World-first hip surgery proves highly effective

World-first revision hip replacement surgery techniques at the Royal Adelaide Hospital are providing patients with some of the best outcomes in the world by getting patients back on their feet within a day and walking without a persistent limp.

Royal Adelaide Hospital (RAH) Orthopaedic and Trauma Surgeon, Professor Lucian Bogdan Solomon, said the techniques have been in use since 2012 and were developed through research at the RAH and the University of Adelaide.

“Traditionally, up to 80 per cent of patients who had surgery using previous techniques had a persistent limp due to muscle damage, tension or rubbing, or nerve damage,” Professor Solomon said.

“The Extended Posterior Approach (EPA) is used to revise or re-do previous hip replacements where patients have lost significant pelvic bone due to the implant becoming worn out, infected or unstable leading to severe discomfort and movement difficulties.

“The EPA technique involves a slightly longer incision which allows surgeons to identify and protect a vital nerve bundle. This guarantees that important muscles, which are known to be damaged during alternative techniques, remain protected. It also allows customised modification and fitting of the replacement implants to ensure there is optimum contact with the remaining bone.

“In the first 70 patients with severe pelvic defects that we treated using the EPA technique, all patients could bear weight on their hip and begin walking within a day of surgery, while 88 per cent were able to return to full muscle power within three months.”

During the EPA surgery, the team attach markers to the bone surrounding the implant so special X-rays can be performed during subsequent hospital visits to monitor precisely how well-fixed the customised implant remains over time.

RAH Orthopaedic Senior Medical Scientist, Dr Stuart Callary, said the RAH is one of the only centres in the world to use radiostereometric analysis (RSA) to monitor implant stability.

“These complex cases mean it is difficult to achieve stability of the implant due to limited bone for the attachment, which in the past has caused many implants to become loose and require additional surgery,” Dr Callary said.

“By using accurate RSA measurements, we have been able to identify an improvement in the success rates of revision surgery with loosening rates decreasing from 17 per cent to zero per cent.

“These results are very exciting and prove patients undergoing complex hip surgery at the RAH are currently having some of the best outcomes in the world.”