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1. Preparation

WHAT IS A TOTAL HIP REPLACEMENT?

The hip is a ball and socket joint. The ball is formed by the head of the femur (thigh bone) and fits snugly into the cup shaped bone in the pelvis called the acetabulum. The bones are covered with cartilage that act as a cushion between the two bones and allows movement.

Total Hip Replacement is surgery to replace both the damaged femoral head and the hip socket with a prosthetic device. This restores smooth movement of the hip.

hip-replacement.gif

WHY IS IT DONE?

The natural bones of the hip joint are lined with surface cartilage and are surrounded by a thin layer of cells called synovial cells. The synovial cells produce a layer of lubrication film and, together with the cartilage, act as a shock absorber that allows the joint to move smoothly and last for many years.

The biggest problem with hips is arthritis. Pain, stiffness and swelling are the main symptoms.

  • Osteoarthritis - Is the result of mechanical wear and tear on the joint. This condition can also be the result of an injury to the hip cartilage even though the injury may have happened years ago.
  • Rheumatoid arthritis – Stems from a problem with the immune system and affects not only the joints of the hips but also the hands, feet and knees. Damage to the cartilage is caused by an over-production of synovial fluid.

Both types of arthritis result in hip cartilage being worn away over time. Bone grinding on bone causes pain and the body tries to reduce the pain by increasing the amount of fluid in the joint. The increase in fluid causes swelling.

The purpose of a Total Hip Replacement is to relieve pain and improve movement.

Another issue affecting hips is Osteoporosis (whereby bones become brittle and fragile), which particularly affects the elderly and post-menopausal women. The diagnosis is often made on presentation of a fracture (break) in the neck of the femur, requiring a total hip replacement. A healthy diet (including calcium and Vitamin D), weight resistant exercise, healthy lifestyle (non smoking & limited alcohol) & oestrogen help maintain healthy bones and thereby reduces the risk of fractures.

HOW DO I CHOOSE A SPECIALIST?

You may be happy to accept the advice of your GP with regard to an orthopaedic surgeon, or you may like to investigate your choices: either option is safe and valid. In Australia each medical speciality has a governing body to which the consultants belong. These organisations are often a good reference for information about what to expect from your medical specialist. You can access the Australian Orthopaedic Association via their website at www.aoa.org.au. The site provides an overview of orthopaedic services, and will allow you to search for surgeons in your area.

To access a list of Orthopaedic Specialists who participate in HCF’s Medicover no gap arrangement:

  • Call HCF Member Services on 13 13 34
  • Visit one of HCF’s customer service branches
  • Access HCF’s website at www.hcf.com.au / members / find a health professional / find a doctor

Please note: Participation in HCF’s no gap initiatives is at the doctor’s discretion. HCF does not guarantee that every medical service provided by these doctors will be a no gap service. Some doctors who participate in the HCF Medicover No Gap arrangement have chosen not to be listed on the HCF website. Patients are encouraged to confirm with their doctor whether they will support HCF’s no gap initiatives for their treatment.

Some other useful sites you can visit to help prepare you for surgery and guide you through your recovery phase are:
www.ori.org.au
www.zimmer.com.au

WHAT SHOULD I ASK MY SPECIALIST?

  • Make sure you fully understand the procedure that is planned; do not be afraid to ask questions. It is your right to know all the relevant information and associated costs, as this is part of informed clinical and financial consent.
  • Your doctor will ask you to sign a consent form. Do this once you have a satisfactory understanding of the procedure.
  • Apart from what the procedure involves, there are many lifestyle questions you need to ask about:
    • Discuss your lifestyle so the surgeon can select appropriate prosthesis as there are some variations in the types of prostheses
    • What you can expect from an artificial joint and the limitations (when can you drive, how far can you walk, when can you resume sports, sexual activities etc)
    • Take a family member or friend with you to the consultation so they can record instructions as it is hard to remember everything when you are anxious (quite normal when discussing surgery)
    • For male patients it is important to let your surgeon know if you have any trouble passing urine or hesitancy or poor flow as you may have an enlarged prostate and these symptoms can be exacerbated whilst on bed rest.
    • Discuss donating your own blood several weeks pre operatively to be re transfused post surgery
    • Let doctor know if you have any skin lesions, sores, cuts, or a raised temperature as you will need to have these treated before surgery.
    • Follow up appointments – (before your initial appointment or between appointments, jot down any questions or concerns you may have so you won’t forget to ask them)
  • Most medication should be continued as usual, but some may interfere with the surgery. Your doctor will inform you of the medication you should stop. As a guide, the following medication may require special instruction:
    • Aspirin (or any related products),
    • Blood thinners (Warfarin, heparin.),
    • Arthritis medication,
    • Pain medication,
    • Insulin.

