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Total Hip Replacement (Arthroplasty)

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A surgical procedure to relieve pain and restore mobility in severely damaged hip joints

Your hip joint plays a crucial role in supporting your body’s weight and allowing you to move freely, whether it’s for everyday activities like walking or for more complex movements like bending and twisting. Often, you may only realise just how important this joint is when pain or stiffness begins to disrupt your daily life.

If you’re struggling with hip arthritis that hasn’t improved with non-surgical treatments, a total hip replacement might provide you with significant relief. This procedure involves replacing the damaged parts of your hip with artificial components, aiming to ease your pain, improve joint function, and restore smoother, more comfortable movement.

In the following sections, you’ll find detailed information about total hip replacement surgery, the specific techniques Dr McGrath uses, and the advanced technology that guides his work.

Could You Benefit From A Hip Replacement? Key Signs And Symptoms

Deciding on hip replacement surgery is a significant step, typically considered when intense hip pain and restricted movement severely impact your quality of life. Understanding the various conditions that may lead you to contemplate surgery is crucial, as it helps identify the symptoms and diagnoses indicating the need for a hip replacement.

Common Reasons for a Hip Replacement:

  • Osteoarthritis: Osteoarthritis is often the primary reason for hip replacement. It involves the deterioration of cartilage in the hip joint, leading to pain, stiffness, and decreased mobility.
  • Rheumatoid Arthritis: As an autoimmune disorder, rheumatoid arthritis causes chronic joint inflammation. This can result in significant damage and pain in your hip, with replacement surgery becoming a potential solution.
  • Avascular Necrosis: If blood flow to the hip bone is reduced, avascular necrosis may occur, causing bone decay and severe pain, often necessitating hip replacement.
  • Hip Fractures: Particularly in older adults, hip fractures may require a hip replacement to restore joint function and alleviate pain.
  • Congenital Hip Dysplasia: If you were born with abnormalities in your hip joints, you might experience pain and instability. Hip replacement surgery can become necessary when other treatments are not successful.
  • Post-Traumatic Arthritis: Arthritis that develops after significant hip injuries or trauma can lead to damage and arthritis in the joint, making hip replacement a viable option if other treatments haven’t helped.
  • Other Conditions: Various other issues, including certain bone tumours, infections in the hip joint, and systemic diseases affecting the joints, might also necessitate a hip replacement.

It’s important to understand that the decision to undergo hip replacement surgery is highly personal and varies from person to person. The choice is based on a thorough assessment of your specific situation and how much your daily life and mobility are affected.

Are You A Candidate For Hip Replacement? Important Factors To Consider

Deciding to undergo hip replacement surgery is a major decision, influenced by various factors specific to your health and lifestyle. Dr McGrath takes a personalised approach to determine if you are a good candidate for this procedure.

Here are the key factors considered during your evaluation: 

THE SEVERITY OF YOUR SYMPTOMS:

  • Chronic Pain: Persistent hip pain that significantly affects your daily activities and does not respond to non-surgical treatments is a primary indicator. This pain may interfere with simple tasks such as walking, climbing stairs, or even resting.
  • Limited Mobility: Reduced range of motion and stiffness that limits your ability to perform routine activities is another crucial factor. If you find it difficult to bend, rotate, or move your hip normally, hip replacement might be necessary.

IF CONSERVATIVE TREATMENTS ARE NO LONGER WORKING:

  • Candidates for hip replacement are typically those who have tried and failed conservative treatments, such as medications, physiotherapy, or lifestyle modifications. If these treatments have not provided sufficient relief, surgery may be the next step.

YOUR OVERALL HEALTH, FITNESS & AGE:

  • Your overall health is essential in determining whether hip replacement surgery is suitable for you. Dr McGrath will assess your medical history, including any chronic conditions like diabetes or heart disease, to ensure the procedure can be performed safely.
  • Maintaining a healthy weight supports the success of your hip replacement by reducing stress on your new joint, enhancing its longevity, and aiding your recovery. Strong bones are also important, as conditions like osteoporosis may affect the stability and integration of the hip implant.

While hip replacements are often performed on older adults, younger patients with severe hip damage may also be considered. Dr McGrath bases his decision on the degree of hip degeneration and its impact on your quality of life, rather than age alone. Your desired activity level after surgery is another important consideration. Dr McGrath will discuss your lifestyle goals, whether you aim to return to sports or simply enjoy pain-free mobility, and how a hip replacement can support these goals. Being mentally and emotionally prepared for surgery and recovery is also key to achieving the best outcomes.

Special Considerations: When A Hip Replacement Might Not Be Right For You

While hip replacement surgery can offer significant pain relief and improved mobility for many, it’s not always the best option for everyone. Certain conditions and factors may make the procedure less suitable, so a thorough assessment of your health and circumstances is essential.

Here are some common considerations that may delay or contraindicate hip replacement surgery:

  • Active Infections: If there is an active infection anywhere in your body, especially near the hip, surgery may be postponed preventing complications. Infection can spread and interfere with healing, potentially leading to severe issues.
  • Uncontrolled Medical Conditions: Advanced heart disease, poorly managed diabetes, or severe respiratory issues can increase surgical risks and impact recovery. Dr McGrath will assess these conditions to ensure a safe approach.
  • Weakened Immune System: A compromised immune system, due to conditions like HIV/AIDS or medications such as immunosuppressants, may increase infection risk and slow healing.
  • Severe Osteoporosis: Significant bone loss can impact the stability of the hip implant, as weakened bones may not fully support the new joint.
  • Joint Deformities: Extreme deformities or anatomical abnormalities in the hip can complicate surgery and affect the results. Dr McGrath will evaluate these conditions to determine the safest path forward.
  • Blood Clotting Disorders: Conditions such as haemophilia can elevate surgical risks. Coordination with a haematologist may be necessary to evaluate your readiness for surgery.
  • Excess Weight: Being significantly overweight can increase stress on the new hip and raise the risk of complications, both during surgery and in recovery.
  • Severe Neurological Disorders: Conditions like Parkinson’s disease, multiple sclerosis, or severe neuropathy may limit your ability to follow post-operative rehabilitation, which is key to success.
  • Mental and Emotional Readiness: Conditions such as severe depression, anxiety, or cognitive impairments can affect your ability to follow post-surgical instructions and participate in rehabilitation. Mental and emotional stability is crucial for recovery.
  • Non-Adherence to Medical Advice: A history of not following medical or rehabilitation recommendations may affect your suitability for surgery, as adherence is essential for optimal results.
  • Substance Abuse: Ongoing drug or alcohol abuse can interfere with surgery and the recovery process. Addressing these issues is important before considering a hip replacement.

