(08) 7099 0188 FAX: (08) 7099 0171 contact@orthopaedics360.com.au


Join Dr Liew in answering your questions. Post a comment on the Facebook Post specific for HIPS and Dr Liew will read, and answer most questions on here. The current segment is focussing on Hip Arthritis and Hip Replacement Surgery. Please note that sensitive medical information will not be disclosed on this page. This area will be used for general questions that can be used to help others that may have the same questions as you.

How To Ask a Question

Just click the link above, and you will be brought to the relevant Facebook post. This will be related to the appropriate body part. Ask you question, and you will receive a notification on our Facebook page that your answer has been added to the Ask the Surgeon answers below.

Do genetics play a huge part in osteoporosis?

Does genetics play a huge part in osteoporosis? My husband has it, his mother had it too. In the last few yrs our son 18yrssnapped through both bones in his leg- compound fracture, our daughter 14yrs broke both bones in arm in 4 places and has on two occasions damaged her SUB-talar joint in her ankle. I’m wondering is it worth them both getting bone densitometry testing done.

Thankyou for your enquiry. I can give you some general information on this, but osteoporosis management is often in the department of an endocrinologist.

Osteoporosis is different to osteoarthritis. Osteoarthritis mean “Osteo” (Bone), “Arth” (Joint), “Itis” (Inflammation). Osteoporosis means Porous Bone. In essence, one is a disease of the joint (resulting in someone needing a total hip replacement or total knee replacement, whilst the other affects the entire body.

Osteoporosis is generally an ageing process of the bone, which abnormally causes the bone to become weak and susceptible to fractures. It sounds like many of your family have had fractures, and whilst osteoporosis has a large genetic component, there are other diseases that can be important too, especially when young people are involved.

There is a spectrum of diseases, that affect the bone in young people. This can be due to genetic abnormalities in collagen formation. This group of diseases can be something like Osteogenesis Imperfecta. This affects children as well as adults, and can be the cause of multiple broken bones from a young age. If there is a family history of fractures from low energy injuries, then it is possible that your family has one of these. To get tested, you would need a referral from your GP to see a geneticist as DNA testing can confirm the diagnosis if it is one of the known types.

Bone density scans are usually performed on elderly people, rather than young children. I would suggest that it is not necessary to get a bone density test on your children, but rather get an overall picture of what else might be the cause first. I hope this answers your question.

A lot of hip pain and when i cross my leg there is a sharp pain the goes into my hip

When I walk for a while my hip gets quite sore also i fing that if I cross my leg to change my shoes it is quite painful and I get a sharp pain in the hip…I have a lot of hip pain and when I cross my leg there is a sharp pain the goes into my hip

Thankyou for leaving your message. Hip pain often gets worse in certain positions. The most common symptoms is groin pain, and the positions that would normally cause most concern are anything where you are flexing your hip and rotating at the same time. This often occurs when you are crossing your legs, or trying to reach your shoes and socks.

Hip pain from osteoarthritis often radiates from the groin, down into the thigh, and commonly into the knee. Depending on where in the hip the worst part is, can affect the sensation of pain that you are experiencing. Buttock pain or pain on the side of the thigh are also possible.

It certainly sounds like you are getting hip pain related to osteoarthritis. The next step is to start some non operative management. Click here to read more about hip osteoarthritis.

I hope this helps your situation.

How long does a hip replacement last

How long does a hip replacement last

Great question and one that we answer all the time. The general consensus in the community is that all joint replacements will fail at some point – which is true in a way, but in real life, does not generally get tested. In some circumstances, the lab studies show that prosthesis wear patterns would outlive us all, by a long way!

When we look at Australian data using the Australia National Joint Registry, we can see that the survivability of a joint replacement, when using a “revision” operation as the marker for a failure, shows that there is about an 8% revision rate for hips at the 15 year mark (The registry has only been running for 15 years). This is when the hip replacement is performed for osteoarthritis. When we look at data from around the world that has more data, this varies, but in general terms, a joint replacement has a revision rate of about 20% at the 20-25 year mark.

Philosophically, I chose to use ceramic on ceramic articulations. They are suggested to be slightly harder to place during surgery, however under the electron microscope, are one of the smoothest surfaces that we can use for a total hip replacement. My goal is to provide the longest lasting hip replacement – and hopefully, never having to re-operate on a hip.

What does this general data mean? It means that 92% of total hip replacements are concluded to be still performing well, or are surviving, at LEAST 15 years. The statistics are quite good, when you consider all the reasons for revision.

Hips and knees do have similar profiles, and in the past, I wrote a more detailed summary on knee replacements which can be found HERE.

I hope this answers your query.

How soon after a full hip replacement could I expect to be able to resume Windsurfing/ kitesurfing?

How soon after a full hip replacement could I expect to be able to resume Windsurfing/ kitesurfing?

Thanks for a great question. As a beginner kite surfer myself, I can certainly relate to the rigours and pressures of the sport, from the beginnings to what I can see the advanced people perform. It is a fantastic sport and like most sports, injuries generally happen when you’re first learning, and when you’re pushing the envelope at the other end.

From a hip replacement perspective, in general terms, impact activities and any activities that may abnormally twist your leg around without being completely controlled by you, is a risk. From a personal perspective, with the direct anterior approach, we have found this to be an extremely stable type of hip replacement, one that I have not personally worried as much about dislocations for.

In kite surfing (or kite boarding), the risks are different. In the surf, if you were to have a leg rope attached to your board, and you were thrown from a wave (dumped), you may find that your leg is more at risk of dislocating, as the leg rope may pull your leg in various directions. This is if your hip replacement is on your back leg.