Always remember to tell your doctor what medication you are taking and don’t forget to include any herbal remedies or alternative medicines as these too may have interactions and side effects.

WHERE IS IT DONE?

A Total Hip Replacement is done in a hospital and average length of stay is 8 days.

HOW LONG IS THE PROCEDURE?

Surgery time for a Total Hip Replacement is approximately 1.5 to 2 hours.

WHO IS INVOLVED?

  • The Orthopaedic surgeon, your Specialist doctor
  • Anaesthetist: they give you medication that make you relaxed and sleepy and look after you whilst the procedure is being carried out
  • Assistant surgeon
  • Nurses will care for you during your hospital admission
  • Radiologist for x-rays
  • Pathologist for blood tests
  • Physiotherapist for mobilisation and exercises

HOW DO I PREPARE FOR A TOTAL HIP REPLACEMENT?

To optimise your procedure and recovery phase there are some activities you can do in the weeks leading up to your surgery:

  • Exercises: deep breathing and coughing (especially if a smoker), foot, ankle and knee strengthening. Discuss these with a physiotherapist as it is important to also perform these after surgery
  • If you are a smoker and you cannot give up completely, try not to smoke in the weeks leading up to your operation, to reduce the risk of post-operative complications such as chest infections
  • Making your home safe: remove long cords that you could trip on, if you have rugs on the floor, roll these up
  • Place a non slip mat in the shower and organise a high shower chair
  • Rent or buy a long handled grabber for picking up things whilst you can’t bend or squat
  • Organise a cleaner or family for a couple of weeks (no sweeping, mopping, vacuuming for several weeks)
  • Place commonly used items within arms reach, especially if limited home support.
  • Prepare some meals and freeze them for days you are too tired to prepare a meal
  • Check out grocery stores and chemists in your local area who will home deliver
  • If you live alone arrange an alert signal with your neighbour / family in case of emergency (eg. they should check on you if your blind is not up by 9am)

Your doctor will probably ask you to cease taking any aspirin and anti-inflammatory medication ten days prior to surgery to ensure they are out of your bloodstream, allowing bleeding and clotting times to return to normal.

Any infections should be treated and cleared up prior to surgery as infectious organisms anywhere in the body, including on the skin, can travel through the blood stream to the joint replacement and cause problems. You shall be notified of your fasting times prior to theatre. If surgery is scheduled for the morning, fast from 12 midnight otherwise if surgery scheduled for the afternoon you are expected to fast 6 hours prior to admission time.

Your affected leg and hip will be shaved or clipped whilst in hospital and you will be given an antiseptic soap to use prior to surgery.

Your doctor will have his/her own specific preparation requirements. These instructions should be strictly followed.

WHAT DO I TAKE WITH ME TO THE HOSPITAL?

  • Any recent, relevant x-rays or scans
  • Do not bring any valuables with you
  • Leave all jewellery at home (wedding ring acceptable)
  • Bring only enough money for items such as newspapers and magazines
  • Slippers or flat rubber soled shoes for walking in the hallways
  • Loose fitting clothing for the trip home
  • Make sure that you bring any medication that you would usually take during the day, under some circumstances you may still be able to take these
  • Personal grooming items such as hairbrush, comb, toothbrush, deodorant etc.
  • Undergarments and a robe

2. Costs and Charges

WHAT IS IT GOING TO COST?

Ask your doctor whether he will participate in HCF’s no gap arrangement for your surgery so that you do not incur any out of pocket expense. If your doctor does not wish to participate, it is your doctor’s responsibility to fully inform you of your financial liability and any out of pocket expense prior to you consenting to the surgery.