Dr McGrath will review these factors and others during your consultation to ensure that hip replacement surgery is a safe and effective option tailored to your health needs.

Understanding the Surgical Techniques used in Total Hip Replacement Surgery

Total hip replacement surgery involves removing damaged bone and cartilage from the hip joint and replacing them with durable, artificial components designed to restore comfort and mobility. While there are multiple well-recognised surgical techniques, each with unique advantages, all have demonstrated effectiveness when performed by a skilled surgeon. According to data from the Australian Joint Replacement Registry and extensive research, a surgeon’s expertise is one of the most critical factors in achieving positive, long-lasting outcomes from hip replacement surgery. Dr Ben McGrath’s extensive experience and specialised skill set enable him to deliver advanced surgical options tailored to each patient’s anatomy, lifestyle, and recovery goals.

Following is an overview of the primary surgical techniques that could be used in your hip replacement surgery:

THE DIRECT ANTERIOR APPROACH (AMIS®)

The direct anterior approach (also referred to as DAA or AMIS), is a minimally invasive technique that accesses the hip joint from the front of the body. Dr McGrath frequently uses this approach due to its potential benefits for his patients:

This muscle-sparing approach may lead to lower post-operative pain, as it avoids cutting major muscles, allowing for a more comfortable recovery.

With approval from Dr McGrath, patients may begin standing and walking with support within hours after surgery, often speeding up recovery and mobility.

Patients may experience shorter hospital stays due to the less invasive nature of this technique, although Dr McGrath may recommend additional time if necessary for safe recovery.

The anterior approach typically requires a smaller incision, potentially resulting in less visible scarring and faster healing.

Preserving key muscle groups and blood vessels helps maintain joint stability, reducing dislocation risk and promoting a natural gait.

With Dr McGrath’s guidance, some patients may be able to drive within 8-10 days post-surgery once pain control and mobility have been achieved.

AMIS® (DAA) APPROACH CONSIDERATIONS

  • The direct anterior approach (DAA) requires specialised surgical training, specific equipment used in theatre, and usually, a dedicated surgical table, which means it is available only through surgeons specifically trained in this technique.
  • Unlike most hip replacement surgeries that limit hip flexion, anterior approach patients typically need only to avoid hip extension for approximately six weeks to ensure proper healing.

As a registered proctor (teaching) surgeon for the anterior approach, Dr Ben McGrath not only performs this advanced technique but also provides training to other surgeons. His role in training helps maintain high standards in hip replacement surgery, ensuring that patients receive skilled, evidence-based care.

THE POSTERIOR APPROACH

While Dr McGrath primarily uses the anterior approach, the posterior approach may be chosen with certain patients. This technique accesses the hip from the back, providing the following benefits:

  • Improved Joint Visibility: your surgeon has clear access to the hip joint, which can be beneficial for complex cases.
  • Established Success: the posterior approach has a proven track record and is well-understood, with many surgeons trained in its techniques.

 To support recovery, patients  are however, typically required to follow specific restrictions following a posterior approach total hip replacement:

  • Avoid combining hip bending with internal foot rotation.
  • Use a pillow between your legs while sleeping for six weeks.
  • Avoid crossing legs, low chairs, and bending past a 90-degree angle.
  • Use assistive devices like grabbers and elevated toilet seats to limit hip strain. 

 

THE MINIMALLY INVASIVE APPROACH

Both anterior and posterior approaches can be performed with minimally invasive techniques, involving smaller incisions and minimal tissue disruption.

Potential benefits of a minimally invasive technique may include:

  • Reduced Pain: Minimally invasive surgery may help reduce post-operative discomfort.
  • Faster Recovery and Smaller Scars: Many patients may experience quicker recovery, shorter hospital stays, and smaller, more cosmetically appealing scars.

Customising Your Hip Replacement With Advanced Technology

Modern hip replacement surgery has evolved significantly, with the use of advanced materials such as metals, ceramics, and highly cross-linked polyethylene. These are combined with state-of-the-art surgical techniques and technologies including patient-specific planning and custom 3D-printed components, to support more precise implant positioning and potentially improved recovery.

Dr Ben McGrath embraces these innovations to help tailor each procedure to the individual needs of his patients. Using minimally invasive techniques, including the direct anterior approach in most cases, Dr McGrath focuses on procedures that may support a faster recovery, reduced pain, and better long-term function.

Rather than applying a one-size-fits-all approach, Dr McGrath carefully considers your anatomy, health, and lifestyle when planning your surgery, aiming to provide a personalised experience and the best possible outcome for your situation.

MyHip & Patient-Specific Instrumentation (PSI)

To support accuracy and personalisation in hip replacement surgery, Dr McGrath uses the MyHip system and Patient-Specific Instrumentation (PSI). These advanced planning tools combine 3D imaging with customised surgical guides to help ensure your procedure is precisely tailored to your unique anatomy.

What This Technology Involves:

  • 3D Imaging for Surgical Planning: A detailed 3D model of your hip is created before surgery, allowing Dr McGrath to plan the procedure with a high degree of accuracy.

  • Custom-Made Surgical Guides: Using 3D printing, personalised guides are created to match the contours of your hip, assisting with accurate implant placement during surgery.

