9 Tips About Hip Replacement Treatment – Dr.Simon Coffey

Dr Coffey is experienced in Revision Hip Replacement, where a worn out or painful hip replacement is converted to a new device. There are many reasons why this may be necessary including infection, loosening, metal hip failure, dislocation, fracture and wear.

skeleton-leg-pain

1. Hip replacements are not just for your grandparents.
2. The hospital will give you sex instructions.
3. Your hip will feel better, amazingly so, even as the rest of you aches.
4. Pain medication is both your best friend and your worst enemy.
5. You might get bizarrely emotional.
6. What you do before the surgery is as important as after.
7. You’ll lose some independence for awhile, no two ways about it.
8. Your doctor will likely tell you you’ll never run again, but that’s not necessarily the last word.
9. Fixing the joint is only part of the battle.

Dr Coffey has extensive experience in hip replacement surgery. Hip replacement is one of the most successful operations performed around the world, restoring function and relieving pain for many people disabled by hip arthritis.

Source – prevention

Hip Replacement Recovery

When I started my training in orthopaedics, hip replacement was seen as big operation with a high rate of blood transfusion and an extended stay in hospital. Despite its clearly defined long term success the operation often took over two hours and had infection rates between 2-5%.

Hip Replacement Recovery

Fast forward to 2017 and we find many things have changed. No doubt the technology of our devices has changed, but so has our approach to surgery, pain management and rehabilitation timelines.

SURGICAL APPROACH

There are a number of different ways of approaching the hip for performing hip replacement. The two most popular today are the posterolateral approach and the direct anterior approach. Both approaches have their pros and cons, but when performed well these approaches allow a safe and rapid return to activities without a long hospital stay. The most important considerations when assessing suitability for either approach are the patient’s own anatomy, the surgeon’s experience and training.

Today, hip replacement is routinely performed in less than one hour of operating time, which helps to reduce the risks of extended anaesthesia and infection.

BLOOD PRESERVATION

In the last 5-10 years surgeons have recognised that the lower the transfusion rate the lower the complication rate. This has led hip replacement surgeons to develop surgical approaches and anaesthetic techniques that minimise intraoperative and postoperative blood loss. Blood transfusion in routine hip replacement used to be commonplace, now it is rare.

PAIN MANAGEMENT

Along with shorter operating times and less invasive surgical approaches, better techniques of post-operative pain management have revolutionised total hip replacement. Instead of catching up with the pain modern pain management preemts pain to encourage early mobilisation and weight bearing from day one.

POST OPERATIVE REHABILITATION

Hip replacement rehabilitation today is a far cry from twenty years ago. Patients are encouraged to walk, with full weight bearing from day one. Crutches and sticks are used as ‘training wheels’ so that patients can confidently regain balance and confidence. These walking aids can be dispensed as soon as strength and confidence are restored. Often the soreness of the surgery is much less than the preoperative arthritis pain.

Many fit and healthy patients are ready for discharge from hospital after one or two days.

The best exercise after hip replacement is often walking, with appropriate advice for the physiotherapist about muscle control and retraining. Often the muscles around the hip have deteriorated before surgery, and specific strengthening exercises to strengthen the core and butt muscles will help a lot.

Depending on the patient and their physical condition, many patients are walking independently within 2 weeks of surgery and are ready to return to light work soon after.

How to treat hip pain at young age?

total_hip_replacement

Surgical Advancement to treat hip pain at a young age with Total Hip Replacement. The painful and stiff hip can keep you from doing even the least complex things in life.  Activities, like walking or moving between the stove and the sink, can turn out to be so challenging your ability to look after yourself is compromised. On the off chance that this happens, gradually all the essential demonstrations of self-care like shopping, eating, preparing, and notwithstanding dozing soundly, becomes the burden. So every one of the things that once came so effectively, turn out to be excessively difficult for you work appropriately on an everyday premise.

Without the assistance of family, companions or some type of home-care, individual’s general involvement of hip issues can be one of indignity and separation. Indeed, even with help, there is forever your loss of autonomy and the occasionally humiliating loss of privacy. Both choices have genuine drawbacks, so when your hip condition confines your development to this degree, one humane option is to have total hip replacement surgery.

One of the immense surgical advances throughout the most recent century is the total hip replacement. Total hip replacement revolutionised the treatment of hip ailments and is today one of the most successful, safe and reliable orthopaedic interventions in practice.

Prevalence and Benefits of hip Surgery

In 2010 in the US, 332,000 total hip replacements were performed, while in Australia for the same year there were approximately 34,000. It is also estimated by the American Academy of Orthopaedic Surgeons, that 10 years after the surgery, 90-95% of people don’t need revision surgery. The success rate is similarly high in Australia. This means in both countries in 2010 at least one in a thousand people relied on a total hip replacement to remain active and self-sufficient.

