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Wednesday, 03 December 2014 00:00

Hip Revision Arthroplasty Pre-Surgery Information

The following is what can be expected prior to hip revision arthroplasty surgery:

Examinations: Routine blood tests will be conducted in order to rule out infection, CT scan to look closer at the anatomy and bone scans to help to determine if a component is loose. X-rays will also be taken.

Skin preparation: Night prior to and morning of operation patient is required to wash leg, hip and pubic area to the midline with a sponge provided in the pre-admission clinic. Occasionally a Betadine Skin test is used if there is suspicion of an allergy to iodine.

Bowel Prep: Glycerin suppositories will be provided at the pre-admission clinic. Patient to is required to administer the evening prior to surgery (instruction leaflet given at the pre-admission clinic).

Patient education: Physiotherapy assessment will include: instruction of gait training, use of crutches and pre and postoperative exercises. Patient will be fitted for crutches to take home and practice preoperatively.

Medications: Cease aspirin or anti-inflammatory medications 10 days prior to surgery as well as any naturopathic or herbal medications.

 

Day of Surgery

Surgical paperwork will be administered by the nurses and the anaesthetist will meet with you to ask a few questions.  

A hospital gown will be given and the operation site will be shaved and cleaned.

Betadine skin prep will be applied to above area and wrapped.

All x-rays are to be sent with patient to theatre.

Published in Pre Surgery
Wednesday, 03 December 2014 00:00

Hip Dysplasia Post Surgery Information

The following is what can be expected following surgery for hip dysplasia: 

On the day following surgery your drains will usually be removed and you will be allowed to sit out of bed or walk with a physiotherapist.

You can expect to be discharged home or to a rehabilitation hospital approximately 5-7 days after surgery depending on your level pain and available help at home.

Your rehabilitation plan will vary depending on the surgical procedure and approach decided upon but you can expect to use crutches or a walker for a period of time. 

Physiotherapy is recommended and a physiotherapist will run through what is involved in the post-surgical program. 

 

Concerns:

Please contact the office if you are worried about your level of pain, have significant bleeding, or have fever or redness around the surgical site.

If you require assistance after hours please contact the hospital where the surgery was performed and they will contact Professor Al Muderis on your behalf. 

Norwest Private Hospital: (02) 8882 8882?

Sydney Adventist Hospital: (02) 9487 9111

Macquarie University Hospital: (02) 9812 3000

 

Published in Post Surgery
Wednesday, 03 December 2014 00:00

Hip Dysplasia Pre-Surgery Information

The following is what can be expected prior to surgery for hip dysplasia:

Skin preparation: Night prior to and morning of operation patient is required to wash leg, hip and pubic area to the midline with a sponge provided in the pre-admission clinic. Occasionally a Betadine Skin test is used if there is suspicion of an allergy to iodine.

Bowel Prep: Glycerin suppositories will be provided at the pre-admission clinic. Patient to is required to administer the evening prior to surgery (instruction leaflet given at the pre-admission clinic).

Patient education: Physiotherapy assessment will include: instruction of gait training, use of crutches and pre and postoperative exercises. Patient will be fitted for crutches to take home and practice preoperatively.

Medications: Cease aspirin or anti-inflammatory medications 10 days prior to surgery as well as any naturopathic or herbal medications.

 

Day of Surgery

Surgical paperwork will be administered by the nurses and the anaesthetist will meet with you to ask a few questions.

A hospital gown will be given and the operation site will be shaved and cleaned.

Betadine skin prep will be applied to above area and wrapped.

All x-rays are to be sent with patient to theatre.

Published in Pre Surgery
Wednesday, 03 December 2014 00:00

Hip Arthroscopy Post Surgery Information

The following is what can be expected following hip arthroscopy surgery:

Dressings: The incisions are closed with absorbable cosmetic sutures and covered by a waterproof dressing. The dressing remains intact for 7-10 days and will be removed by Dr Al Muderis during the first post operative review. Keep the wounds dry. Showering is advisable, applying warm water and soap gently to the wound, and then dry very well.

