Hip Replacement Bundaberg

How the Ageing Process Affects the Hips

Just like you look different in the mirror as you age each year, so too does the inside of our joints. The hips take load walking, running, jumping, kneeling, climbing and everything else we throw at them over life – and they are not immune to the ageing process. The cartilage thins each year and the bone beneath begins to get exposed, and tissues and muscles around the hip become stiffer. People often think only skin ages – but our bones, ligaments, muscles and tendons – in fact all organs of the body, age at the same rate.

Understanding Hip Anatomy: The Ball and Socket Joint

The hip is comprised of the femoral head (ball) in the acetabulum (socket). It has a supporting tissue called a labrum that is the thickness/size and consistency of uncooked calamari – rubbery like that – encircling the cup. The ball is covered in cartilage – a soft spongy layer – and the cup is covered in cartilage. These suffer ageing like the rest of your body and degenerate over time.

Recognizing When You Might Need Hip Replacement Surgery

There is no way to know you need hip replacement surgery – your body will just let you know its sore and fatigued, and you will seek expert opinion. Things like aches and pains, reduced movement, reduced motion and activity, or any number of other symptoms can occur. A specialist surgeon will determine the appropriate management for your condition – whether non surgical or surgical. There is no ‘right time’ for hip replacement surgery to be done, but I like to tell my patients they will know and they will tell me when they have had enough of their existing arthritic joint.

What Happens During Total Hip Replacement Surgery

Total hip replacement surgery involves changing the ball and socket. Your ball has lost its cartilage as too has your socket, so by changing the bearing surface you walk on – by removing the ball from the socket, re-coating the socket with a shell and liner, and replacing your ball with a new replacement, pain is removed.

Expected Lifespan of Hip Replacements

I utilise the costly but premium ceramic or polyethylene liner with a ceramic femoral head replacement, but there are many versions of this eg metal ball in plastic socket.

How Hip Replacements Are Evaluated for Longevity

After a hip replacement you will have freedom of movement restored for the ball and socket. The durability and lifespan of the implants varies – changes in ‘lifespan’ will vary according to the implants used. A hip replacement should last a lifetime in the vast majority of people. This is VERY different to the common held misconception by people in the community that they will only last 10 years or so. This is a historical old wives tale, and a classical question in consulting rooms.

Defining a Successful Hip Replacement

We think of how long a hip replacement will ‘last’ based on its likely need to be revised – ie re-done with another operation. We collect data in Australia on every joint replacement ever done since 2001, and can look at this data to see how a hip replacement is performing over time by its need to be re-done. Any hip replacement being re-done will be recorded, and can be assessed to its ‘lifespan’.

So for all hip replacements done in Australia from 2001, the likelihood of it needing to be re-done at 24 years is only around 8%. So you have a 92% likelihood at 24 years after your new hip goes in, of it still being in there without needing to be replaced. (Correct at January 2025)

This should comfort many people!

We do not judge how successful a hip replacement is by how long ‘it lasts’ though. A successful hip replacement operation is one in which you feel pain relief after your recovery, your arthritic pain is gone, and you have movement and function that you feel allows you to do the things you want to in life. All data suggests that rate of satisfaction after a total hip replacement to be around 90-95% in Australia. Higher volume subspecialty surgeons tend to cluster with more patients satisfied post surgery than lower volume surgeons.

The Benefits of the Anterior Approach in Hip Replacement Surgery

In the specialised anterior approach I utilise, the tissues surrounding the hip are untouched, and as a result, you get back to moving much quicker. BUT – you need to work diligently with physiotherapists to restore your movement and activity, as we do not replace your muscles and tendons – these have contracted up and lost their tone and strength. This is the big challenge in hip replacement surgery – to ensure people know it is not a brand new muscly pain free robot powered ball and socket – we just remove the arthritis but cannot do the physiotherapy and home exercises for you. This involves strengthening and stretching muscles you forgot you had!

Recovery Timeline After Total Hip Replacement Surgery

Recovery after total hip replacement is variable from person to person, but generally speaking for patients aged 50 right through to 90 years old – the operation takes approximately 60 minutes. Complex replacements can take up to 2 hours or more.

Early Mobility: Walking and Climbing Stairs After Surgery

A 60 year old recovery after an anterior approach hip replacement is similar to a 70 year olds recovery, and is mirrored to an 80 year olds recovery after hip surgery. When an anterior approach hip replacement is performed – you can expect to be up walking an hour or 2 after the operation with nurses using a big frame, then progress quickly the next day to forearm crutches to getting around. The length of stay in hospital is generally 2 nights for nearly all patients – yes this can be shocking!

But I am older, I live alone, I have stairs? You will be extremely surprised that you can do stairs before you leave hospital, that you can get on and off a toilet, shower yourself, and walk around.

Patients old or young tend to use crutches for a week or two (but often discard much sooner) to feel stable when walking.

Bilateral Hip Replacements: When Are They an Option?

Bilateral hip replacements or double hip replacements, is having both hips replaced at once. Dr. Murray performs bilateral anterior approach hip replacements for appropriate patients. Those people that are not suitable are over 70 years old, have pre-existing major heart problems, or prior stroke. This is because the strain on your body and organs having a long operation and recovery increases the risk over these ages of having major problems such as stroke and heart attack at, or after the surgery.

Post-Surgery Wound Care and Stitches

A check of your wound occurs 2 weeks after the operation. I utilise an all dissolving stitch material buried under the skin so nothing needs to be removed, simply a waterproof dressing is peeled off and that is all. A lot of surgeons use metal staples, which will leave scars either side of your wound, and need removing with a staple remover 2 weeks after your surgery.