  • Tailored to You: This technology supports Dr McGrath’s surgical approach whether, direct anterior, posterior, or robotic-assisted, by aligning the implant with your individual anatomy and needs.

By integrating MyHip and PSI into his practice, Dr McGrath aims to enhance the precision of your hip replacement and support a smooth recovery. 

Robotic-Assisted Technology

Dr Ben McGrath may use robotic-assisted technology during hip replacement surgery to support accurate implant positioning and alignment tailored to your individual anatomy.

This advanced technique offers several potential benefits:

  • Enhanced Precision: Robotics assist with the accurate placement of the implant, which may help optimise joint alignment and function.

  • Personalised Planning: 3D imaging is used to create a customised surgical plan based on your unique anatomy.

  • Support for Long-Term Outcomes: Emerging research suggests robotic-assisted surgery may contribute to improved joint function and implant longevity.

Dr McGrath will discuss whether robotic-assisted surgery is suitable for your needs during your consultation.

Prosthetic Implants For Hip Replacement: Design, Structure, And Durability

Hip replacement implants are advanced medical devices designed to replicate the natural movement of your hip joint. Each implant typically includes three key components: the acetabular component (which replaces the hip socket), the femoral component (which fits into the thigh bone), and the bearing surface (which allows the joint to move smoothly). Together, these parts are engineered for strength, stability, and compatibility with the body to help restore function and reduce pain.

Dr McGrath takes a personalised approach when selecting the most suitable implant for your hip replacement. Factors such as your anatomy, age, activity levels, and future lifestyle goals are carefully considered. This tailored decision making process supports the goal of achieving the best possible outcomes, whether that’s improved mobility, reliable pain relief, or long-term durability of the implant.

FEMORAL COMPONENT

The femoral component is the part of the hip implant that fits into your thigh bone (femur). Made from strong, biocompatible metal, this stem is inserted into the hollow centre of the femur, where it provides stability and support for the new hip joint. Over time, it is designed to integrate with your natural bone to create a secure and long-lasting fit.

Dr Ben McGrath offers a range of femoral components, selected based on your anatomy, lifestyle, and surgical needs. His preferred option for most primary hip replacements is the AMIS Stem.

The AMIS Stem is a cementless, press-fit implant designed for reliable bone integration and long-term performance. It features a textured surface to promote bone ingrowth, including a porous titanium layer and a hydroxyapatite coating for immediate stability. Its polished neck and anatomically shaped collar help reduce stress on the surrounding bone, supporting both comfort and durability after surgery.

ACETABULAR COMPONENT

The acetabular component is the part of the implant that replaces your hip socket. It is typically made from durable metal and may include a separate inner liner made of plastic, ceramic, or metal. This liner allows the ball of the new joint to move smoothly within the socket, supporting natural joint function and reducing wear over time.

Choosing the right acetabular component is a key part of your hip replacement procedure. Dr McGrath frequently uses the M-pact cup, a trusted implant known for its strength, stability, and ability to replicate natural hip movement. This component forms part of a well matched system designed to provide comfort, function, and longevity, tailored to your individual anatomy and lifestyle.

 

 

 

ARTICULAR INTERFACE COMPONENTS

The articular interface is where the movement of your new hip joint takes place. It involves two key parts: the femoral head, which attaches to the top of the femoral stem, and the acetabular liner, which fits inside the hip socket component. Together, they form a smooth, gliding surface that allows the joint to move freely and comfortably, much like a natural hip.

These components can be made from different materials, each chosen for their durability and wear resistance.

Dr McGrath often recommends a ceramic-on-polyethylene pairing. The ceramic head moves against a highly cross-linked polyethylene liner, a combination known for reduced wear and long lasting performance. This option is designed to support both joint function and the longevity of your implant.

Potential Risks of Hip Replacement Surgery

Hip replacement surgery is an effective procedure to reduce pain and restore mobility in those with severe hip damage. Like all surgeries however, it carries some risks. Dr McGrath ensures that each patient is fully informed of these risks and carefully works to minimise them through detailed planning and advanced techniques.

Here are the main risks associated with hip replacement surgery:

  • Infection: Infections can occasionally occur at the incision site or within the new joint, potentially requiring antibiotics or further surgery. Dr McGrath follows strict sterilisation protocols and advises careful post-operative care to help minimise infection risks.
  • Hip Fracture: Rarely, small fractures can occur during or after surgery, particularly if bone quality is reduced. In such cases, further treatment or surgery may be necessary.
  • Blood Clots (Thrombosis): Blood clots can form in the leg veins (deep vein thrombosis) or travel to the lungs (pulmonary embolism). Dr McGrath uses blood-thinning medications and compression devices to help reduce this risk.
  • Implant Loosening or Wear: Over time, hip implants may wear down or loosen, potentially causing pain or joint dysfunction. This is more likely with high-impact activities or in patients with higher body weight. Modern implants are designed for durability, although revision surgery may eventually be necessary.
  • Dislocation: In the early stages of recovery, the new hip may dislocate if the joint’s ball comes out of the socket. Advanced techniques, such as the anterior approach, are used to support joint stability and minimise this risk.
  • Nerve or Blood Vessel Injury: Nerves or blood vessels near the hip can sometimes be affected during surgery, which may result in numbness or weakness in the leg. Dr McGrath’s expertise and careful surgical approach aim to minimise this risk.
  • Leg Length Discrepancy: Minor differences in leg length may occur post-surgery, particularly when stability adjustments are required. Dr McGrath takes measures to equalise leg lengths, and any minor discrepancy can often be managed with physiotherapy.
  • Allergic Reactions: Some individuals may have sensitivities to metals or materials used in implants. Dr McGrath assesses for known allergies and considers the most appropriate materials to suit each patient’s needs.
  • General Surgical Risks: As with any surgery, there are general risks, including potential reactions to anaesthesia, bleeding, and wound healing complications. A comprehensive preoperative assessment and close post-operative monitoring help manage these risks effectively.
  • Long-Term Considerations: Over the years, implants may wear down, potentially requiring revision surgery. Regular follow-ups help monitor the implant’s function and detect any early issues.

