Hip Preservation and Replacement - Orion Ortho

Introduction

The hip is a ball and socket joint that is lined with cartilage and a labrum. These two important structures ensure painless and smooth movement of the hip as we go about our daily activities. There are many degenerative and developmental conditions which may cause a breakdown of these shock absorbers of the hip to bring about pain and stiffness. If left untreated, simple injuries of the hip may escalate into full blown arthritis (degenerative wear and tear). Hip preservation techniques are aimed at rectifying and treating injuries around the hip and prevent the need for a hip replacement. If the hip condition is too far advanced, a hip replacement surgery may be required to ensure you continue to live a healthy and active life.

Total Hip Replacements-new-1

Hip Anatomy and common hip conditions

The labrum is a thin cartilage around the edges of the socket (acetabulum). It helps to distribute lubricating (synovial) fluid around the hip to keep it healthy and smooth. Trauma and injury may cause a labrum tear. This may bring about pain in the groin accompanied by clicking or clunking sensations. If left untreated, the labral tear may get bigger and lose its ability to protect the hip against arthritis. Physiotherapy is instituted after surgery to help with flexibility of the hip and ensure a satisfactory recovery.

Femoral acetabular impingement (FAI) is a developmental condition where there is excess bone along the edges of the acetabulum, at the junction of the femoral head and neck or both. It’s like having pebble in your shoe which keeps irrigating the sole of your foot until you get a severe abrasion. FAI can cause your hip labrum to tear and hip cartilage to wear out. Your hip may progress to arthritis if this is left unchecked. MRI scans may be done several months after your surgery to ensure that your hip cartilage and labrum are in good order. Physiotherapy is an important tool that we use to ensure you maintain strength and flexibility in your hips and lower limbs.

Avascular necrosis (AVN) is a condition where the blood supply to the femoral head bone in the hip is disrupted. This may be due to a variety of causes including excessive alcohol intake, long term steroid use and chemotherapy medications. AVN leads to a collapse of the femoral head and eventual arthritis.

Hip arthritis is a condition where there is degenerative wear and tear or thinning of the hip cartilage. The protective and shock-absorbing functions of the cartilage are lost, leading to severe pressure to the hip joint itself. Patients often experience debilitating hip pain, stiffness and walk with a limp with hip arthritis.

Hip arthritis with the call and socket joint is worn out

Hip Preservation Surgery

There are now arthroscopic (key hole) techniques to preserve the hip and prevent or delay the need for a formal hip replacement. Labral tears are repaired and stitched back to the rip of the acetabulum using long and narrow instruments which are inserted through small 1-2cm skin incisions around the hip (arthroscopic labral repair). FAI injuries are also managed by this same technique where abnormal fragments of bone around the acetabulum and femoral neck are removed using burr and shaver instruments (arthroscopic pincer and CAM resection). Key hole techniques help reduce the risk of infection and collateral damage to other structures in the hip. Your surgeon will have an excellent view in the hip as these minimally invasive techniques are associated with minimal blood loss. We have a formal rehabilitation program that patients embark on after their surgery to optimise their recovery.

AVN is associated with an increased pressure in the femoral head. This prevents blood flow to it and causes it to eventually collapse. It is important to seek early treatment for this as hip preservation techniques can only be used in its early stages (Stage I and II). In these instances, a small 2cm incision is made on the side of the hip. Small wires and then advanced into the femoral head itself to decompress the pressure within the bone (core decompression). This encourages blood flow to return to the bone and help with its healing. We also improve the biology of bone healing by including bone graft into the femoral head. In combination, these techniques help to reduce bone pressure and improve bone healing mechanisms within the femoral head. Serial x-rays are done several weeks and months after surgery to ensure that the femoral head in the hip maintains its spherical shape and continues to heal. We also ensure that our patients refrain from excessive drinking and steroid use to prevent deterioration of their condition.

