What is a total hip replacement (THR)?
Posterior VS Anterior Approach for Total Hip Replacement
With the posterior approach, there is a significant risk of the implants popping out (dislocating) if patients squat or cross their legs. This is because the stabilising structures at the back of the hip (capsule and muscles) are compromised during surgery. These same structures are stressed when patients squat or cross their legs.
Modern innovations in orthopaedic surgery have introduced a minimally invasive surgical technique in total hip replacement surgery. The direct anterior approach (DAA) has been widely adopted by orthopaedic surgeons across the world because of the several advantages that it yields over traditional hip replacement methods.
At Orion Orthopaedic Surgery, total hip replacement is performed using the direct anterior approach (DAA).
Dr. Mizan spent a year in Melbourne on his orthopaedic fellowship learning about the DAA technique of performing the total hip replacement. This technique preserves the muscles in the hips, by pushing muscles aside rather than cutting through them to access the hip joints.
Preservation of muscles maintains leg strength and facilitates quick recovery. By Preserving all the posterior structures of the hip, it nullifies the risk of posterior hip dislocation. After the surgery, patients are allowed to kneel, squat, and cross their legs. Another advantage of the anterior approach is that surgeons can assess the lengths of both legs accurately using X-rays since patients are lying on their back rather than on their sides.
Total hip arthroplasty via the direct anterior approach has the following benefits:
Muscles are pushed to the side during surgery (muscle preservation)
Patients lying on their backs (supine) during surgery allows for accurate assessment of leg length
Accurate X-rays are done to assess leg length and implant positioning
Hip abductor muscles are preserved
Minimal risks of hip dislocation
In a total hip replacement surgery, the worn-out bones and cartilage are carefully removed and replaced with implants. The whole procedure takes about 2 hours. With the DAA technique, patients are encouraged to walk just hours after the surgery and allowed to go home the following day. Our philosophy at Orion Orthopaedic Surgery is to allow patients to mobilize early to prevent muscle wasting and deconditioning.
The worn-out cartilage is scraped and reamed out to make way for the new cup.
We use X-rays to ensure that the cup is appropriately sized and placed in an optimal position (medial enough with adequate inclination and anteversion).
The jagged metal is a trial implant. Like buying shoes, we ensure this implant is sized appropriately and placed optimally for you.
Once satisfied, we replace the trial implants with actual implants. X-rays help to ensure there are no fractures around the hip, the implants are well-sized and positioned for you.
A bikini skin incision is an oblique incision about 9 to 10cm around the groin crease.
A standard post-operative X-ray is performed to assess the new hip.
Bilateral total hip replacement performed for hip athritis secondary to dysplasia (shallow hip sockets) to facilitate a more meaningful rehabilitation in patients with several disease in both hips.
How much does hip replacement surgery cost in Singapore?
The cost of hip replacement surgery in Singapore Private Hospitals ranges from $35,000 to $45,000. This includes doctors (surgeon and anaesthetist) fees, hospitalization and facilities fees as well as implants costs. The cost is largely covered by the insurance policies which our patients have. Medisave may also be used. We provide financial counseling for our patients and facilitate the insurance claim process so they may focus on their wellbeing and recovery.
How long do hip replacement implants last?
The longevity of your implants depends on the quality and size of the implants, whether they were placed in an optimal position, your age, body weight, and the types of physical activities you indulge in.
The hip implants used in Singapore are made in the US and the manufacturing quality and storage techniques have drastically improved over the years. Several countries around the world maintain joint registries to monitor all implants that have been used and highlight major issues with defective products or implants.
A majority of patients undergo hip replacement surgery in their early 60s and above. In this phase of life, most patients are retired and do not engage in highly strenuous activities such as marathon running. The stress placed on their implants is therefore mild to moderate. Based on the average lifespan of Singaporeans which is about 85 years, we do expect most implants to be long-lasting. This is especially so if there are no infections, falls, or fractures sustained by the patient.
Younger patients below 50 years old can also experience severe wear and tear of their hip due to various reasons (developmental, infection, trauma, alcohol, medication). These patients are generally gainfully employed, and enjoy their sports and active lifestyles. The materials of hip implants in a younger patient wound include the use of ceramic bearings, which have been shown to last longer than traditional metal and plastic bearings. Younger patients are at higher risk of requiring revision surgery in the future to replace worn-out parts of their implants. In large trials, about 95% to 97% of implants are still in good working order 20 years after surgery.
Speak to our orthopaedic surgeon if you are having pain and trouble with your hips. We are here to help you on your journey.