Pain and swelling: The hip and groin area will be painful and each patient will experience different levels of pain, however there should be no severe pain. The patient will be prescribed analgesia and anti-inflammatories on discharge from hospital. These should be taken as prescribed. It's important patients don’t wait for pain to set in before they take the prescribed medications. Due to the traction during surgery there may be some numbness in the groin or thigh but this should resolve during recovery. Ice therapy around the incisions and groin will help (a maximum of 15 minutes per hour) for the first week until the inflammation subsides, then after one week keep the wound warm.

Mobilising: Once you recover from anesthetic you will be mobile and able to bear weight. Crutches may be needed initially for support and safety. ?Limping is expected for the first few weeks but you will notice a significant improvement in your gait.

Exercise: Commence gentle exercise such as walking within a few days of surgery. Hydrotherapy can commence after the wounds have been checked. Non-impact exercises with a physiotherapist can commence within 7-10 days. Do strengthening exercises without deep flexion of the hip and use an exercise bike with the seat raised high.? Physiotherapy will improve range of motion, proprioception, strength, control and stability of the hip.

Exercise precautions: Avoid deep flexion. No impact activity such as running for at least six weeks.

Concerns: Please contact the office if you are worried about your level of pain, have significant bleeding, or have fever or redness around the surgical site.

If you require assistance after hours, please contact the hospital where the surgery was performed and they will contact Professor Al Muderis on your behalf. 

Norwest Private Hospital: (02) 8882 8882?

Sydney Adventist Hospital: (02) 9487 9111

Macquarie University Hospital: (02) 9812 3000

 

Published in Post Surgery
Wednesday, 03 December 2014 00:00

Hip Arthroscopy Pre-Surgery Information

The following is what can be expected prior to hip arthroscopy surgery: 

Skin preparation: Night prior to and morning of operation patient is required to wash leg, hip and pubic area to the midline with a sponge provided in the pre-admission clinic. Occasionally a Betadine Skin test is used if there is suspicion of an allergy to iodine.

Bowel Prep: Glycerin suppositories will be provided at the pre-admission clinic. Patient to is required to administer the evening prior to surgery (instruction leaflet given at the pre-admission clinic).

Patient education: Physiotherapy assessment will include: instruction of gait training, use of crutches and pre and postoperative exercises. Patient will be fitted for crutches to take home and practice preoperatively.

Medications: Cease aspirin or anti-inflammatory medications 10 days prior to surgery as well as any naturopathic or herbal medications.

 

Day of Hip Arthroscopy Surgery

Surgical paperwork will be administered by the nurses and the anaesthetist will meet with you to ask a few questions

A hospital gown will be given and the operation site will be shaved and cleaned

Betadine skin prep will be applied to above area and wrapped

All x-rays are to be sent with patient to theatre

Published in Pre-Surgery
Wednesday, 03 December 2014 00:00

Hip Arthroscopy Indications

Hip arthroscopy is often indicated if the patient has a painful hip condition that does has not responded to nonsurgical treatment. 

The procedure is used to relieve painful symptoms that result from damage to the labrum, articular cartilage or other soft tissues surrounding the joint. 

Common reasons for hip arthroscopy surgery to be indicated include the following:

  • Debridement of loose bodies: Bone chips or torn cartilage debris causing hip pain and decreased range of motion. These can be removed with hip arthroscopy
  • Debridement of joint surfaces: Conditions such as arthritis can cause the breakdown of tissue or bone in the joint
  • Removal of adhesions: Adhesions are areas of built of scar tissue which can limit movement and cause pain
  • Removal of bone spurs: Bone spurs are extra bone growth caused by injury or arthritis that damage the ends of the bones and cause pain and limit joint mobility
  • Repair of torn labrum: The labrum lines the outer edge of the acetabulum, the 'socket' (the hip joint is known as a ball and socket joint), to ensure a good fit with the femoral head (the 'ball'). Tears can occur in the labrum causing hip pain
  • Repair after trauma: Hip arthroscopy can be used to repair fractures or torn ligaments caused by trauma
  • Partial Synovectomy: Removal of portions of the inflamed synovium (joint lining) in patients with inflammatory arthritis can help decrease the patient's pain. However, if the damage is more severe and requires a complete synovectomy this will need to be done with an open, larger hip incision
  • Evaluation and diagnosis: Patients with unexplained pain, swelling, stiffness and instability in the hip which is unresponsive to nonsurgical or conservative treatment may undergo hip arthroscopy for further evaluation and diagnosis of the condition 

