Treatment
Hip Replacement Surgery in Sydney
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Meet Dr Farey
What is hip replacement surgery?
A hip replacement involves removing the arthritic ball-and-socket hip joint, and restoring this with a prosthetic hip. There are many technical aspects of hip replacement, and Dr Farey will recommend an implant that recreates your anatomy.
There are two main approaches to hip replacement: the anterior approach and the posterior approach. Both are safe ways to access the hip joint, and Dr Farey performs both. Dr Farey will recommend an approach based on your clinical assessment and imaging.
There are two main approaches to hip replacement: the anterior approach and the posterior approach. Both are safe ways to access the hip joint, and Dr Farey performs both. Dr Farey will recommend an approach based on your clinical assessment and imaging.
Common Indications
- OsteoarthritisCause of 88% of hip replacements
- Hip dysplasia
- Avascular necrosis
- Rheumatoid arthritis
- Hip fracture
Approaches of Hip Replacement Surgery
Anterior Approach
Also known as ‘through the front’
Faster recovery
Protective against dislocation
Higher risk of numbness
Higher risk of wound problems
For some patients, the anterior approach may be associated with a faster early recovery and it can be protective against post-operative hip joint dislocation. The downsides are that many patients will have a patch of numbness on the outside of the thigh, and the risk of wound problems is slightly higher than with the posterior approach. This is because the incision is closer to the groin and lies adjacent to the waistline.
Posterior Approach
Also known as ‘through the back’
Best for complex cases
Best for revisions
Higher risk of post-operative dislocation
The posterior approach provides full access to the femur and pelvis, and is often preferred for more complex primary procedures and revision surgery. The downside is that the posterior approach has a higher risk of post-operative hip joint dislocation, although the risk remains low with modern techniques and appropriate precautions during recovery.
Robotic Surgery
Dr Farey uses robotic-assisted technology to help precisely position and balance the hip replacement according to your individual anatomy.
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Dr Farey will recommend an approach based on your clinical assessment, medical history, X-rays and surgical risk profile.
How to prepare for hip replacement
Attend appointments with any additional specialists involved in your care.
Focus on low-impact exercises such as cycling and swimming.
Participate in prehabilitation with a physiotherapist to support your recovery after surgery.
Complete any required blood tests and investigations before your procedure.
Ensure your General Practitioner receives all relevant correspondence and recommendations.
Maintain your activity levels and fitness as much as possible before surgery.
Risks to consider
Hip replacement is a major surgical procedure, and there are many important risks that will be discussed in consultation, both prior to making a decision to proceed with surgery and as part of the informed consent process. If you have a specific concern that is important to you, please let us know about it.
Frequently asked questions
A total hip replacement consists of four components. The ‘socket’ of the hip replacement consists of a titanium cup with a highly cross-linked polyethylene liner. The ball (‘bearing surface’) is made of a tough ceramic designed to resist wear. The ball is impacted onto a stem made of titanium or cobalt chrome that is stabilised in the femur. The implants can be stabilised with or without an acrylic bone cement.
In general, around 90% of total hip replacements performed in Australia will last more than 20 years. This is based on data from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR). If you are interested, I recommend browsing the Annual Report, available in the Publications section of the AOANJRR website (https://aoanjrr.sahmri.com/en-US/). The AOANJRR is viewed as the gold standard resource on implant survivorship internationally.
The average age is 68 years. Similar to total knee replacement, this can vary widely, but for different reasons. For example, many young people with a condition called ‘hip dysplasia’ may have severe symptoms in their 30’s or 40’s requiring hip replacement. Some older patients may fall and have a hip fracture type (‘femoral neck fracture’) that is best treated with a hip replacement, and these patients are usually in their mid to late 70’s.
The majority of the recovery and symptom improvement occurs in the first 3 months, with some gradual ongoing improvement up to 12 months.
Yes, many patients will be able to manage their hip osteoarthritis with a combination of oral paracetamol and anti-inflammatories, weight-loss, physiotherapy exercise programs, and radiologist-guided steroid injections. There is good scientific evidence in support of this as an initial strategy, for example, the GLA:D program (https://gladinternational.org/glad-hip-and-knee/). Total hip replacement should be considered when these strategies aren’t working and you can’t achieve your desired activity levels.
In general, most patients are 80% recovered by 3 months, but it takes a full year to experience the maximum benefit from surgery. Upon full recovery, most patients have significantly less pain, have greater walking endurance and are able to more fully participate in the activities they enjoy.
In general, most patients are 80% recovered by 3 months, but it takes a full year to experience the maximum benefit from surgery. Upon full recovery, most patients have significantly less pain, have greater walking endurance and are able to more fully participate in the activities they enjoy.
Spinal stiffness from spine arthritis or previous spinal fusion can change the position of the pelvis and predispose to prosthetic hip joint dislocation. Measurements from the whole spine X-rays will be used to personalise the acetabular socket position to minimise the risk of hip joint dislocation.
Studies show that hip replacements performed using either computer-assistance or a robot to help navigate the position of the acetabular socket are less likely to require revision (‘re-do’) surgery for prosthetic hip joint dislocation. This is because the implant can be mapped to a pre-operative CT scan and incorporate the measurements of the spinal X-rays.