Preoperative preparation, including diet and exercise, plays an important role in reducing many of these risks. Dr McGrath emphasises “prehabilitation” to help optimise patient health before surgery, supported by a multidisciplinary approach.

How Hip Replacement Surgery May Improve Your Quality of Life

Total hip replacement is the second most successful operation to improve quality of life behind cataract surgery.

Here are some key benefits you might expect following total hip replacement surgery:

  • Pain Relief and Comfort: One of the most notable benefits of hip replacement surgery is the significant reduction or even elimination of hip pain and discomfort. By removing the damaged joint surfaces responsible for your pain, the procedure aims to provide you with lasting relief from chronic discomfort.
  • Enhanced Mobility: Many individuals experience a notable improvement in the mobility and range of motion of the hip joint following surgery. Replacing the damaged components of your hip with prosthetic ones can lead to smoother, more natural movements, making activities that were once difficult or painful much easier.
  • Improved Daily Functioning: The ability to perform everyday tasks more effortlessly is a significant advantage of hip replacement surgery. With enhanced joint functionality, you might find an increase in independence, enabling you to engage in daily activities and hobbies with fewer limitations.
  • Restoration of Independence: Regaining the ability to move freely without depending on others is a transformative benefit for many. Hip replacement surgery can empower you to live a more active and self-reliant lifestyle, restoring your independence and improving your overall well-being.
  • Long-Term Durability: Contemporary hip replacement surgeries aim for durability, with many prosthetic joints designed to last over 20 years. This extended durability offers the potential for long-term improvement in your quality of life, reducing the need for future interventions.
  • Resuming Sports and Activities: Post-hip replacement, many patients find they can return to various sports and physical activities, albeit with some adjustments. Activities such as walking, swimming, cycling, golfing, and doubles tennis are generally encouraged for their low-impact nature. These sports can help maintain your fitness and mobility without placing undue stress on your new hip.

Dr McGrath’s commitment to personalised care means that your unique needs and objectives are carefully considered throughout the surgical journey. From the initial consultation to post-operative care, the emphasis is on helping you achieve the best possible outcomes, enhancing your overall well-being and satisfaction with the procedure.

Your Hip Replacement Journey With Dr Ben McGrath: What To Expect

Deciding to have a hip replacement is a significant decision, and Dr McGrath is committed to providing comprehensive, personalised care every step of the way. With over a decade of experience and a dedication to leveraging the latest advancements in orthopaedic surgery, Dr McGrath ensures that your journey is smooth, informed, and focused on achieving the best possible outcomes.

INITIAL CONSULTATION: COMPREHENSIVE EVALUATION AND DISCUSSION

Your journey begins with an in-depth consultation at The Orthopaedic Clinic in The Junction, where Dr McGrath will conduct a thorough evaluation of your hip condition. This assessment includes a review of your medical history, a physical examination, and advanced imaging tests such as X-rays or MRI scans to help determine the severity of your hip issue and whether hip replacement may be the right option for you.

During this consultation, Dr McGrath will take the time to discuss your symptoms, lifestyle, and treatment goals. He’ll explain the potential benefits and risks of hip replacement surgery, ensuring you have a clear understanding of what to expect. This open dialogue encourages you to ask questions and share any concerns, helping you make an informed decision about your treatment.

If hip replacement is recommended, surgery can typically be scheduled within three to six weeks after your consultation.

In the lead-up to your procedure, you will also participate in an Enhanced Recovery Program, which often includes patient education and a physical and psychological optimisation program to prepare you for surgery (see ‘Pre-Surgery Preparations’ for more details).

DIAGNOSTIC HIP IMAGING

Dr McGrath will arrange for you to have X-rays and CT scans of your hip. These detailed images provide a clear view of your hip’s structure and are typically scheduled within 1-2 weeks following your initial consultation.

SURGICAL PLAN ANALYSIS

Using images obtained from your CT scan, Dr McGrath collaborates with a team of engineers in Switzerland to develop a comprehensive, pre-surgical plan tailored specifically for you. This behind-the-scenes process includes creating a 3D model of your hip and custom surgical instruments that are designed to fit your unique anatomy.

These personalised tools provide crucial information to ensure precise surgical planning, helping Dr McGrath optimise each step of your procedure to suit your individual needs.

PRE-SURGERY PREPARATIONS

Before your total hip replacement, there are a few important steps that need to be completed:

  • Prehabilitation aims to optimise your functional status and psychological readiness prior to surgery to improve postoperative outcomes (Cabilan et al 2015, Hines & Munday 2015). This stage is crucial and involves thorough preparation to help ensure you’re in the best possible condition for surgery. This includes both physical preparations, like exercises, and psychological preparation, ensuring you know what to expect and feel confident going into surgery. More information on ERAS here: GETTING HEALTHY FOR SURGERY

Informed consent is a vital step in your pre-operative journey. It involves a detailed discussion between you and Dr McGrath about your surgical procedure. During this conversation, Dr McGrath will explain the procedure in detail, including the benefits, potential risks, and possible complications associated with total hip replacement surgery. Once all your questions have been answered and you fully understand the procedure, risks, and benefits, you will be asked to sign a consent form. This form confirms that you have been adequately informed about the surgery and agree to proceed with the procedure.

The following appointments should be scheduled in:

1-2 weeks pre-op (at least): Complete your online hospital admission form

7-10 days post-op: Pencil in an appointment with your GP (as a back-up) for a potential rescript of analgesics (if they are required) or, to discuss any other issues after the surgery.

10 days post-op: Follow-up appointment with the wound care nurse at The Orthopaedic Clinic (unless alternative arrangements are made). At this appointment, you may receive an X-ray form for any necessary imaging.

8 weeks post-op: Appointment with Dr Ben McGrath at The Orthopaedic Clinic. Please bring any up-to-date X-ray’s with you.