For your information, the average charges for claims paid for Total Hip Replacement admissions for the financial year 12/13 are provided below:

On Average

Charge Medicare Pays HCF Pays 3 If your doctor DOES NOT use HCF’s No Gap Arrangement YOU PAY % of all admissions where your doctor DOES NOT use HCF’s No Gap Arrangement 4 If your doctor USES HCF’s No Gap Arrangement YOU PAY % of all admissions where your doctor USES HCF’s No Gap Arrangement
Total Average Hospital Component (accommodation, theatre and hospital related services) $22,854 $0 $22,576
1 Medical Services Component
Anaesthetic Services $1,284 $439 $372 $937 50.4% $0 49.6%
Assistant in Operations Services $481 $201 $127 $411 37.0% $0 63.0%
Orthopaedic Surgical Services $3,059 $999 $1,022 $2,310 44.9% $0 55.1%
Pathology Services $275 $129 $136 $159 5.5% $0 94.5%
Specialist Consultation $624 $368 $248 $86 8.5% $0 91.5%
Radiology Services $278 $145 $76 $134 41.0% $0 59.0%
2 Total Average Medical Services $5,336 $1,977 $1,755 $2,351 68.1% $0 31.9%
Hospital and Medical Services Average for Total Hip Replacement Admissions $28,190 $1,977 $24,331 $2,351 68.1% $0 5 31.9%

Total Hip Replacement Procedure_13.gif

Points to Note:

  • Charges are based on HCF claims for a sample size of 1,496 overnight admissions with an average length of stay of 7.6 days in private participating hospitals (private hospitals that have an agreement with HCF for accommodation, theatre and hospital related services) – covered under Medicare item 49318.
  • As a private patient in a non-participating hospital you may incur an out of pocket expense for the hospital component (accommodation, theatre and hospital related services).
  • These charges are for comprehensive product only. Check the level of your benefit under your hospital product.

1 These medical services are in-patient services only.


2 The medical charges are based on averages and each episode of care is different, i.e.

you may not have all of these medical services, and/or you may also have other medical

services not indicated here e.g. diagnostic procedures. Therefore, the total average

medical service charge ($5,336) differs from the sum of the individual average charges

as shown.


3 Doctors who do not use the HCF no-gap arrangement have a higher average out of

pocket charge, as their charges are higher than those doctors who use the no-gap

arrangement and incur nil out of pocket charges to the patient. Therefore, the sum of the

average benefits plus the average out of pocket charge you pay will not equate to the

charge as shown in the table.


4 Doctors’ charges vary so always ask your doctor whether he/she will participate in

HCF’s No Gap Arrangements.


HCF Medicover Schedule of Benefits lists all services for extra benefit in excess of the

Commonwealth Medicare Benefits Schedule (CMBS) fee, which providers, registered

under the HCF Medicover No Gap arrangement will receive as full payment for

services provided. This also applies to unregistered providers should they charge within

the schedule of benefit listed. This arrangement ensures that our members incur no out of

pocket expense.


5 This percentage indicates the total coverage of hospital and medical services for all total

hip replacement admissions. The percentages shown for each type of medical service

are much higher as they are calculated for those services only and not the entire

admission, which includes all medical services and the hospital services. In an admission

you may have one medical service with an out of pocket expense, which then excludes

the whole admission from being fully covered. Hence the significant difference in

percentage for individual types of medical services as compared to the total admission

fully covered.

For your information, the average charges for claims paid for Total Hip Replacement Rehabilitation admissions for the financial year 12/13 are provided below:

On Average

Charge Medicare Pays HCF Pays 3 If your doctor DOES NOT use HCF’s No Gap Arrangement YOU PAY % of all admissions where your doctor DOES NOT use HCF’s No Gap Arrangement 4 If your doctor USES HCF’s No Gap Arrangement YOU PAY % of all admissions where your doctor USES HCF’s No Gap Arrangement
Total Average Hospital Component (accommodation, theatre and hospital related services) $8,141 $0 $8,091
1 Medical Services Component
Pathology Services $194 $87 $106 $22 0.6% $0 99.4%
Specialist Consultation $741 $442 $299 $0 0.0% $0 100.0%
2 Total Average Medical Services $864 $495 $368 $22 0.4% $0 99.6%
Hospital and Medical Services Average for Total Hip Replacement Rehabilitation Admissions $9,005 $495 $8,459 $22 0.4% $0 5 99.6%

Total Hip Replacement Rehab_13.gif

Points to Note:

  • Charges are based on HCF claims for a sample size of 244 overnight admissions with an average length of stay of 12 days in private participating hospitals (private hospitals that have an agreement with HCF for accommodation and hospital related services).
  • As a private patient in a non-participating hospital you may incur an out of pocket expense for the hospital component (accommodation and hospital related services).
  • These charges are for comprehensive product only. Check the level of your benefit under your hospital product.