In the early stages of hip arthritis, hip preservation techniques include intra-articular injections into the hip joint itself. Single and multiple doses of Hyaluronic acid have been shown to improve hip pain and function as a result of hip arthritis.

Hip Replacement Surgery

This surgical technique involves removing the worn out parts of the hip and replacing them with specialised implants. The aim of this surgery is for patients to return to their active lifestyle and enjoy continued employment, sports, holidays or simply go about their daily activities without hip pain and disability.

Your orthopaedic surgeon will analyse your latest x-ray or MRI scans of the hip and conclude that the cartilage (shock absorber) and labrum (stabiliser) of the hip are worn out. This leads to very rough and painful movements in your hip. At this point, you have already experience the following symptoms:

Deep-seated hip pain and stiffness
Walking with a limp or waddling gait (your body swinging from side to side when walking)
Having to use a walking aid
Difficulty putting on clothes and socks
Difficulty cutting your toe nails
Difficulty with daily activities like climbing stairs
Pain killers becoming less effective

The hip replacement surgery takes about two and a half hours. The 10cm skin incision is located in your groin at the front of your hip. The muscles are pushed aside so that we may access the hip. The worn out bones and cartilage are carefully removed using specialised equipment. Implants are then put in their place which best fit your bone shape and size. During surgery, your orthopaedic surgeon will move your hip about to simulate daily activities such as sitting n a chair, squatting and sleeping on your side. This is to ensure your hip is stable and does not dislocated when you go about your daily activities. We also ensure both legs are of the same length by clinical measurement and the use of x-rays.

My patients are able to walk on the same day as their surgery. Under the watchful eye of our physiotherapist, my patients are able to walk with the use of a walking frame and stick around their hospital room. Your minimally invasive techniques allow accelerated walking and physiotherapy after surgery. My patients are discharged the day after surgery once they are deemed to be safe on their feet. I always encourage my patients to walk as much as possible after their surgery. They are allowed to return to their favourite sporting pastimes such as brisk walking, swimming, tennis and golf. My patients are also allowed to squat and kneel after their hip replacement surgery. To improve their confidence, I will guide them to perform these movements and exercises in the safety and comfort of my clinic room in the presence of their family members or care givers.

I often explain to patients and their loved ones that a hip replacement is often the start of a new and refreshing phase of their life. This is especially so since many of them would have experienced years of hip pain and crippling disability. We encourage our patients to live an active and healthy life after hip replacement surgery.

Conclusion

Please seek professional orthopaedic help if you experience any hip, knee or back pain. An early assessment and clinical examination accompanied with appropriate imaging (x-rays and/or MRI scans) will allow the early diagnosis of injuries and conditions of the hip. In these instances, hip preservation techniques may be instituted to get you back to your active life. If the hip injury and degeneration is too far advanced, a hip replacement procedure is an excellent option to manage your chronic pain and significantly improve your quality of life.

A total hip replacement (also called total hip arthroplasty) is a surgical procedure that replaces a damaged or worn hip joint with an artificial implant. The damaged ball (femoral head) and socket (acetabulum) are removed and replaced with a metal, ceramic, or polyethylene prosthesis that restores smooth, pain-free movement.

It is most commonly performed for advanced hip osteoarthritis, but also treats:

Rheumatoid and inflammatory arthritis of the hip
Avascular necrosis (loss of blood supply to the femoral head)
Hip fractures, particularly in older patients
Hip dysplasia and post-traumatic arthritis

Surgery is considered when hip pain and stiffness significantly limit walking, sleep, and daily activities despite conservative treatment.

Common indicators that a hip replacement may be necessary include:

Deep-seated hip or groin pain that continues even at rest or during sleep
Stiffness that limits your ability to walk, bend, or put on clothes and socks
Difficulty with daily activities such as climbing stairs or cutting your toenails
Walking with a limp or a waddling gait, or needing a walking aid
Pain that no longer responds to medication, as painkillers become less effective

If hip pain is eroding your quality of life and conservative measures have failed, it is worth consulting a hip specialist for assessment with an X-ray or MRI scan.

