day of surgery.

7. What is considered a normal amount of pain after hip-replacement surgery and what kind of pain management can be expected?

We aim to make the surgery as comfortable and pain-free as possible. The anaesthetist will decide with the patient on the pain management strategy best suited for them. This may include general or regional (spinal or epidural) anaesthesia, nerve blocks, local anaesthetic wound injections, patient-controlled pain medicine pumps, and intravenous and oral pain medication.

8. How can the patient reduce the likelihood of injury or complications?

The best strategy is to follow the instructions given to you by your surgeon and physio- and occupational therapists. The wound is to be left undisturbed (clean and dry) until your first check-up, care should be taken when walking with crutches; certain movements need to be avoided (like crossing the legs or squatting) for the first 6 weeks; infections elsewhere need to be managed early.

9. How soon can regular activities (sport, driving, going to work) be resumed?

Most patients will be off regular activity for around 5 - 6 weeks, including work and driving. Walking, however, should resume soon after surgery. We recommend a slow and progressive return to sport, in consultation with the physio, as this is governed by your activity and fitness level and the type of sport played.

10. What factors could hinder recovery?

The most important factor is to follow what you have been advised to do by your surgeon and physiotherapist. Not being active enough with rehabilitation, or the converse - trying to do too much too soon - will work against you. Recovery is cumulative and progressive, and the vast majority of patients will enjoy a return to an active and pain-free quality of life.

11. How long does the hip implant last and will the other hip also need to be replaced?

With modern surgical techniques, implant designs and manufacturing materials, most hip implants will have good longevity, often in the region of 15 -20 years or more. There are some patients who have had hip replacements over 30 years ago who are still going strong!

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As Cape Town's premier orthopaedic group, Melomed Orthopaedics pairs decades of experience with unrivaled skill, state of the art treatments and surgical techniques to provide compassionate care to patients of all ages.
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