1 These medical services are in-patient services only.


2 The medical charges are based on averages and each episode of care is different, i.e.

you may not have all of these medical services, and/or you may also have other medical

services not indicated here e.g. diagnostic procedures. Therefore, the total average

medical service charge ($864) differs from the sum of the individual average charges as

shown.


3 Doctors who do not use the HCF no-gap arrangement have a higher average out of

pocket charge, as their charges are higher than those doctors who use the no-gap

arrangement and incur nil out of pocket charges to the patient. Therefore, the sum of the

average benefits plus the average out of pocket charge you pay will not equate to the

charge as shown in the table.


4 Doctors’ charges vary so always ask your doctor whether he/she will participate in

HCF’s No Gap Arrangements.


HCF Medicover Schedule of Benefits lists all services for extra benefit in excess of the

Commonwealth Medicare Benefits Schedule (CMBS) fee, which providers, registered

under the HCF Medicover No Gap arrangement will receive as full payment for

services provided. This also applies to unregistered providers should they charge within

the schedule of benefit listed. This arrangement ensures that our members incur no out of

pocket expense.


5 This percentage indicates the total coverage of hospital and medical services for all total

hip replacement rehabilitation admissions. The percentages shown for each type of

medical service are much higher as they are calculated for those services only and not

the entire admission, which includes all medical services and the hospital services. In an

admission you may have one medical service with an out of pocket expense, which then

excludes the whole admission from being fully covered. Hence the significant difference

in percentage for individual types of medical services as compared to the total admission

fully covered.

2. Day of procedure

WHAT HAPPENS TO ME AT THE HOSPITAL?

When you arrive at the hospital, the receptionist will do all the associated paperwork for your admission to hospital.

On arrival to the ward a nurse will orientate you, ask your medical and surgical history, list your medication and ask about any known allergies.

The Anaesthetist will visit you. He /she may order you a pre-med (something to relax you prior to transfer to theatre) discuss your anaesthetic options as below and also your pain management options for the post-operative period.

There are two types of anaesthetic that may be used:

  • General – You are asleep throughout the procedure
  • Epidural – Numbing from the waist down, however you will be awake throughout the procedure

An intravenous line will be put into the back of your hand so that you can be given fluids and antibiotics for prevention of infection. A small injection, usually in the abdomen is given to thin the blood and prevent clots forming. This will be done approximately half an hour prior to surgery.

WHAT CAN I EXPECT DURING THE PROCEDURE?

Once in theatre, anaesthetic will be administered. You will be covered in sterile drapes so that only the leg to be operated on is showing. The entire hip area will be swabbed with an antiseptic solution.

A majority of hip surgery is done with the patient lying on their side, so once you are asleep you may be positioned in a special brace that stabilises your pelvis and keeps you on your side throughout the operation.

An incision will be made above the hip joint. The ball at the end of femur is removed with a specialised bone saw to prepare it for the femoral component. The component looks like a highly polished ball on the end of a long stem. A hole is drilled in the centre of the femur and the stem is inserted. In some cases but not all, the femoral component may be cemented into place using special, fast drying, bone cement.

The hip socket is re-shaped and the damaged cartilage removed with a special tool at the end of a drill. The acetabular (cup) component is put in place.

Once the new ball and socket are in place, the joint capsule that produces the synovial fluid that lubricates the new joint is closed. As the different muscle layers are sewn together, a drainage tube made of perforated plastic is laid between them. Drainage of the wound helps the healing process and also assists in preventing infection.

The wound is then closed and dressings are applied.

3. Aftercare

WHAT HAPPENS AFTER THE PROCEDURE?

Following the surgery, you will be taken to recovery where you will be closely monitored by nursing staff. Your vital signs and pain management will be checked on a continual basis until you are fully conscious.

Once you return to the ward,

  • you will be lying on your back with your affected leg abducted (extended outwards) to prevent dislocation. You often have a pillow placed between your legs to prevent your leg rolling in
  • pain management may include a PCA (Patient Controlled Analgesia), which is a machine that allows you to deliver a dose of painkiller as required. The anaesthetist sets the dose and the lock out period so you cannot overdose yourself . Other pain relief options include an epidural or regular pain relief administered by nursing staff (not common option)
  • you will be wearing TED stockings to prevent clots forming
  • you will have a tube into your bladder to drain your urine
  • a tube coming from your wound to drain away excess fluid
  • the line in your hand will be connected to IV fluids
  • the wound will be covered with a dressing, which will be replaced on a regular basis

The intravenous fluids, urinary catheter, wound drain and PCA are usually removed over the next 24 – 48 hours.