Published in Information
Wednesday, 03 December 2014 00:00

Hip Arthroscopy Surgical Procedure

The following is what can be expected during hip arthroscopy surgery:

The patient will be admitted into hospital for a day or overnight.

The procedure is performed under general anesthesia or spinal anesthesia.

At the start of the procedure the leg will be put in traction. The hip will be pulled away from the socket enough for the entire joint to be visible and for instruments to be inserted. 

A small puncture (about the size of a button hole) will be made for the arthroscope through which the inside of the hip and its damage can be identified. 

X-ray control using an image intensifier is used to gain access to the joint.

Two or three small incisions (portals) are made just above the bony prominence of the hip. Instruments are then inserted, first to visualise and treat any spurs on the femoral neck or acetabulum, then traction is applied and the instruments gain access to the hip joint to treat any pathology intra-articulary on the hip. These instruments can also smooth off rough surfaces, remove loose pieces of cartilage and excise bony osteophytes that may be causing a problem.

Sufficient traction is applied to open the joint by 7-8mm. 

Following the procedure local anesthetic is injected into the hip and wound.

However, depending on the approach taken the above overview will vary.

 

Complications:

As with any operation complications are possible but unlikely. Possible complications following hip arthroscopy can include:

  • Permanent damage to the lateral femoral cutaneous nerve may occur in around 2% of patients
  • Inadvertent chondral damage
  • Infection in the skin or deep in the hip which occurs in less than 1% of patients
  • Vascular injury; resulting in excess bleeding
  • Nerve injury – the pudendal nerve may be damaged by the traction post. This is usually temporary and rarely permanent
  • Ongoing pain: especially if there is significant arthritis 

Published in Information
Wednesday, 03 December 2014 00:00

Hip Arthroscopy Information

Hip arthroscopy is classified as keyhole surgery or minimally invasive surgery, and is performed through very small incisions to evaluate and treat a variety of hip conditions. Arthroscopy is a surgical procedure which gives the surgeon a clear view of the inside of the joint. During hip arthroscopy surgery a small camera, called an arthroscope is inserted into the hip joint. The surgeon uses the images to guide intricate surgical instruments. 

The term arthroscopy comes from the Greek words; arthro, meaning joint and skopein, meaning to examine. 

Hip arthroscopy can used to treat a variety of hip conditions such as:

  • Debridement of loose bone chips or torn cartilage
  • Debridement of joint surfaces
  • Removal of torn labrum
  • Removal of bone spurs
  • Removal of adhesions
  • Removal of portions of inflamed synovium (joint lining). This is known as a partial synovectomy. A full synovectomy requires larger hip surgery
  • Repair of fractures or torn ligaments caused by trauma
  • Unexplained hip pain, stiffness and instability in the joint 

 

Labral Tears

One of the most common reasons for hip arthroscopy is to treat labral tears. The acetabular labrum is a fibrous rim of cartilage around the hip socket which helps keep the head of the femur (thigh bone) inside the acetabulum (hip socket). It provides stability and seals the joint.

Acetabular labrum tears (labral tears) can cause pain, stiffness and other debilitating symptoms of the hip joint. Pain can occur if the labrum is torn, frayed, or damaged and is most often casued by trauma or developmental hip dysplasia.

Labral tears are extremely common in elderly people and are less common in young adults.