Since the inception of hip replacement surgery, the medical profession continues basically breaking down agent practices to enhance persistent results. This has implied techniques and the sorts of prosthesis materials utilised, have consistently turned out to be more secure and more compelling.

Total Hip Replacement Developments

The enhancements made since ivory was utilised as a part of 1891 to supplant the femoral heads of patients, have been various. Skin and different tissues, glass and afterwards stainless steel, have all been utilised to supplant corrupted joint surfaces, trying to make the development of the hip joint smooth and torment free.

In the 1960’s Sir John Charnley, planned what he called a ‘low friction arthroplasty’, which was on a fundamental level the same as the prostheses utilised today. His prosthesis came in three sections; a metal femoral stem, a polyethylene acetabular glass, settled with an acrylic bone bond. The component of ‘low friction’, Charnley figured out how to accomplish by the litter surface range of his femoral head outline.

These effects increase the longer the patient’s working life after surgery, so the younger the patient the more economic and social benefit. As the treatment gets more advanced, younger people are more regularly recommended and opting to have total hip replacements.  

Metal-on-polyethylene prostheses

Metal-on-polyethylene prostheses have become the most popular type and much of the hip replacement research carried out has been done to enhance metal-on-polyethylene prostheses exclusively.  

The most well-known issue to happen throughout the years with metal-on-polyethylene inserts is the arrival of polyethylene particles into the encompassing tissue of the joint. Though, exceptional treatment of the plastics utilised all the more as of late builds their wear resistance and limits the arrival of these hurtful particles.

 

Metal-on-metal prostheses

Metal-on-metal prostheses have recovered support since they were thought to possibly create  harmful metal ions. It is thought today that blemishes the early designs of metal-on-metal prostheses were the main reason for most of the troubles associated with these implants, instead of the material they were made from.

Metal-on-metal prostheses are much more durable than polyethylene implants.Because of this component the femoral head can be made bigger which builds the weight bearing stability of the implant.   

Ceramic-on-ceramic Hip Replacement prostheses

The utilization of ceramic-on-ceramic prostheses was embraced to reduce friction and wear. Ceramic-on-ceramic implants are hard and scratch safe also react well to dampness. Every one of these components constrain the likelihood and impacts of contact. Loose ceramic particles additionally dormant and favorable in contrast with polyethylene and metal debris when discharged into the body.

Because ceramic-on-ceramic prostheses are comparatively wear-resistant, they are more commonly used for younger and more active patients. Since fired on-artistic prostheses are similarly wear-safe, they are all the more generally utilized for more youthful and more dynamic patients. They are, be that as it may, more costly and require exact surgical inclusion to abstain from chipping and disengagement, both of which, can trade off the accomplishment of the embed.

Source: Total Hip Replacement Great Surgical Advances Over the Last Century.

The Common Causes Of Severe Knee Surgery Pain – Simon Coffey

Most people experience knee surgery pain at some point in their lives. Sports, exercise, and other activities can cause muscle strains, tendinitis, and more serious injuries to ligaments and cartilage. For some, knee pain can be so severe that it limits daily activities. For others, mild knee pain may be a chronic hindrance to the active lifestyle they desire. In either case, chances are that you’re dealing with a knee problem that shouldn’t be ignored.

knee-surgery-simon-coffey

Knee Ligament Injuries
The ligaments are what connect your thigh bone to your lower leg bones. They hold your bones together and keep the knee stable. Knee ligament sprains and tears are very common sports injuries and can occur to the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), and medial collateral ligament (MCL). Any of these injuries can result in severe knee pain and could require surgery.

Knee Cartilage Tears
Other injuries, including tears, can take place in the cartilage of the knee. Cartilage is a semi-hard (tough, but flexible) tissue that covers the end of your bones. Knee cartilage comprises the two menisci on either side of the joint: the medial meniscus, located on the inside of the knee and the lateral meniscus, positioned on the outside of the knee. You’ve probably heard the phrase “meniscus tear”. A tear in the knee cartilage is a common injury, and typically requires surgery.

Arthritis of the Knee
Arthritis is a common cause of severe knee pain and disability. Unfortunately, arthritis is a chronic degenerative condition that can eventually require surgery. The three most common types of arthritis are rheumatoid arthritis, post-traumatic arthritis, and osteoarthritis. In the case of any of these three, you may experience stiffness and swelling, and it may be hard to bend your knee.