It is important to start moving around as soon as possible because it not only helps to prevent clotting but also helps to increase flexibility and decrease any muscle loss in the new hip. You will begin by being asked to wiggle your toes shortly after the surgery and a physiotherapist will visit you to show you a variety of hip exercises. You should be up using a walking frame 2 days after the surgery and will graduate to crutches and then a walking stick after a few days.

You will be in hospital for 7-10 days and will be ready for discharge when you can walk about 30 metres, get in and out of bed on your own, access the toilet and shower successfully and get up and down stairs.

It takes about 3 months to recover from a Total Hip Replacement and during this time you will be advised to avoid the following:

  • Driving a vehicle
  • Bending your hip past 90 degrees
  • Bending down to pick something up from the floor
  • Crossing your legs either at the knees or ankles
  • Using pillows between your legs when lying on your back
  • Lying on your operated hip

Contact your doctor if you experience any of the following symptoms:

  • Redness, swelling or warmth around the wound
  • Leakage from the wound
  • Severe hip pain that cannot be eased with medication
  • Sudden sharp pain, clicking or popping sound in the hip joint
  • Loss of control over leg movement

Having an artificial joint in your body makes you susceptible to infection in the future. Ensure you always tell other doctors or dentists, as you may need to have preventative antibiotics if having other procedures attended in the future.

WILL I NEED REHABILITATION ?

Sometimes your Specialist may refer you to a Rehabilitation Unit for improved mobilisation and increased independence in self - care. This may occur as an inpatient. The average length of stay is 12 days for an inpatient. Rehabilitation involves care under a specialised team including a Rehabilitation Specialist, Rehabilitation Nurse, Physiotherapist and Occupational Therapist. This team works together to ensure you reach your goal with mobilisation and independence, enabling you to return to your normal activities of daily living.

1. Preparation

WHAT IS A TOTAL HIP REPLACEMENT?

The hip is a ball and socket joint. The ball is formed by the head of the femur (thigh bone) and fits snugly into the cup shaped bone in the pelvis called the acetabulum. The bones are covered with cartilage that act as a cushion between the two bones and allows movement.

Total Hip Replacement is surgery to replace both the damaged femoral head and the hip socket with a prosthetic device. This restores smooth movement of the hip.

hip-replacement.gif

WHY IS IT DONE?

The natural bones of the hip joint are lined with surface cartilage and are surrounded by a thin layer of cells called synovial cells. The synovial cells produce a layer of lubrication film and, together with the cartilage, act as a shock absorber that allows the joint to move smoothly and last for many years.

The biggest problem with hips is arthritis. Pain, stiffness and swelling are the main symptoms.

  • Osteoarthritis - Is the result of mechanical wear and tear on the joint. This condition can also be the result of an injury to the hip cartilage even though the injury may have happened years ago.
  • Rheumatoid arthritis – Stems from a problem with the immune system and affects not only the joints of the hips but also the hands, feet and knees. Damage to the cartilage is caused by an over-production of synovial fluid.

Both types of arthritis result in hip cartilage being worn away over time. Bone grinding on bone causes pain and the body tries to reduce the pain by increasing the amount of fluid in the joint. The increase in fluid causes swelling.

The purpose of a Total Hip Replacement is to relieve pain and improve movement.

Another issue affecting hips is Osteoporosis (whereby bones become brittle and fragile), which particularly affects the elderly and post-menopausal women. The diagnosis is often made on presentation of a fracture (break) in the neck of the femur, requiring a total hip replacement. A healthy diet (including calcium and Vitamin D), weight resistant exercise, healthy lifestyle (non smoking & limited alcohol) & oestrogen help maintain healthy bones and thereby reduces the risk of fractures.

HOW DO I CHOOSE A SPECIALIST?

You may be happy to accept the advice of your GP with regard to an orthopaedic surgeon, or you may like to investigate your choices: either option is safe and valid. In Australia each medical speciality has a governing body to which the consultants belong. These organisations are often a good reference for information about what to expect from your medical specialist. You can access the Australian Orthopaedic Association via their website at www.aoa.org.au. The site provides an overview of orthopaedic services, and will allow you to search for surgeons in your area.

