Total hip replacement

The most common reason for hip replacement is osteoarthritis, where the cartilage covering the hip joint gradually wears away.

Other conditions that may lead to hip replacement include:

Hip replacement is usually considered when pain and stiffness significantly affect walking, sleep, work, exercise or normal daily activities, and non-operative treatment is no longer providing adequate relief.

The hip is a ball-and-socket joint.

During a total hip replacement, the damaged femoral head is removed and replaced with a metal stem and new artificial ball. The damaged surface of the socket is replaced with an acetabular component and bearing surface.

Modern hip replacements may use cemented or uncemented components, depending on factors such as bone quality, anatomy and individual patient requirements.

Different bearing surfaces and implant designs are available, and these are selected according to the individual patient.

There is more than one safe and effective way to perform a hip replacement.

Dr Pienaar performs hip replacement using both the Anterior AMIS approach and the Posterior approach.

The most appropriate approach is selected according to the patient's anatomy, underlying hip condition, previous surgery, complexity of the procedure and individual requirements.

AMIS (Anterior Minimally Invasive Surgery) is an anterior approach to the hip where the joint is accessed from the front.

The approach works through an intermuscular and internervous plane, allowing access to the hip without routinely detaching the major muscles surrounding the joint.

The long-term goal, however, remains the same as with any successful hip replacement: a stable, pain-free and well-functioning hip.

The posterior approach accesses the hip from the back and side of the joint.

It is a well-established and highly versatile approach that provides excellent exposure of both the femur and acetabulum.

The posterior soft tissues are carefully repaired at the end of the procedure to restore stability around the hip.

Modern surgical techniques, implant positioning and appropriate soft-tissue repair have contributed to excellent outcomes following posterior hip replacement.

Both approaches can provide excellent pain relief, function and long-term results when performed appropriately.

The anterior approach may provide advantages during the early recovery period in selected patients, while the posterior approach remains extremely versatile and is particularly valuable in more complex situations.

Importantly, the surgical approach is only one part of a successful hip replacement.

Accurate implant positioning, restoration of hip biomechanics, appropriate implant selection, careful soft-tissue management and structured rehabilitation are equally important.

The approach is therefore selected according to the individual patient and the requirements of the operation.

Most patients are encouraged to stand and begin walking soon after surgery, often on the day of surgery or the following morning.

Physiotherapy focuses on safe mobilisation, walking, muscle activation and gradually returning to normal activities.

Recovery varies between patients, but there is usually progressive improvement during the first 6–12 weeks, with strength and function continuing to improve for several months.

The timing of returning to driving, work and exercise depends on the individual patient's recovery and the type of activity involved.

In practical terms, a typical hip replacement involves:

The aim of hip replacement is to allow patients to return to a comfortable and active lifestyle.

Once fully recovered, activities such as:

are generally encouraged.

Return to higher-impact activities should be discussed individually.

Modern hip replacements have excellent long-term survival.

Implant longevity depends on several factors, including the patient's age, activity level, implant type, bone quality and the underlying condition of the hip.

Current implants and modern bearing surfaces are designed to provide reliable function for many years, and many hip replacements continue to function well beyond 15–20 years.

The primary aim of total hip replacement is to relieve pain, restore mobility and improve quality of life.

Modern hip replacement is not simply about replacing an arthritic joint. Careful planning aims to restore the patient's hip biomechanics, stability, leg length and function while selecting an appropriate surgical approach and implant for each individual patient.