Rheumatoid Arthritis of the Knee
Rheumatoid arthritis is an autoimmune disease that causes the tissue around the joint to become inflamed and thickened. Chronic inflammation often leads to damage and loss of cartilage. Rheumatoid arthritis represents only about 10 percent to 15 percent of all arthritis cases.

Post-Traumatic Arthritis
Post-traumatic arthritis can result after a serious knee injury, including bone fractures and ligament tears. These injuries can damage the cartilage in your knee over time and lead to pain, swelling, and stiffness.

Osteoarthritis of the Knee
The most common type of arthritis is osteoarthritis, which is a progressive wearing of the cartilage in the knee joint. It occurs more frequently in individuals 50 and older. After 50, the impact of osteoarthritis can worsen due to accumulated use and the wearing down of cartilage that occurs with age. Osteoarthritis of the knee causes pain, limited range of motion, stiffness of the knee, swelling of the joint, tenderness, deformity and weakness.

Causes of osteoarthritis include age, weight, genetics, previous injuries, infections, and illness (such as a tumor or gout). Osteoarthritis can also be caused by sports injuries and wear and tear resulting from physical work in occupations, such as construction and manufacturing.

Diagnosing Knee Pain
Doctors diagnose arthritis and other knee problems using x-rays and a physical evaluation. You will be asked about your pain level, knee flexibility and function, and general mobility. Medical professionals will also use special tests to identify the type of arthritis affecting your knee.

Treating Knee Pain from Arthritis
Knee pain usually becomes worse as arthritis progresses. Common treatments include: weight loss, strengthening exercises, wrapping, and pain relievers—such as acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs).

While osteoarthritis is the most common surgical patient diagnosis, those with severe pain from any type of arthritis may benefit from surgery, including a partial or total knee replacement. It’s crucial to discuss and explore all treatment options with your doctor before opting for surgery.

Source By – healthline

Revision Total Knee Replacement

Most knee replacements provide very good long term function for many years after implantation. The most recent figures from The AOANJRR (Australian Orthopaedic Association National Joint Replacement  Registry) reveal that the revision rate for Primary Total Knee Arthroplasty at 15 years is 7%. Most of these replacements have failed either as a result of infection or premature wear.

After a long period of time, a knee replacement can wear out. Sometimes the procedure to correct this problem is as simple as changing the polyethylene bearing insert in the knee – much like a retread on a car tyre. Other times a much more extensive procedure is required where all the major components of the knee are exchanged. Each of these procedures can renew the life of knee replacement for another 10-15 years.

Below is an example of a worn out polyethylene bearing which was able to be swapped out for a new one.

Another example of a much more extensive procedure appears below.

knee-arthroscopy

The decision as to whether to do the more minor operation or the larger one is best left to your specialist total knee replacement surgeon who will consider the pros and cons of each operation.

Knee Replacement surgeons, Sydney

For those who suffer severe and debilitating pain from osteoarthritis or injury of the knee, there is always the option to consult the expertise of orthopaedic or knee replacement surgeons. Sydney has a number of knee replacement Orthopaedic surgeons though few capable of safely completing the simultaneous replacement of both knees.

bilateral-knee-replacement

One knee replacement surgeon in Sydney with experience in replacing both knees in one procedure is Dr. Simon Coffey. He is practicing in both Penrith and Macquarie University, Sydney.

Patients eligible for bilateral simultaneous knee replacement most often suffer from the osteoarthritic degeneration of both knees. Both knees are required to be equally dysfunctional and painful for the procedure to be considered. This is due to the fact that the progress of the disease can stabilise once strength is restored to the knee operated on. This post-operative improvement can often delay the need for a second knee replacement by several years.

If a patient meets the criteria for simultaneous bilateral  knee replacement, the benefits are twofold in comparison to having two separate operations.

The first is that the recovery time of the rehabilitation process is reduced. The advantage of a single recovery period also lessens the work-related burdens of asking for two extended blocks of sick leave. Asking for two lots of sick leave can lead to secondary financial issues as well.

The second benefit is the reduced cost of undergoing one procedure as opposed to having to pay for two.

However, due to the longer duration, higher potential for blood loss and cardiovascular complications of the surgery, the overall health of the patient needs to be robust in order for the operation to go ahead.

The preconditions a patient must meet to be eligible for a bilateral simultaneous knee replacement are:

  • Under 80 years of age
  • No history of systemic cardiovascular disease
  • No history of Kidney disease
  • No history of Diabetes
  • Presently experiencing bilateral debilitating knee pain

To be certain patients meet these criteria, thorough preoperative tests need to be undertaken. Other personal considerations like the impact on your work commitments and support network are also an important part of making your decision.

