(08) 7099 0188 FAX: 7099 0171 liewadmin@orthopaedics360.com.au
Adelaide Orthopaedic Surgeon - Direct Anterior Approach

YOUR OWN PATIENT PORTAL

Welcome to your patient portal. This page is a specific portal for you to read about, and view information about your Total Hip Replacement. By now, you would have received your username and password. This is required each time you login to this page, for security. Below there is information made specific to you, as we are aware that there is a lot of information during your appointment that you may have missed. Dr Chien-Wen Liew and the team at Adelaide Orthopaedic and Trauma Specialists hope that this information is useful to you. After your operation, please stay tuned for information about your operation.

DETAILS OF YOUR SURGERY

Your Total Hip Replacement has been scheduled for: DATE The location of your Total Hip Replacement will be at: Burnside Hospital Total Hip Replacements is surgery that can affect your medical conditions. Therefore, in order to provide you with the safest possible outcome from the surgery and anaesthetic, we require all patients to undergo baseline testing. This includes: – Preadmission appointment at Burnside Hospital – Pre-operative routine bloods (This may include HIV, Hep B and Hep C screening) – Pre-operative urine sample to screen for infection – You may be referred to a physiotherapist prior to your operation. – Depending on your medical circumstances, you may be required to have a pre-operative appointment with a peri-operative physician. This will have been organised for you when booking for surgery if required.

WHAT TO BRING

All your current medications or an up to date LIST

Comfortable clothes

Toiletries – toothbrush, favourite shampoo, soap etc

Magazines or entertainment (For the time you aren’t exercising post op!)

Medicare card

Private health card

Your own walking frame or stick that you have been using

YOUR PROSTHESIS

For your Total Hip Replacement, you will receive an impact made of Nobium/Titanium alloy. This is similar to Titanium. In 95% of cases, you will receive an uncemented prosthesis. This is coated with Hydroxyapatite, which is a similar structure to bone, allowing your own to “grow into” the prosthesis over time. You will not notice when this occurs, as it occurs, slowly. Once bone has grown into the stem, the stem is fixed very solidly in place. The other 5% of cases use cement to fix the prosthesis. Dr Liew may decide to use cement if your bone quality is poor. There is no difference in your post operative course. The acetabular component (cup side) is also coated in a similar material. Your bone is shaped to accept the prosthesis before it is inserted into place. Occasionally screws are used if your bone quality is deemed to be slightly below normal. In severe cases of bone softening (osteoporosis), cement can be used to fix the acetabular component. In general, 95% of cases do not require cement. During insertion of the acetabular component, a small hole in the tip of the acetabular component is used to ensure that the component is appropriately positioned, and deep enough. This hole is then covered with a specific screw. The small flat screw is not visible during Xray as it sits flush with the cup. Its use is to prevent particles eroding the bone under the acetabular component. For your total hip replacement, Dr Liew has chosen to use a ceramic on polyethylene bearing surface. This has been shown to have excellent wear properties, and also means that no metal is touching metal in the entire hip replacement. The polyethylene is a specially constructed one, which has cross-links – a new development over the last 10 years, which has been shown to reduce wear rates, and improve longevity. Using a ceramic on polyethylene bearing also greatly reduces the chance of a “squeaking” hip. This prosthesis is designed to remain in situ for your entire life. In some cases, the bearing surface will wear out. This usually occurs when the hip replacement is in place in very young people. Like all bearings, they wear out over time. If this occurs, you may need a revision hip operation. This is unlikely to be required within the first 15 years, but you are followed up closely by Dr Liew indefinitely, to ensure that any problems are caught early. For detailed prosthesis information: Click Here to view detailed prosthesis information

POST OPERATIVE PERIOD

Your post operative period will last anywhere from 2-5 days, depending on your requirements. In some cases, we organise rehabilitation for you if you would benefit from more intensive rehabilitation. In general, the first 6 weeks are all about walking, and no specific exercises are required, as long as you are independently mobile.