1 Year Post-Op: Routine follow-up appointment with Dr McGrath.

Before your surgery, your medical records will be sent to the anaesthetist, who will review them and arrange either a phone or face-to-face consultation with you. During this consultation, you’ll discuss a personalised anaesthetic plan that takes into account your medical history, general health, any relevant risk factors, and your preferences to support the best possible outcome. Your anaesthetist will also provide pre-operative instructions regarding your medications. It’s essential to share your most up-to-date medication list, including important medications such as blood pressure medications, blood thinners, diabetes medications, and over the counter or herbal supplements.

To reduce the risk of infection, Lingard Private Hospital will provide you with three to five antiseptic sponges to use in the days leading up to your surgery. You may also be asked to provide a urine sample to screen for any urinary tract infections (UTIs). Identifying and treating a UTI before surgery is essential, as an untreated infection can increase the risk of complications. By screening for UTIs early, Dr McGrath aims to ensure a safer and smoother surgical experience, helping to lower potential risks and support a successful outcome. Routine pre-surgery procedures may also include a nasal swab several weeks prior to surgery to screen for bacteria, which allows for appropriate decolonisation if necessary.

Five Days Prior to Surgery: Begin preparing your skin by using the antiseptic sponges as directed.

Two Days Before Surgery: Use one antiseptic sponge in the shower each day. Thoroughly scrub your body to ensure your skin is as clean as possible.

The Morning of Surgery: Use the final antiseptic sponge during your shower. Dry yourself with a clean towel afterwards.

It’s essential to avoid any cuts, scratches, or skin abrasions, as these can increase the risk of infection. Take extra care to avoid activities that may cause skin injuries, such as gardening or playing roughly with pets, in the days leading up to your surgery.

Equally important, is making arrangements for your recovery phase, post-surgery. This includes organising transportation home from the hospital, preparing a safe and comfortable area in your home for recovery, and planning for any necessary support. Whether from family or professional caregivers, having help available is crucial for a smooth recovery process.

HOSPITAL ADMISSION | THE DAY OF SURGERY

Most patients are admitted on the same day as their surgery, ensuring a smooth transition into the procedure.

The Day of Surgery

  • Skin Prep: Use the final sponge during your shower & make sure to dry yourself with a clean towel.
  • Fasting: you must stop eating solid food at least six hours before receiving any type of anaesthetic. This precaution is crucial to prevent the risk of your stomach contents entering your lungs while you are under anaesthesia, which can be life-threatening.

If your surgery is in the morning:

  • Stop eating at midnight.
  • Drink up to 600mL of water until 2hrs of clear fluids before your admission.

If your surgery is in the afternoon:

  • Stop eating at 7am.
  • Drink up to 600mL of water until 2hrs of clear fluids before your admission

The Anterior Approach Surgical Procedure

Dr Ben McGrath performs the majority of total hip replacements using the direct anterior approach—a minimally invasive surgical technique designed to preserve key muscles and soft tissues around the hip. By accessing the joint from the front of the hip rather than the side or back, this approach aims to reduce post-operative pain, support a faster return to mobility, and minimise the risk of hip dislocation.

Each step of your procedure is carefully planned and personalised using advanced tools, including the MyHip system and patient-specific instrumentation (PSI), to help ensure a precise fit and long-term success of your implant. Below is an overview of what you can typically expect during surgery.

1. ANAESTHESIA AND PREPARATION

Your procedure begins when you’re brought into the operating theatre, where you’ll meet a member of the anaesthetic team. Most patients receive a combination of:

A low-dose spinal anaesthetic
A nerve block targeting the hip and surrounding areas
A light general anaesthetic

This combination helps ensure you remain comfortable and pain-free throughout the procedure, with effective post-operative pain control.

2. SURGICAL INCISION

Once the anaesthesia takes effect and the nerves supplying your hip are numbed, Dr McGrath makes a small incision at the front of your upper thigh, approximately 3 cm from the groin crease. The length of the incision typically ranges from 7.5 to 10 cm, depending on your body shape and specific surgical requirements.

3. ACCESSING THE HIP JOINT

Through this incision, Dr McGrath carefully navigates between muscles rather than cutting through them, gently moving them aside to access the hip joint. This muscle-sparing technique is a key benefit of the anterior approach and may lead to less pain and a faster recovery.

4. REMOVING THE DAMAGED HIP JOINT

Using the MyHip pre-operative planning system, Dr McGrath removes the damaged portions of your ball-and-socket hip joint with high precision. This involves:

Removing the arthritic head of the femur (thigh bone)
Cleaning out the damaged cartilage from the hip socket (acetabulum)

This process is tailored to your individual anatomy to help ensure an accurate fit for your new implant.

5. PREPARING THE HIP SOCKET

The acetabulum (hip socket) is carefully reshaped and smoothed to accommodate the new prosthetic cup. Patient-specific cutting guides—created using 3D imaging—are used to help position the socket accurately and securely.

6. TRIAL ACETABULAR COMPONENT PLACEMENT

Before the final implant is inserted, Dr McGrath positions a trial acetabular component into the socket. This temporary part allows him to assess alignment, fit, and stability, making any fine adjustments required before proceeding to the final stage.

7. INSERTING THE ACETABULAR CUP

Once the socket is prepared, the final acetabular component, such as the Mpact cup, is inserted into place. A liner—made from ceramic, metal, or polyethylene (plastic)—is then fitted into the cup, creating a smooth surface for joint movement.

8. PREPARING THE FEMUR

Next, Dr McGrath prepares the femur to receive the new femoral implant. Specialised surgical instruments called broaches are used to shape the canal within the femur according to the MyHip pre-operative plan. A trial femoral component is placed first to evaluate alignment, leg length, and hip stability. X-ray-guided checks are also performed at this stage.

9. INSERTING THE FEMORAL COMPONENT (STEM)

Once everything is confirmed, the final femoral stem, such as the Amis stem, is inserted into the thigh bone. This stem is designed to bond securely with your natural bone to provide long-term support and stability. Patient-specific guides assist with accurate positioning.

