MAKO Robot-Assisted Total Hip Replacement
Total Hip Replacement, sometimes called Total Hip Arthroplasty involved replacing a damaged or worn hip with an artificial joint called a prosthesis. Hip replacements are can be manufactured using numerous materials and these include metals such as stainless steel and titanium, ceramics, highly engineered polyethylenes and cements made of acrylic polymer. My recommendation for the type of prosthesis and surgical technique used for each patient should be individualised to the need of that patients taking into consideration the specific requirements of each person being treated.
I use MAKO Robot-Assisted technology for all my Total Hip Replacements. This state of the art technology based on a decade of research allows me, using a Robotic Arm to precisely and reproducibly position components exactly where I wish to every time. Although surgeons think they are good at accurately positioning components we know this is not the case. MAKO Robot-Assisted technology removes surgeon error in component positioning. In the short term this means accurate leg length equality without the need to use X-ray in theatre. Not using X-rays means I am not irradiating patients nor bringing additional equipment into the surgical field thus reducing the risk of infection. In the long-term accurate component positioning facilitates less wear and longer lasting components.
Compared to alternative techniques evidence shows that MAKO Robot-Assisted Total Hip Replacement:
Are more Bone Conserving ie less bone is removed, which is important especially with younger patients who may require a future revision (re-do) procedure.
Results in a more ‘natural feeling hip’ as evidenced by the ‘Forgotten Hip Score’
Has a lower dislocation rate
Results in better functional outcome at 12 months post-surgery compared to other techniques
What is the best Total Hip Replacement for me?
I treat all patients as individuals and certain types of Total Hip Replacement are best suited to some people than others. In my opinion, selection of the type of Total Hip Replacement used should not be a ‘one size fits all’ approach. The decision regarding this choice occurs after a detailed two-way discussion during which I learn what each individual’s expectations of surgery are. Other factors such as your bone anatomy (shape/size/density), anticipated level and nature of post-surgical activities as well as the underlying cause for you needing a Total Hip Replacement are also considered
How long will it take to recover?
Typically you are permitted to place your whole body weight onto the hip and walk (with assistance initially) once the anaesthetic has worn off and you are safe to do so. This can be within 4-6 hours post-surgery but I understand some patients may not wish to mobilise that early. Safety is paramount. My approach to patients undergoing Total Hip Replacement is to encourage mobilization as soon as possible after their surgery as I do not regard you as ‘ill’, you have simply had your hip replaced. You will see a physiotherapist twice daily while in hospital. Prior to discharge you will be given ample instruction and practice on how to best perform daily functional activities such as climbing stairs, getting into and out of cars etc. Hospital stay is usually 2-4 days but everyone is treated as an individual and occasionally a longer inpatient stay is required.
For more complex Total Hip Replacements it may be necessary for patients to only put some of their weight through their new hip. This can make recovery slightly slower and may need a longer hospital stay. Crutches are otherwise recommended for comfort for the first two weeks mainly for confidence and to make those around you aware you have had surgery. These can be discarded as soon as you are confident to do so. Depending on occupation you will require 2-6 weeks off work. You can be driven in a car as a passenger immediately on discharge from hospital. Patients managed by anterior approach surgery can drive a car when they feel confident but no earlier than 2 weeks after their surgery (4 weeks for posterior approach surgery). Patients MUST be able to perform an Emergency Stop and short journey are recommended initially. The decision to drive after surgery remains the responsibility of the patient. Air travel of less than 6 hours can be undertaken immediately
What are the Risks of Total Hip Replacement?
Hip replacement surgery is very safe, and serious complications are uncommon. Serious wound infection occurs in less than 1%. Dislocation occurs in less than 1% of people managed by direct anterior approach hip replacement (3% for posterior approach). Clots can form in the veins of the leg (deep venous thrombosis ‘DVT’), which on rare occasions may dislodge and travel to the lungs causing breathing difficulty. Many patients with hip arthritis have a short leg on the effected side, which is corrected during surgery. Occasionally it is not possible to make the leg lengths equal, particularly if very large length discrepancy is present before surgery. I will discuss the risks of the procedure with you in detail prior to the operation.