Analgesia: For pain relief, you will only generally require tablet medications. This is given to you on an “as needed” basis. We opt to use multiple modalities for pain relief, to decrease the chance that you will require any injectable agents. In general, tablet pain relief is safe, and effective, and does not cause as much post operative drowsiness, nausea and dizziness as the injectable ones. After your operation, you will be prescribed pain relief to go home with. Only take this is required. You are not required to take pain relief constantly. If you are not in pain, you should stop taking your pain relief.

Walking: Due to the benefits of the anterior approach for total hip replacements, we encourage all patients to walk the day of surgery, or the next morning. You will require the help of a physiotherapist or nurse to begin with, who will assess your legs to see if it is safe to do so. In some cases, the spinal anaesthetic or nerve blocks may still be working, which affect your muscle strength. It is best to wait until these have worn off fully prior to commencing any walking. During your stay in hospital, you will start with a walking frame, and progress to a walking stick. You will also be required to practice walking up and down steps. Once you can achieve these milestones, you can go home. In general, most patients only require a walking stick on discharge. If you are using a walking frame, do not worry – every progresses at different rates. It is better to be safe than to fall over.

Showering: The wound dressing placed on your leg will be a waterproof dressing. You can see the two green ends. Under the clear part is a small strip of absorbant dressing which covers your wound fully. Under this are steristrips which act to keep the scar nice and thin as it is healing. For the first 2 weeks, you are encouraged to keep the wound clean and dry. Your dressing will be removed by Dr Liew at the 2 weeks appointment. Until your first post operative appointment, you will learn how to stick a bag over your dressing to keep it dry. Even though the dressing is waterproof, there are small gaps under the edges which can let dirty water in. Keeping it dry allows the skin to heal without issue, and decreases the risk of infection significantly. After your wound has been inspected by Dr Liew, you will be given further instructions – in general, you will be allowed to get the wound wet. Dr Liew will place a small strip of Hypafix over your dressing at your appointment, which will fall off on its own after about a week. This is expected.

Driving: In general, you will be able to drive quite early in your post operative course. This is due to the fact that your surgery does not cut any of the muscles to the hip, so your rehabilitation is relatively quick. You will be allowed to drive once you are walking well independently and can move yourself in and out of a car with relative ease. For most patients, this occurs after your 2 weeks appointment with Dr Liew. Some patients may take longer. Safety is the priority.

Wound: The wound lies beneath the white strip you can see. If it remains white, with small areas of ooze, then this is normal. If the entire white area becomes discoloured in anyway, you should advise Dr Liew by calling (08) 7325 4850. In some cases, your wound dressing will need to be changed prior to your 2 week appointment. This is rare.

Dislocation risk: All total hip replacements can dislocate, however, total hip replacements performed via a direct anterior approach tend to be a lot more stable than for other approaches. You will be allowed to sit up in bed as you wish, and sit on a normal toilet seat. During the first 6 weeks, you should be careful about falling, as the twisting force on your leg may cause the hip to dislocate. Because your total hip replacement will be performed using a direct anterior approach, you will not have the same post operative restrictions as hips performed via other means. In general, the only position to avoid is pushing your leg back behind you and twisting at the same time. This is a very unusual position to be in, and you are unlikely to find yourself in this position unless you specifically try to perform it.

Physio Clinic Information

Information Sheets for Download

Information Sheets

Hip Patient Flyer

Physio Sheet

Privacy and Security

Security is taken very seriously. Your information is highly important to us. This page is specifically designed for educational purposes only, and information held within this website is to be coupled with the advice and information you obtain from your doctors. If you are unsure about what is written anywhere on this website, please feel free to contact us for more information.

This private patient portal is not designed for wide distribution. Please feel free to share your login details with close family or friends if you should require, but please ensure that you only give your unique login details to those who you wish to share this information with.

This patient portal is only active for a limited time before and after your operation, after which time is it removed and unrecoverable.

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