10. ATTACHING THE FEMORAL HEAD

The femoral head—the new “ball” part of the joint—is attached to the top of the femoral stem and then placed into the newly implanted socket. This completes the ball-and-socket structure of your new hip.

11. FINAL ADJUSTMENTS

Dr McGrath then performs final checks and adjustments to:

Confirm proper leg length
Ensure smooth joint movement
Verify the stability and alignment of the implant

These final steps are important for achieving balanced movement and reducing the risk of post-operative complications.

12. CLOSING THE INCISION

Once the procedure is complete, the incision is closed using dissolvable sutures, which typically break down naturally over about three months. A local anaesthetic is applied around the hip area to help manage pain after surgery.

Around 8 weeks after surgery, you may notice small suture knots pushing through the skin. These are harmless and can either be trimmed or left to dissolve naturally.

OPERATION DURATION AND HOSPITAL STAY

The operation generally takes between 1 to 2 hours, although this can vary depending on your individual needs. Most patients stay in hospital for 2 to 4 days, with the exact duration tailored to your recovery progress and overall health.

The anterior approach to total hip replacement offers a modern, minimally invasive alternative to traditional techniques. By avoiding major muscle disruption and using advanced planning systems like MyHip and patient-specific instrumentation, Dr Ben McGrath aims to provide a highly precise and personalised procedure.

If you’re considering hip replacement surgery, Dr McGrath will guide you through every step of the process and provide tailored advice to support a safe recovery and improved quality of life.

Managing Pain After Hip Replacement Surgery

Effective pain management is a critical component of the recovery process following anterior total hip replacement surgery. Dr McGrath employs a comprehensive, multimodal approach to ensure that you experience minimal discomfort and can focus on regaining mobility and returning to your daily activities. Here’s an overview of the pain management strategies that may be utilised:

PREOPERATIVE PAIN MANAGEMENT

  • Pre-Emptive Analgesia: Before surgery, you may receive medications to reduce pain and inflammation. This can help decrease the amount of pain you experience immediately after the procedure.

 INTRAOPERATIVE PAIN MANAGEMENT

  • Anaesthesia: During the procedure, a combination of a low-dose spinal anaesthetic, a nerve block, and a light general anaesthetic is typically used. This approach helps to manage pain effectively during surgery and provides extended pain relief in the immediate postoperative period.

 POSTOPERATIVE PAIN MANAGEMENT

  • Medications: A variety of medications are used to manage pain after surgery, including:
  • Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): These medications help reduce inflammation and pain.
  • Opioids: These may be prescribed for short-term use to manage more severe pain.
  • Acetaminophen: Often used in conjunction with other pain medications for additional relief.
  • Nerve Pain Medications: Drugs like gabapentin or pregabalin may be used to address nerve-related pain.

 MULTIMODAL PAIN MANAGEMENT

Combining different types of pain relief can be more effective than using a single method. This approach targets various pain pathways, providing comprehensive pain control with fewer side effects.

  • Regional Pain Blocks: During surgery, a nerve block may be administered to provide prolonged pain relief. This involves injecting a local anaesthetic near the nerves that supply the hip, helping to numb the area and reduce pain after the operation.
  • Ice and Compression: Applying ice packs to the surgical area can help reduce swelling and numb pain. Cold therapy is typically recommended at regular intervals during the initial days post-surgery.
  • Early Mobilisation: Engaging in gentle movements and exercises soon after surgery can help manage pain and improve circulation. Physiotherapists will guide you through a personalised exercise plan designed to enhance recovery while minimising discomfort.

 SUPPORTIVE DEVICES

  • Walking Aids: Using crutches or a walker initially can help alleviate pain by reducing pressure on the new hip joint as you begin to move around.

 CONTINUOUS MONITORING AND ADJUSTMENT

  • Follow-Up Appointments: Regular follow-up appointments with Dr McGrath are essential to monitor your pain levels and adjust your pain management plan as needed. This ensures that any issues are promptly addressed and that your recovery progresses smoothly.
  • Patient Education: Understanding your pain management plan and knowing how to use medications and supportive devices correctly is crucial. Dr McGrath and his team will provide detailed instructions and support throughout your recovery.

By implementing a comprehensive and individualised pain management plan, Dr McGrath aims to ensure your comfort and facilitate a faster, smoother recovery following anterior total hip replacement surgery. The goal is to minimise pain, enhance your mobility, and help you return to your normal activities as quickly and safely as possible.

Your Recovery Journey After Total Hip Replacement Surgery

The recovery phase after a total hip replacement marks the beginning of your journey toward regaining mobility and improving your quality of life. Dr Ben McGrath places a strong emphasis on ensuring you are well-informed about the recovery process, providing you with the knowledge and support needed for a successful outcome.

  • You will wake up in the Recovery Unit, although you may not remember this. An X-ray will be taken to confirm that everything looks as expected. Nurses will carefully monitor you to ensure you have recovered well from the anaesthetic. The IV tubes attached to you can usually be removed at this time.
  • Once these steps are complete, you will be taken back to the surgical ward. Upon arrival, it will be time to eat and drink something to regain your energy. Try to drink 2 or 3 cups of water at a minimum.
  • Your legs will have stockings on them to prevent blood clots, and your feet may have foot pumps as well. A foot pump is a Velcro shoe device that squeezes your feet to encourage blood flow and prevent blood clots.
  • Your leg will be bandaged, and there will be a small anaesthetic infusion device attached near your hip that looks like a ball. Your leg will be a bright pink colour from the surgical preparation.
  • After eating and drinking, get dressed in your own clothes, which should be loose and comfortable. If necessary, ask the nurses for help with this.
  • Pain Management: Immediately after surgery, managing your pain is a priority. You’ll be given medication to help control pain levels, allowing you to start moving and walking as soon as possible. Please let the hospital team or Dr McGrath know if your pain isn’t well controlled. Pain relief medications, along with swelling management, play a significant role in your recovery. Rest, ice, elevation, and compression all contribute to reducing swelling.
  • Monitoring and Wound Care: Your healthcare team will closely monitor your recovery, paying particular attention to your wound, ensuring it’s healing properly and showing no signs of infection.
  • Rehabilitation and Physiotherapy: From day one, you’ll start a rehabilitation program tailored to strengthen your hip muscles and improve mobility, crucial for a speedy return to full function. You will be out of bed and walking within 4 hours after surgery. Make sure a nurse or a physiotherapist is present the first time you get up to supervise. Initially, you will use a frame, crutches, or a stick for balance—whichever aid works best for you. You will be allowed to put your full weight on your leg.
  • Hospital Stay: Typically, patients stay in the hospital for 48-72 hours, depending on the complexity of the surgery, overall health, and individual recovery progress. In some cases, you may even be able to go home the day of surgery.

