Changing perspectives on hip replacement surgery – Siri’s story
Before coming to The London Hip Unit, Siri had previously visited a sports and exercise medicine consultant elsewhere for a pain in her hip, and she was told she might need a hip replacement. This came as a shock to her – being in her forties, she’d believed that hip replacements were something for an older demographic. But, as Consultant Orthopaedic Surgeon Mr Alastair Dick explains, this viewpoint isn’t entirely accurate.
“The average age for a hip replacement in the UK is about 70, but at The London Hip Unit, we see a lot of younger patients with more complex conditions,” Mr Dick says. “Amazingly, Siri, in her forties, wouldn’t be seen as that young of a patient for us – we do hip replacements for patients in their twenties, or even as young as teenagers.” These patients, like Siri, often have an underlying hip issue that prevents them from enjoying their active lifestyles, leading to their need for surgery.
Treatment options
After researching The London Hip Unit, Siri decided to book an appointment with Mr Dick to discuss her options. When a patient like Siri comes to Mr Dick, they often have one of two surgical options – hip preservation surgery or a total hip replacement. This treatment decision relies on a number of factors unique to each patient. “It’s quite a complicated decision,” Mr Dick explains.
In Siri’s case, her hip pain was caused by hip dysplasia, which is a shallow hip socket. Over time, and with her active lifestyle, this resulted in damage to her hip joint, causing her pain. In some cases, this can be treated with a hip preservation surgery called a periacetabular osteotomy, where the acetabulum (the hip socket) is cut and repositioned so that the femoral head (the ball of the hip joint) fits in it better.
Preservation or replacement?
Mr Dick always recommends the best treatment option for his patients, and for Siri, there were a number of factors that influenced his decision to recommend hip replacement surgery. “A hip replacement can be an excellent choice for a young, active patient,” he says. “It’ll allow them to get back to the activities they want to do, and it should last a very long time.” Age was one factor that influenced this decision – Mr Dick generally advises hip replacements for patients beyond their early forties. With the developments in the prostheses used, a hip replacement at age 40 might last a patient’s entire life. The condition of the patient’s hip also influences the treatment decision. Siri’s hip dysplasia had caused a lot of wear and tear over the years, and at a point this wear becomes too great for hip preservation to be beneficial.
Finally, Mr Dick's treatment decision is based on the patient’s goals and their lifestyle before their hip problem. Siri led a very active life and has young children, and the recovery time for periacetabular osteotomy is significantly longer than that of a hip replacement. With Siri’s goals of getting back to sport and having her children to look after, her and Mr Dick came to the joint decision that a hip replacement would be the best course of action. Siri’s hip replacement will hopefully last her whole life, but the main goal of Mr Dick was to get her back to doing what she loves. “We do warn patients that there’s a chance they’ll need a revision surgery,” Mr Dick says, “but we believe that getting someone back to their activities in the prime of their life is important.”
Siri’s surgery
While hip replacements in younger patients are routine at The London Hip Unit, this doesn’t detract from their complexity. Siri’s hip dysplasia added to this complexity as replacing these hips requires specialist surgical experience. “People with dysplasia often have an increased range of movement, so we have to be sure to position the components as perfectly as possible to keep it stable,” explains Mr Dick.
Siri’s hip replacement was an uncemented ceramic-on-ceramic replacement. Rather than being held in place with cement, the implants are initially held in place by press fit. The bone then grows around the implant, with the implant becoming part of the body. The medical-grade ceramic that the implant is made of is incredibly hard-wearing, meaning that it may last indefinitely. Mr Dick used a bone-preserving technique with a short thigh bone stem in case she needs a revision surgery in future.
The key to a successful rehabilitation
Siri’s surgery was a success, and six months later she completed an Olympic distance triathlon with a time of 2 hours 39 minutes. Such a feat was possible thanks to her rehabilitation after surgery. A modern hip replacement lets patients get moving almost right after their surgery. Most patients use crutches for the first couple of weeks post-surgery, but some are able to walk without these sooner. With support from a physiotherapist, patients are encouraged to walk up stairs and carry out their normal functions of daily living. Once home, patients begin an outpatient physiotherapy programme to restore their range of movement and muscle strength. At this point, the programme is then tailored to each patient’s specific goals – in Siri’s case, this was getting back to running, cycling and swimming for her triathlon preparation.
While the physiotherapy programme played a large role in the success of Siri’s recovery, a patient’s mindset is important too. “A lot of Siri’s success was down to her dedication,” Mr Dick says, “and her desire and drive to get back to what she wanted to do.” By being diligent, adhering to the physiotherapy program and moving their hip, patients can make their recovery faster, better and overall more successful.