 

Labral Tear Symptoms

  • Pain in the front of the hip (most often in the groin area) accompanied by clicking, locking, or catching of the hip
  • Joint stiffness and a feeling of instability
  • The pain may radiate to the glute, along the side of the hip, or down to the knee
  • Pain may be aggravated by long periods of standing, sitting, or walking and is often worse on flexion (when the joint is bent) . Pain may progress to become continuous

 

Hip Arthroscopy Contraindications: 

Arthroscopic debridement treatment is not advised if you have any of the following conditions:

  • Advanced hip arthritis
  • Acetabular protrusion
  • Hip ankylosis
  • Skin lesions at portal sites.

 

Published in Information
Wednesday, 03 December 2014 00:00

Hip Arthroplasty Post Surgery Information

The following is what can be expected post Total Hip Replacement surgery:

Day 1:  Exercises in bed, up with physiotherapist during the late am or pm at physiotherapist discretion using forearm support frame and weight baring as tolerated. Sit out of bed as tolerated.

Day 2 on: Progress mobility with physiotherapist.

Day 3:  Commence hydrotherapy at physiotherapist discretion and commence crutches if able.

Day 4-6: Education handouts will be given detailing ‘Care of hip’ and ‘Home Exercise program’. Stair practice and discharge information will be provided. By this stage patient should be able to get out of bed, sit in a chair and use the toilet independently.

Day 5-7: If the patient is independent they will be discharged directly home. Patient may be discharged earlier if being transferred to a rehabilitation facility. Follow up appointment is to be made with Professor Munjed Al Muderis for six weeks time from discharge and outpatient physiotherapy/hydrotherapy is to be commenced.

The following post-operative medications are to be expected to be prescribed following your hip replacement surgery: 

  • Endone (as per doctors orders), then panadeine forte (as per doctors orders)

  • IV antibiotics as ordered, anticoagulation as per the physician

  • Patient to wear anti-embolic stockings for 6 weeks

Post-op precautions:

It is important that you avoid any movements that will stress, damage or lead to dislocation of your new hip:

  • For the first six weeks it is recommended you sleep with a pillow between your legs

  • Avoid crossing your legs and bending your hip past a right angle

  • Avoid low chairs and bending over to pick things up. Grabbers can be helpful with this as well as shoe horns

  • Avoid the combined movement of bending your hip and turning your foot in, this can lead to dislocation

Concerns: Please contact the office if you are worried about your level of pain, have significant bleeding or have fever or redness around the surgical site.

If you require assistance after hours please contact the hospital where the surgery was performed and they will contact Professor Al Muderis on your behalf.

Norwest Private Hospital: (02) 8882 8882

Macquarie University Hospital: (02) 9812 3000

Wednesday, 03 December 2014 00:00

Tumour Removal Pre-Surgery Information

The following is what can be expected prior to tumour removal surgery: 

Routine blood tests will be conducted to check infection and inflammatory markers. Bone scans, x-rays and CT will be taken in order to look closer at the anatomy.

Skin preparation: Night prior to and morning of operation patient is required to wash leg, hip and pubic area to the midline with a sponge provided in the pre-admission clinic. Occasionally a Betadine Skin test is used if there is suspicion of an allergy to iodine.

Bowel Prep: Glycerin suppositories will be provided at the pre-admission clinic. Patient to is required to administer the evening prior to surgery (instruction leaflet given at the pre-admission clinic).

Patient education: Physiotherapy assessment will include: instruction of gait training, use of crutches and pre and postoperative exercises. Patient will be fitted for crutches to take home and practice preoperatively.

Medications: Cease aspirin or anti-inflammatory medications 10 days prior to surgery as well as any naturopathic or herbal medications.

 

Day of Surgery:

Surgical paperwork will be administered by the nurses and the anaesthetist will meet with you to ask a few questions.

A hospital gown will be given and the operation site will be shaved and cleaned.

Betadine skin prep will be applied to above area and wrapped.

All x-rays are to be sent with patient to theatre.

Published in Pre Surgery