In the first week after your total hip replacement surgery, you may experience several common post-operative symptoms. Dr McGrath emphasises the importance of understanding these symptoms and managing them effectively to ensure a smooth recovery.

  • Swelling: It is common to experience swelling from your thigh down into your foot. This swelling may increase during the first few days after surgery and can be quite pronounced. Swelling can be reduced by walking, as muscle activity helps push fluid away. When not walking, elevate your limb above the level of your hip to help diminish the swelling. Swelling may persist for up to 12 months but will gradually diminish over time.
  • Bruising: Marked bruising can occur from your thigh down to your foot, sometimes appearing quite dramatic. This bruising is due to residual bleeding making its way to the surface and is more pronounced due to the blood-thinning medications you will be taking. The bruising will resolve as your body reabsorbs the blood. The use of blood thinners is essential to prevent blood clots, despite the increased bruising.
  • Blistering: Occasionally, blisters may develop near the operation site, possibly extending above it. These blisters are caused by surface fluid and can appear dramatic but are usually of no consequence. Blisters typically resolve on their own. If they are large, they may be drained to make dressings more comfortable. Bandages will be changed after about a week, once the wound is sealed enough to reduce the risk of infection. Tissue swelling associated with bruising can also cause blistering.
  • Muscle Soreness: You may experience stiffness and soreness in the muscles around the operated site due to the stretching and pulling of muscles during surgery. This can result in pain similar to a corked thigh, and you may also feel cramps and spasms. This discomfort will resolve over time. Activities such as walking, stretching, and physiotherapy will help speed up the improvement.
  • Heat: The operated site may feel hot, a sensation that can last for up to 12 months. This heat is due to increased blood supply required for the healing process. This is a normal part of the healing process and should not be a cause for concern.
  • Modified Activity Level: For the first 2 weeks after surgery, your activity level is usually limited; however, you will be able to walk independently, use the bathroom, and perform normal activities of daily living. Remember, this operation is done from the front. As a result, hip bending will not be limited.

Most patients are able to return to many of their usual daily activities within six weeks following surgery. While significant improvements are often seen in the first 3–6 weeks, full surgical healing continues to progress over 6–8 weeks and beyond.

It’s normal to experience some swelling and discomfort during this period, which should be manageable with prescribed pain relief. Staying positive and focused on your recovery goals can be incredibly helpful. The anterior approach is designed to minimise muscle damage, allowing many patients to return to movement and daily life more quickly than with traditional techniques.

  • Recovery timelines vary – Each person heals at their own pace. Some patients progress quickly, while others may take longer, and both are completely normal.
  • Recovery is not always linear – It’s common to feel like you’ve taken two steps forward and one step back. This doesn’t mean something is wrong, just that recovery can fluctuate from day to day.
  • Walking: You’ll begin walking early in your recovery using a walking aid. With guidance from your physiotherapist, you’ll gradually reduce your reliance on this aid as your strength and balance improve.
  • Cycling: Avoid cycling for the first 8 weeks following surgery.
  • Driving: You may be able to return to driving around 4 weeks after surgery, provided you are no longer using strong pain medication and can move comfortably. Always begin with short, safe trips and confirm with your doctor first.
  • Swimming and Hydrotherapy: Swimming can usually resume 10 days to 2 weeks post-surgery, once the wound has healed completely. Although your dissolvable sutures will continue to break down over 2–3 months, it’s safe to enter water once the wound is closed and dry. Wound protection should still be used in hydrotherapy settings.
  • Sports and Physical Activity: A gradual return to activities like golf, tennis, or skiing may be possible after 6–12 weeks, depending on your progress. Contact sports should be avoided to reduce the risk of injury to your new hip.
  • Travel: Short domestic flights are often possible 5–7 days after surgery. For longer flights, wait at least 6 weeks and follow appropriate precautions to reduce your risk of deep vein thrombosis (DVT), such as wearing compression stockings, staying well hydrated, and moving regularly. For the first three months post-op, be especially mindful of DVT prevention strategies when travelling.
  • Airport Security: Your hip implant may activate security scanners at airports. Consider informing staff beforehand and carrying a letter from your surgeon if needed.
  • MRI and Imaging: Your implant is MRI-compatible, meaning future scans and imaging tests can be safely performed.

If you have any concerns during your recovery, or if something doesn’t feel right, don’t hesitate to contact Dr McGrath’s team. Every recovery is unique, and support is always available to help you return to doing the things you enjoy.

Post-Operative Care And Precautions After Hip Replacement

After hip surgery, it’s essential to follow specific precautions to ensure proper healing and avoid complications.

ANTERIOR APPROACH Total Hip Replacement Precautions Post-Op:

  • Limit hip extension for six weeks following the surgery.
 

POSTERIOR APPROACH Total Hip Replacement Precautions Post-Op:

  • Avoid Twisting Movements: Keep your hips aligned and avoid twisting at the waist to maintain the stability of your new hip joint.
  • Limit Bending: When bending forward, do not go beyond 90 degrees at the hip. This precaution helps prevent dislocation.
  • No Crossing Legs: Avoid crossing your legs or ankles, as this can put undue pressure on your hip and disrupt the healing process.