If you experience severe and debilitating pain in both knees, then there is a knee replacement surgeon in Sydney who can help you investigate your options. With a successful record for knowing and picking the right candidates to receive this life-changing operation, Dr. Simon Coffey is one of the very few Sydney based surgeons able to help.

Hip Replacement Surgery Has Come a Long Way

In the 100 plus years, hip replacement has been practiced, the surgery has come a long way. This is due to rigorous testing and research into the prosthetic materials used, as well as, technological developments in diagnostic tools like the arthroscope. This single instrument has come to change industry practice and improve results worldwide. It offers highly-magnified imagery of inside the body, in real-time, so doctors can make their decisions quickly based on detailed evidence.

hip replacement simon coffey

The most common candidates for hip replacement are people with the degenerative form of arthritis called osteoarthritis. There are many other treatments designed to treat and manage osteoarthritis, but in some cases these treatments don’t properly restore the quality of life expected. So, when a limit to the amount of pain relief you get from other medications has been reached, hip replacement is one option that addresses your pain and immobility at its source.

Below is a short list of experiences worth consulting your doctor or specialist over:

    • Persistent pain despite pain relief medication
    • Pain increases with walking, even with a cane or walker
    • Discomfort interferes with your sleep
    • Stiffness and tenderness affects your ability to go up or down stairs
    • Immobility makes it difficult to rise from a seated position

There are also numerous other conditions that can require a range of treatments. Here is a list of other potential treatments for a range of hip conditions:

  • Arthritis in general;

Educational and exercise programs designed to improve general health, flexibility and self-management. Some regimes are more tailored and adapted uniquely to the different forms of the disease.

Assistive Devices: walking frames, canes etc.

Natural and Alternative therapies:  nutritional supplements, acupuncture or acupressure, massage, relaxation techniques and hydrotherapy are examples.

Analgesics for pain relief and include Acetaminophen, Opioids, (narcotics), and an atypical opioid called Tramadol. These pain-killers are commonly prescribed and can be effective for maintenance.

Nonsteroidal anti-inflammatory drugs (NSAID’s), are the most commonly used drugs to ease inflammation and related pain. NSAIDs include Aspirin, Ibuprofen, Ketoprofen and Naproxen sodium.

Corticosteroids to reduce inflammation like Prednisone, Prednisolone and Methyprednisolone, which are potent and quick-acting.

Hyaluronic acid. Hyaluronic acid acts as a shock absorber and lubricant in the joint naturally but breaks down in people with osteoarthritis.

Surgery: Arthroscopy, Total Hip Replacement or partial Hip Replacement.

  • Rheumatoid Arthritis and Ankylosing Spondylitis:

Nonsteroidal anti-inflammatory drugs, (NSAID’s), such as Ibuprofen, Ketoprofen and Naproxen sodium can be taken or for those with a vulnerability to ulcers a COX-2 inhibitor version called celecobix is an alternative.

Corticosteroids to reduce inflammation like Prednisone, Prednisolone and Methyprednisolone, which are potent and quick-acting.

Disease-modifying anti-rheumatic drugs, (DMARD’s), are drugs that work to modify the course of the disease and include Methotrexate, Hydroxycholorquine, Sulfasalazine, Leflunomide, Cyclophosphamide and Azathioprine.

Biologics are a sub-category of DMARD’s which target specific phases in the inflammatory process.

Another sub-category is the JAK inhibitor class which block the Janus Kinase pathways involved in the body’s immune response. Tofacitinib is a JAK inhibitor.

Surgery: Arthroscopy, Total Hip Replacement or partial Hip Replacement.

  • Fracture:

Treatment such as hospital admission, rest, braces, some forms of cast and surgery.

  • Dysplasia:

With developmental dysplasia of the hip a special harness is worn for 6 to 12 weeks to hold the joint in place while the baby’s skeleton matures.

  • Perthes’ disease:

Bed rest, pain-killers and a brace or splint. This is worn for up to 1 and 2 years for regrowth of femoral head. Possible surgery to treat deformities.

  • Slipped capital femoral epiphysis:

Surgery to reposition femoral head to fix into place.

  • Irritable hip syndrome:

Bed rest, pain-killers and NSAID’s.

  • Soft tissue pain:

Exercise program, Anti-inflammatory creams and pain-relieving medications for soft tissue pain.

When other treatments prove ineffective, hip replacement is one option with the potential to increase the scope of your active lifestyle and turn things around. It is even possible after recovery that when asked – ‘What are you capable of doing without pain?’ – you’ll be in a position to list a whole lot of activities you wouldn’t dream of doing today.

Hip Replacement is only ever undertaken on the advice of your specialist surgeon.