Physiotherapy After Hip Replacement Surgery

Physiotherapy starts at 2 weeks after the operation, and tends to be a visit a week for couple of weeks, once a fortnight for a couple of fortnights, then one or two further visits to get your strength and movement improving.

You can walk and swim in a pool after a hip replacement once the wound is fully healed over, normally around 3 weeks.

Resuming Activities Like Walking, Swimming, and Driving

You can drive after your hip replacement depending on which side is operated on and what type of car you have. Generally speaking, you can drive 10-14 days after your anterior approach hip replacement as long as you are not on heavy pain relief medication, can safely get in and out of the car, and comfortably hit the brake if something runs in front of you or conditions change. The left hip for a manual is an effort pressing the clutch repeatedly, and you will feel sore and fatigued early – this tends to be 3-4 weeks after surgery to be safe but can be a little quicker if you’re doing well.

There is no written clearance necessary to drive, it is based on your progress and capability. Starting with short distances such as to the local shops or your physiotherapy appointments only for a few weeks, then progressing to longer journeys around 6-8 weeks after surgery.

Walking Distances and Physical Goals After Surgery

Another common expectation is walking distances after hip surgery. Most people around 8 weeks after their surgery can walk 1.5 kilometres in a burst, often 2-3 times a day, OR can walk 5km’s or thereabouts in a single go. Some people can climb mountains – yes climb a mountain – at this time. This is highly dependent on your motivation, perception of pain, capacity to complete tasks, support at home etc. Do not be concerned if you feel slower than others, it is all a spectrum of healing and it is not a race. Dr. Murray prefers patients to be the tortoise, not the hare.

Managing Pain During and After Hip Replacement Surgery

Hip replacement surgery can be a painful process. Those surgeons advertising anything different are lying. Irrespective of having a minimally invasive muscle sparing total hip replacement like Dr. Murray provides, or the old school large cut posterior approach hip replacement, you will feel quite sore. Pain is managed during and immediately after your operation by the Anaesthetist. Your surgeon and his physician will manage this for you in the days and weeks that follow. Ice over the area, pain tablets, physiotherapy, and activity will be your friends to improvement with time. 

Recovery Variability: Age, Activity, and Pre-Operative Health

Recovery after a hip replacement varies by age, activity and pre-operative function and health status. It is impossible to predict. Generally speaking If you are a 60 year old having a hip replacement, we expect the same timeframe for recovery as a 70 year old overall. This being around 8 weeks before you’re getting around quite freely without too many lingering symptoms. You may find some niggling muscle soreness or pains around the hip and groin, and difficulty sleeping in the evening as your “major” issues at that time – but it will be vastly different to what you experienced before you had your hip replaced. An 80 year old with some background health problems may find it a little slower going early, sometimes needing 3 nights in hospital – but the wound will heal in the same time frame, physiotherapy occurs at the same time frame, and recovery at 8 weeks is still roughly equivalent to that of a 60 year old. Our bodies go through healing phases, and inflammation is a key in this, which you cannot speed up or improve – irrespective of your age. This is why patients, young or old, if appropriate for the operation, and in skilled surgeons hands, tend to do very well after a total hip replacement.

Understanding the Costs of Hip Replacement Surgery in Australia

The cost of hip replacement surgery in Australia is largely determined by your private health fund. A public patient in a public hospital is covered under Medicare with no cost. A Veteran under Department Veterans Affairs incurs no cost also. A self funding patient with no insurance getting a hip replacement in a private hospital will generally be out of pocket approximately $27-30,000 dollars. A private patient will have out of pocket expenses that vary from health fund to health fund. Not all funds are the same – you may think they are just cheaper for you with less out of pocket and the same refunds and returns but this is most certainly not true. The cheapest premium cost insurers (eg NIB) will give you back the lowest returns on the surgery costs. So whilst you pay less year to year on your insurance premiums, the surgery out of pocket costs will be much higher if and when you do need to see a specialist. The major insurers (BUPA/Medibank Private/HCF) all cover similar middle range costs but there are still out of pocket expenses. So whilst you think you have “top cover” – you indeed do not and that is just a term these companies create to enhance their client numbers. These are big businesses – they are not in the interest of providing top level care to their customers. They are about profits – a recent Australian Medical Association press release spoke to the fact that patients are receiving less in rebates as a proportion of premiums each year. The costs you will likely incur are your private insurance ‘gap’, and a gap for the anaesthetist and surgeon.

Overall the out of pocket amount varies but is generally a few thousand dollars for a high volume top surgeon. Your costs are provided to you with a full breakdown after the decision you need a joint replacement is made, and you receive this as an independent financial consent to allow you to make clear decisions when money matters.

Why You Should Be Cautious of Fly-In, Fly-Out Surgery

Beware of fly in-fly out surgery. Like cosmetic tourism in Thailand and Turkey that have been popularised in recent years, seldom do you hear of the good outcomes. A surgeon who meets you only via phone, and does not ever follow you up in person, is a dangerous road. What happens if you require regular review, have a complication, or major issue necessitating surgery and long stays in hospital? These things happen everyday all around Australia – be wary of things too good to be true (anything “free” is never free). Be aware there will be cost cutting everywhere along your journey to maximise profit to some surgeons and insurers. They aren’t in the business of being charitable.

Choosing the Right Surgeon for Your Hip Replacement

Like all big decisions and especially for lifelong hip replacement surgery – ensure you research your surgeon before your appointment, and choose someone that you are comfortable with after meeting, and consulting on your problem. Speak to your GP, or contact a different surgeons consulting rooms directly if you don’t feel comfortable, after all – you are the most important person in this decision tree.