Singapore Medical Specialists Centre 290 Orchard Road #09-23 to 27, 30/31 Paragon (Tower 2 Lift Lobby C) Singapore 238859
whatsapp +65 8838 7111 +65 6881 8000
HIP PAIN AND TOTAL HIP REPLACEMENT

Hip pain has many causes. Osteoarthritis, avascular necrosis, post-traumatic arthritis and rheumatoid arthritis are some of the causes of arthritic hip pain. Total Hip Replacement may be an excellent solution to these conditions.

Osteoarthritis – wear and tear of the hip joint due to age-related degenerative change. It usually occurs in the older patient and may have a genetic cause. Over time the hip cartilage wears away causing hip pain and stiffness. Patients may find it difficult to walk long distance, climb stairs and perform simple activities of daily living such as putting on shoes and socks.

Avascular Necrosis - also known as AVN or ‘osteonecrosis’, this is when the blood supply to the femoral head in the femur is damaged. This may cause bone to die and the surface of the femoral head to collapse, leading to eventual degeneration of the joint and arthritis. Often the cause of AVN is unknown (idiopathic) although sometimes the cause may be due to excessive steroid intake, often unwittingly through TCM, or due to excessive alcohol intake, certain diseases and even deep sea diving.

Post-Traumatic Arthritis – This can follow a serious hip injury or fracture. The joint surface of the hip may become damaged and eventually arthritis may occur over time.

Rheumatoid Arthritis – this is an autoimmune disease and one of the common types of a group of conditions called ‘Inflammatory Arthropathies’. The synovial membrane may become inflamed and lead to joint destruction over time. Typically other joints of the body may involved, and other organ systems may be affected. Patients may present at a younger age with this disease. Special blood tests may be required to diagnose inflammatory joint disease, and an Orthopaedic Surgeon often works closely with Rheumatologists (Medical Joint Specialists) who may prescribe special drugs (DMARD’s) to control the diease before surgery.

Childhood Hip Problems – such as Developmental Dysplasia of the Hip, congenital hip dislocation and Perthes Disease may lead to abnormal hip joint development and arthritis of the hip in later life.

Referred Spinal Pain – commonly spine pain is mistaken for hip pain. Spinal pain may involve back or buttock pain radiating down the back of the leg, sometimes associated with leg numbness or weakness. Hip pain often occurs in the anterior part of the groin and radiates down to the knee.

  • What Happens Before a Total Hip Replacement (THR)

    Once a patient has been deemed suitable for a Total Hip Replacement, they are carefully screened for any pre-existing medical conditions that may need to be treated prior to surgery. Some further investigations such as blood tests, chest X-ray and Electrocardiogram (ECG) may be performed.

    The operation should be discussed in detail so that the patient and their family has realistic expectations regarding the risks as well as the benefits of the procedure, and understand the operation and recovery process.

    Ideally the patient will be sent to a physiotherapist pre-operatively to learn what to expect from the surgery, how to walk with a stick or frame and what exercises to perform following the procedure.

    Before the procedure, the Anaesthetist may offer either General Anaesthesia – where the patient goes to sleep for the entire procedure, or a Spinal Anaesthetic – where an injection is given to the spine which numbs the legs for several hours. It is important not to eat or drink eight hours before the procedure, as this may interfere with the anaesthetic.

    In my practice, as an Arthroplasty Fellowship Trained Surgeon, I take the time to carefully plan the operation and determine what size implants are required and exactly where they will be placed during the procedure. I am also a MAKOPLASTY certified surgeon and can use a Surgical Robot Arm to guide my operation with an excellent and reproducible degree of accuracy.

  • Total Hip Replacement Surgery

    In a Total Hip Replacement Surgery (also known as Total Hip Arthroplasty), the damaged cartilage and bone from the hip is removed and replaced with special implants:

    The femoral head is removed and replaced with a metal stem that can be cemented into the shaft of the femur. For younger patients with good quality bone, sometimes an uncemented stem is impacted into the femoral shaft.

    A metal or ceramic ball is placed on the metal stem to replace the femoral head.

    The worn cartilage of the hip socket (acetabulum) is removed and replaced with a metal shell. A plastic or ceramic liner is placed with this shell. This allows a smooth, low friction articulation with the new femoral head.

    During the operation itself, I aim to use the smallest possible incision (minimally invasive surgery) to perform the surgery. This is not always possible in complex or revision surgery or when the patient is very large. I aim to handle the tissues with care and minimise blood loss, to reduce post-operative pain and allow a swift recovery.

    Typically the operation takes an hour, with several more hours of observation in the Recovery ward before the patient is discharged to the General Ward.

  • Recovery Following Total Hip Replacement

    In my practice I aim to stand the patient up immediately following surgery and have them walking as soon as possible. This is possible because I use modern techniques of ‘enhanced recovery’ and ‘multimodal analgesia’ as well as a local anaesthesia infiltration (LIA) technique during surgery to minimise pain. I also work closely with my anaesthetic and physiotherapy team to assess each individual patient in order to achieve good pain relief and a smooth recovery.

    Typically a patient is discharged either home, or to a rehabilitation unit for more physiotherapy, on or before Day 3 of surgery.

    The wound takes around 2 weeks to heal – it should be kept clean and dry.

    It is important that the physiotherapy instructions are followed carefully and exercises are performed, in order to get the best out surgery.

    Normally a patient may drive 6 weeks following a total hip replacement.

    Depending upon their occupation, most patients can return to work between 6-12 weeks following surgery.

    In summary, Total Hip Replacement can be an excellent solution to hip pain and vastly improve the quality of life of a patient with hip arthritis.

Alan Cheung Orthopaedics
Singapore Medical Specialists Centre 290 Orchard Road #09-23 to 27, 30/31 Paragon (Tower 2 Lift Lobby C) Singapore 238859
Whatsapp
:
Telephone
:
Fax
:
6836 5705
Email
:
Top