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%.
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.
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.
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.
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.