When we have patients who want to perform more extreme activities, or who we feel are at more risk of potentially dislocating their hips, then a modification to the standard prosthesis can be used. This is called the dual mobility hip replacement. This, in addition to the anterior approach is probably one of the most stable types of hip replacements that can be inserted.

Other risks from a kite surfing on a hip replacement is infection to the wound, if you get the wound wet and dirty too early.

When a total hip replacement is performed using the direct anterior approach, no muscles are cut or detached, however the muscles are still slightly de-functioned due to the swelling from the operation. This results in your muscles not being able to act in the normal way when performing activities. This is generally gone by 6 weeks post op.

The hip replacement that I place in 99% of my patients is one where the bone grows into the implant over time. This usually has substantially occurred by 6-8 weeks post operatively.

A lot of information above, however they go someway to highlighting the risks, and advising you that the earliest time that I would be comfortable for a patient of mine to return to kite boarding would be 8 weeks post op, but preferably, once you are given the all clear from a Physio who has had time to assess your muscle function.

I hope this answers your question.

I’m sure that my surgeon is being very conservative and is using a posterior approach. Can the dual mobility replacement be used in conjunction with this?

The posterior approach is a good approach, and one that all orthopaedic surgeons are trained in, as is the lateral approach. I have personally settled on the direct anterior approach for all my total hip replacements. The posterior approach is not a conservative approach, it is just an alternative. Your surgeon will have good reasons for using this as opposed to the anterior approach.

The reasons why I have chosen the direct anterior approach are that it does not require detachment of muscles or tendons, and that there are minimal post operative movement restrictions due to the lower rate of dislocation. In addition, I use intra-operative X-rays to ensure that the final prosthesis is situated correctly which is unique to this approach. I found these to be major factors in my own decision to use the direct anterior approach.

The dual mobility system is an implant choice, that can be used via any approach, and is a fantastic method for those at higher risk of dislocation.

I hope this helps to answer your question further.

X-rays showing Bone on Bone in both hips. Back pain and right buttock pain.

“I have had an Xray for another reason and the specialist said I had bone on bone in both hips. No one else has advised this previously. I get terrible pain in my upper and lower back and down my right buttock. Keep putting wheat bag on the areas. Could this all be related to the bone on bone in the hips?”

Thankyou for your question. I took “extra” as meaning “Xray”. If the X-rays show bone on bone, then this may well be the cause of your buttock pain. The most common places to feel pain in when you have hip osteoarthritis is in your groin, thigh, knee, and buttock. Sometimes, the diagnosis can be mixed in with other things, such as back pain. I am guessing that you had some X-rays of your spine and pelvis for your lower back pain.

Bone on bone means that there is no protective cartilage left in your hip, which usually results in pain due to osteoarthritis. When there is no cartilage left, your joint will release inflammatory cells into your joint, causing swelling and pain. There may be severe limitations in your range of movement, and usually, you may have noticed difficulties reaching your toes, or tying your shoes and socks, as well as difficulties getting in and out of a car.

Hip osteoarthritis can contribute to back pain, and may cause you to feel your back pain more – this is due to the stiffness in your hip, causing your pelvis to tilt, and putting more pressure on your back. Whilst there are no guarantees that replacing your hip will reduce your back pain, it is a common finding for our patients.

When deciding on whether or not to talk to someone about having a hip replacement, it is a good start to try a few things first. Read our non operative measures guide in this post, or speak to your GP. If you are not sure about your diagnosis, then have a talk to your specialist again, or your GP who can go through everything further with you.

If you have gone through these steps, are are contemplating a total hip replacement, do a little bit of research about the method that your surgeon uses, and what you feel would be the most beneficial for you. Our methods are summarised here.

I hope this helps to answer your question.

Cycling after a hip replacement - What are the risks

How safe is cycling after a hip replacement. Is there more risk if we fall off ? Not that I am planning the Olympics or falling off but I am wondering about ebikes where the speed might be more to 20kms…

This is a great question. Cycling is a fantastic exercise, as it is low impact, and great for your cardiovascular system. I noticed that you are talking about ebikes, which can be quite fast at times. Some of them can really add to your own efforts and propel you as fast as a scooter or motorbike. With this in mind, here are some general concepts:

  • A total hip replacement performed via the direct anterior approach is extremely stable, and therefore, there are no restrictions for you when leaning forwards on a bicycle. This enables you to ride a road bicycle without any major difficulties.
  • When falling from any kind of vehicle traveling at speed, there is a risk of fracturing your bone. Any force that would fracture your bone usually, would almost certainly break the bone around your hip replacement. When this occurs, the pattern of fracture can require more specialised equipment to treat, rather than breaking your bone through the normal “weak points” of the bone. If you fall and break around your prosthesis, then you might need the entire hip replacement to be replaced, along with plates, screws and wires.
  • I would recommend making sure that you are very steady with your walking, and starting off with trying a stationary bike first. Commonly people find that they fall when getting on and off their bikes, so try that first in a safe environment before getting out on the road.
  • Cycling is a great sport, and there is no reason why you can’t enjoy it after your total hip replacement.

I hope this answers your question.

Disclaimer: Please note that this is general advice only - for more information, please consult your regular doctor, or obtain a referral to see a specialist orthopaedic surgeon. 

Orthopaedics 360

Orthopaedics 360

P: (08) 7099 0188

F: (08) 7099 0171

Southern Specialist Centre

Orthopaedics 360

P: (08) 7099 0188

F: (08) 7099 0171

Health @ Hindmarsh

Orthopaedics 360

P: (08) 7099 0188

F: (08) 7099 0171

Share This