How Physiotherapy Supports Your Recovery After Hip Replacement

Physiotherapy is a key component in your recovery journey after hip replacement surgery, supporting mobility, reducing pain, and helping you return to your normal activities. This structured approach is designed to guide you step-by-step, addressing any questions or concerns along the way:

INITIAL POST-OPERATIVE PHASE

  • Hospital-Based Therapy: Immediately after surgery, a physiotherapist will work with you in the hospital to initiate gentle exercises that enhance your hip’s range of motion and build strength.

This phase includes:

  • Passive Range of Motion Exercises: Gentle movements are introduced to maintain flexibility and reduce stiffness in your new hip.
  • Strengthening Exercises: These targeted exercises help build muscle around the hip without placing strain on the joint.

Your physiotherapist will also teach you to use assistive devices like walkers or crutches, ensuring safe movement during the early recovery stage.

INTERMEDIATE REHABILITATION PHASE

  • Home and Outpatient Therapy: Once you’re discharged, you may continue physiotherapy at home or in an outpatient setting, focusing on:
  • Active Range of Motion Exercises: These exercises help you regain control over hip movements and reduce muscle tightness.
  • Weight-Bearing Activities: Gradually increasing the load on your hip to improve strength and stability.
  • Functional Mobility Training: Guidance on safe ways to perform daily activities like climbing stairs, getting in and out of bed, and walking.

ADVANCED REHABILITATION PHASE

  • Increased Intensity and Functional Training: As your recovery progresses, your physiotherapy sessions will become more intensive, focusing on:
  • Dynamic Exercises: Activities such as controlled stair climbing, stationary biking, and walking exercises to improve endurance and joint function.
  • Strengthening and Balance Training: Exercises designed to enhance the stability and strength of the muscles surrounding the hip, which is crucial for preventing falls and ensuring a smooth return to daily activities.
  • Pain and Intensity Guidelines: During exercises, avoid pushing through pain higher than 4-6 out of 10. If pain persists, consider taking a mild analgesic, like Panadol, and discuss any concerns with your physiotherapist.

ONGOING SUPPORT

In the months following your surgery, your physiotherapist will continue to work with you to ensure long-term success. This phase includes:

  • Resistance Training: More rigorous activities to build muscle strength and overall stability.
  • Advanced Mobility Exercises: Aimed at restoring full function and allowing you to return to recreational activities and sports, with necessary modifications as advised by your therapist.

Working closely with your physiotherapist is essential to optimise your recovery, reduce the risk of complications, and regain independence. Dr McGrath and his team are dedicated to tailoring your rehabilitation to meet your individual needs, providing the support and expertise needed for a successful recovery.

Life After Total Hip Replacement Surgery: Adjusting Your Activities And Lifestyle

Recovering from a total hip replacement marks the beginning of a promising path towards enhanced mobility and significant pain reduction. The success of this journey relies not only on the surgical expertise of Dr Ben McGrath but also on the adjustments you make in your daily activities and lifestyle. Dr McGrath provides essential advice and recommendations to facilitate a seamless transition to life following your hip replacement surgery.

ACTIVITY GUIDELINES

 Early Post-Surgery Period (0-6 Weeks):

  • Weight-Bearing Instructions: Follow Dr McGrath’s guidelines on weight-bearing activities carefully. Initially, use walking aids like crutches or a walker to reduce stress on your new hip.
  • Gentle Exercise Regimen: Begin with mild exercises as outlined by your physiotherapist to keep the joint flexible and prevent stiffness. Ensure not to overstrain the surgical site.
  • Avoid High-Impact Activities: Refrain from running, jumping, or lifting heavy objects during this period.
  • Activity Level Adjustment: Gradually increase your activities, being mindful of your body’s responses and avoiding pushing yourself too hard.

 

Intermediate Recovery Period (6 Weeks – 6 Months):

  • Continued Rehabilitation: Maintain your exercise routine to strengthen the muscles supporting your hip joint.
  • Low-Impact Activities: Introduce gentle, low-impact exercises such as swimming or stationary cycling and extend to longer walks as your endurance improves.
  • Transition from Walking Aids: Under Dr McGrath’s supervision, progressively move away from using walking aids as your strength and confidence grow.
  • Mindful Movements: Avoid twisting or sudden pivots on the operated leg to protect your hip from undue stress.

Long-Term Recovery (6 Months Onwards):

  • Sustained Active Lifestyle: Commit to a regular exercise routine to enhance strength, flexibility, and overall fitness.
  • Joint-Friendly Activities: Incorporate exercises like yoga, tai chi, or gentle aerobics to stay active while safeguarding your hip.
  • Strength Training: Include exercises to bolster muscle support around the hip, always avoiding movements that cause pain or discomfort.
  • Regular Monitoring: Ensuring ongoing check-ups with Dr McGrath is crucial for the longevity and functionality of your hip replacement.

 Lifestyle Adjustments

  • Weight Management: Maintaining a healthy weight is key to minimising pressure on your hip, thus prolonging the life of the implant. Balance your diet and maintain an active lifestyle for effective weight control.
  • Home Modifications: Make necessary changes in your home environment to prevent falls, such as installing grab bars or using raised toilet seats.
  • Proper Footwear: Choose shoes that provide good support and cushioning to improve stability and reduce strain on your hip.
  • Smoking: Smoking can significantly slow your healing process and increase the risk of complications. Cutting down or quitting smoking altogether is highly recommended for a smoother recovery.
  • Ongoing Care: Attending all follow-up appointments with Dr McGrath and adhering to your rehabilitation plan is essential for optimal recovery and care of your new hip.

Adjusting your activities and lifestyle after undergoing hip replacement surgery is integral not just for your recovery but for thriving in the years to come. With adherence to these guidelines and a dedication to following Dr McGrath’s expert advice, you can enjoy an active and rewarding life post-surgery.

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