Open Hip Reconstructive Surgery

Considering open surgery is always quite daunting, however with respect to the hip if you have had open and/or arthroscopic surgery, after three months, both groups will be in exactly the same position in terms of their phase of rehabilitation and recovery.  The problem with open surgery is of course a longer initial stay in hospital, an increased risk of blood loss and with this also other complications associated with bone healing and wound healing.  Obviously the wound is a lot longer than in arthroscopic surgery, and with open hip dislocation procedures and reconstruction these wounds are approximately 15-30cm long.  However, the wounds heal from side-to-side and not end-to-end and I will show you how to look after your wound for the best cosmetic result as we see each other in the follow-up visits.  Open hip surgery also requires the use of one month’s worth of daily medication to prevent deep vein thrombosis in the limbs.  These blood thinners usually take the form of a mini-aspirin.  Again, sutures are underneath the skin and are absorbable.  Dressings include suture strips, skin glue as well as a water-resistant dressing to allow showering while the dressings are on for the first two weeks.  In all surgeries, patients will receive intravenous antibiotics for 24 hours to minimise the risk of infection.  Following this kind of surgery we reinforce movement immediately and again the leg will be placed in a continuous passive motion machine in order to facilitate this.  The only limitation is weight-bearing, therefore, in most cases you will need to use double crutches with 25% wearing bearing on the affected leg for six weeks, following that a further six-week period of at least using a single crutch and only 50% weight-bearing until three months post-surgery.  After that, if all things are well we will be able to get you off your crutches and normalise your walking with the physiotherapists.  Each open hip reconstructive procedure is fairly unique.  There are many pathologies which we may need to address and every patient is different.  This will not only guide your prognosis but also your recovery.  I will be explaining these aspects to you every step of the way.

Important: Both arthroscopic and open hip surgery for the management of causes of hip pain in the younger patient, with the added aim of preserving the natural hip, are highly specialized surgeries. These are not the purview of the ordinary general orthopaedic or joint replacement surgeon. This is surgery that should rather be done by a surgeon who deals with more than just the worn-out hip and who has spent some time with other surgeons who are leaders in this field. With the mounting body of evidence in the literature, there is growing consensus that preservation of the natural hip is paramount especially for those under the age of 50years or the very active individual.

Complex hip reconstructive surgery for congenital deformities (DDH and PERTHES), causing hip pain in a 20yr old. He is now back surfing and hopefully I have delayed his inevitable hip replacements for a few decades