What activities can I perform after Total Hip Replacement?
Once you have recovered, there are very few restrictions on activity after Total Hip Replacement. Impact pursuits such as running cannot be performed for 6 months after surgery. Actvities such as walking, cycling, skiing and tennis may be conducted without limitation. Your suitability for returning to running activities depends on the nature and intensity of the sport you are undertaking and the type of prosthetic implant selected. Some activities may place the joint replacement at risk (for example extremes of joint flexion and rotation in some advanced yoga postures) – if you are unsure please check with us prior to recommencing.
Is long term surveillance required?
I usually recommend lifetime surveillance with clinical assessment and x-ray evaluation every 5 years after the initial 1 year follow-up review.
Do you perform MAKO Robotic Direct Anterior Approach Hip Replacement?
Yes. In suitable patients, I perform MAKO Robotic Direct Anterior Total Hip Replacement. This is a minimally invasive, muscle-sparing surgical technique that provides advantages of accelerated recovery and lower dislocation rate.
MAKO Robot-Assisted technology is also used in conjunction with Posterior Approach Total Hip Replacement when this is thought to be a better alternative.
What are risks and complications?
As with any major surgery, there are potential risks involved. The decision to proceed with the surgery is made because the advantages of surgery outweigh the potential disadvantages. It is important that you are informed of these risks before the surgery takes place. Complications can be medical (general) or local complications specific to the Knee. Medical complications include those of the anesthetic and your general well being. Almost any medical condition can occur so this list is not complete.
Complications include:
- Allergic reactions to medications
- Blood loss requiring transfusion with its low risk of disease transmission
- Heart attacks, strokes, kidney failure, pneumonia, bladder infections
- Complications from nerve blocks such as infection or nerve damage
- Serious medical problems can lead to ongoing health concerns, prolonged hospitalization or rarely death
Infection can occur with any operation. In the hip this can be superficial or deep. Infection rates are approximately 1%. If it occurs, it can be treated with antibiotics but may require further surgery. Very rarely your hip may need to be removed to eradicate infection.
These can form in the calf muscles and can travel to the lung (Pulmonary embolism). These can occasionally be serious and even life threatening. If you get calf pain or shortness of breath at any stage, you should notify your surgeon.
The plastic liner eventually wears out over time, usually over 10 to 15 years, and may need to be changed. Alternatively the remainder of your own knee may wear out requiring revision to a Total Knee Replacement.
Fractures or breaks can occur during surgery or afterwards if you fall. To repair these, you may require surgery.
The operation will always cut some skin nerves, so you will inevitably have some numbness around the wound. This does not affect the function of your joint. You can also get some aching around the scar. Vitamin E cream and massaging can help reduce this. Occasionally, you can get reactions to the sutures or a wound breakdown that may require antibiotics or rarely, further surgery.
The knee may look different than it was because it is put into the correct alignment to allow proper function.
Your leg will be restored to it’s original length as the deformity caused by wearing of the knee has been corrected.
There are a number of ligaments surrounding the knee. These ligaments can be torn during surgery or break or stretch out any time afterwards. Surgery may be required to correct this problem. This problem is minimised with Robotic Assistance.
Rarely these can be damaged at the time of surgery. If recognized they are repaired but a second operation may be required. Nerve damage can cause a loss of feeling or movement below the knee and can be permanent.
Discuss your concerns thoroughly with your Orthopaedic Surgeon prior to surgery.
Summary
Surgery is not a pleasant prospect for anyone, but for some people with arthritis, it could mean the difference between leading a normal life or putting up with a debilitating condition. Surgery can be regarded as part of your treatment plan it may help to restore function to your damaged joints as well as relieve pain. Surgery is only offered once non-operative treatment has failed. It is an important decision to make and ultimately it is an informed decision between you, your surgeon, family and GP. Although most people are extremely happy with their new knee, complications can occur and you must be aware of these prior to making a decision. If you are undecided, it is best to wait until you are sure this is the procedure for you.