The procedure is performed under general anaesthesia and takes around two and a half hours. Using the direct anterior approach, the incision is located at the front of the hip, and the muscles are pushed aside rather than cut for the surgeon can access the joint.

The worn-out bone and cartilage are carefully removed with specialised equipment, and implants are fitted to best match the shape and size of your bone. During surgery, the surgeon moves the hip through everyday positions, such as sitting, squatting, and lying on the side, to confirm the hip is stable and will not dislocate. The surgeon closes and repairs the anterior capsule which further reduces the risk of anterior hip dislocation and improves its stability. Both legs are checked for equal length using clinical measurement and X-rays.

Many patients are able to walk on the same day of surgery with a walking frame, and are typically discharged a day or two after once they are safe and confident on their feet.

The terms refer to the surgical approach, meaning the direction from which the surgeon accesses the hip joint:

Direct anterior approach (DAA): the hip is accessed from the front, working between muscles without detaching them. This muscle-sparing technique facilitates less post-operative pain and a faster early recovery. The risk of hip dislocation is negligible. Dr Mizan is one of the few surgeons in Singapore trained in this approach.
Posterior approach: the hip is accessed from the back, detaching about 4 or 5 muscles along the way. While it is a widely used and versatile approach that gives the surgeon excellent access, there is a significant risk of implant dislocation through this approach. Patients have to follow a strict regiment of hip precautions to prevent this complication.

The best choice of approach depends on your anatomy, the complexity of your case, and your surgeon's expertise. Both deliver excellent long-term outcomes when performed by an experienced hip surgeon.

Recovery is progressive and begins immediately after surgery:

Day of surgery: many patients stand and take assisted steps with a walking frame
Day after surgery: typical discharge once safe mobility is demonstrated
Weeks 2 to 6: progressive walking with a stick; many patients resume light daily activities
6 to 12 weeks: return to most normal activities and, for many, driving and work
3 to 6 months: full recovery, with restored strength and confidence in the hip

Patients are encouraged to walk as much as possible and can return to activities such as brisk walking, swimming, tennis, and golf. Muscle-sparing approaches may shorten the early recovery phase without any hip precautions.

The cost of hip replacement surgery in Singapore depends on the hospital setting, implant choice, and surgical complexity:

Public hospital (subsidised): significantly lower cost due to government subsidies.
Private hospital: typically ranges from approximately S$45,000 to S$55,000 all-inclusive, depending on the length of stay in hospital and hospital charges.

Costs generally cover surgeon and anaesthetist fees, implant, operating theatre, hospital stay, medication, and follow-up. Orthopaedic procedures performed by Dr Mizan are covered by both private and corporate insurance. Request an itemised estimate from the clinic and confirm insurance coverage with your insurer before surgery.

Choosing an experienced, subspecialised hip surgeon is one of the most important factors in a successful outcome. Look for:

Relevant subspecialty focus: choose a surgeon who focuses on the hip and knee rather than a generalist. Dr Mizan's main focus is hip and knee conditions, including sports injuries, arthritis, and trauma.
Fellowship training and experience: High volume surgeons who regularly perform hip replacements develop more refined technique and better outcomes
Range of techniques: familiarity with both anterior and posterior approaches means the surgeon can tailor the method to your case
Good communication and rapport: a good specialist explains your options, risks and benefits, rehabilitation plan, and answers your questions patiently and clearly. You must be comfortable with and trust your surgeon.
Effective treatment options and close follow-up: the same surgeon should guides you from consultation through surgery and recovery. A good rehab phase will significantly improve your clinical outcome.

Hip Preservation and Replacement - Orion Ortho

What is a total hip replacement, and what conditions does it treat?

What are the signs that I may need a hip replacement?

What happens during hip replacement surgery?

What is the difference between anterior and posterior hip replacement?

How long does it take to recover from a hip replacement?

How much does hip replacement surgery cost in Singapore?

How do I choose the right hip specialist in Singapore?

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