To access a list of Orthopaedic Specialists who participate in HCF’s Medicover no gap arrangement:

  • Call HCF Member Services on 13 13 34
  • Visit one of HCF’s customer service branches
  • Access HCF’s website at www.hcf.com.au / members / find a health professional / find a doctor

Please note: Participation in HCF’s no gap initiatives is at the doctor’s discretion. HCF does not guarantee that every medical service provided by these doctors will be a no gap service. Some doctors who participate in the HCF Medicover No Gap arrangement have chosen not to be listed on the HCF website. Patients are encouraged to confirm with their doctor whether they will support HCF’s no gap initiatives for their treatment.

Some other useful sites you can visit to help prepare you for surgery and guide you through your recovery phase are:
www.ori.org.au
www.zimmer.com.au

WHAT SHOULD I ASK MY SPECIALIST?

  • Make sure you fully understand the procedure that is planned; do not be afraid to ask questions. It is your right to know all the relevant information and associated costs, as this is part of informed clinical and financial consent.
  • Your doctor will ask you to sign a consent form. Do this once you have a satisfactory understanding of the procedure.
  • Apart from what the procedure involves, there are many lifestyle questions you need to ask about:
    • Discuss your lifestyle so the surgeon can select appropriate prosthesis as there are some variations in the types of prostheses
    • What you can expect from an artificial joint and the limitations (when can you drive, how far can you walk, when can you resume sports, sexual activities etc)
    • Take a family member or friend with you to the consultation so they can record instructions as it is hard to remember everything when you are anxious (quite normal when discussing surgery)
    • For male patients it is important to let your surgeon know if you have any trouble passing urine or hesitancy or poor flow as you may have an enlarged prostate and these symptoms can be exacerbated whilst on bed rest.
    • Discuss donating your own blood several weeks pre operatively to be re transfused post surgery
    • Let doctor know if you have any skin lesions, sores, cuts, or a raised temperature as you will need to have these treated before surgery.
    • Follow up appointments – (before your initial appointment or between appointments, jot down any questions or concerns you may have so you won’t forget to ask them)
  • Most medication should be continued as usual, but some may interfere with the surgery. Your doctor will inform you of the medication you should stop. As a guide, the following medication may require special instruction:
    • Aspirin (or any related products),
    • Blood thinners (Warfarin, heparin.),
    • Arthritis medication,
    • Pain medication,
    • Insulin.

Always remember to tell your doctor what medication you are taking and don’t forget to include any herbal remedies or alternative medicines as these too may have interactions and side effects.

WHERE IS IT DONE?

A Total Hip Replacement is done in a hospital and average length of stay is 8 days.

HOW LONG IS THE PROCEDURE?

Surgery time for a Total Hip Replacement is approximately 1.5 to 2 hours.

WHO IS INVOLVED?

  • The Orthopaedic surgeon, your Specialist doctor
  • Anaesthetist: they give you medication that make you relaxed and sleepy and look after you whilst the procedure is being carried out
  • Assistant surgeon
  • Nurses will care for you during your hospital admission
  • Radiologist for x-rays
  • Pathologist for blood tests
  • Physiotherapist for mobilisation and exercises

2. Costs and Charges

WHAT IS IT GOING TO COST?

Ask your doctor whether he will participate in HCF’s no gap arrangement for your surgery so that you do not incur any out of pocket expense. If your doctor does not wish to participate, it is your doctor’s responsibility to fully inform you of your financial liability and any out of pocket expense prior to you consenting to the surgery.

For your information, the average charges for claims paid for Total Hip Replacement admissions for the financial year 12/13 are provided below:

On Average

Charge Medicare Pays HCF Pays 3 If your doctor DOES NOT use HCF’s No Gap Arrangement YOU PAY % of all admissions where your doctor DOES NOT use HCF’s No Gap Arrangement 4 If your doctor USES HCF’s No Gap Arrangement YOU PAY % of all admissions where your doctor USES HCF’s No Gap Arrangement
Total Average Hospital Component (accommodation, theatre and hospital related services) $22,854 $0 $22,576
1 Medical Services Component
Anaesthetic Services $1,284 $439 $372 $937 50.4% $0 49.6%
Assistant in Operations Services $481 $201 $127 $411 37.0% $0 63.0%
Orthopaedic Surgical Services $3,059 $999 $1,022 $2,310 44.9% $0 55.1%
Pathology Services $275 $129 $136 $159 5.5% $0 94.5%
Specialist Consultation $624 $368 $248 $86 8.5% $0 91.5%
Radiology Services $278 $145 $76 $134 41.0% $0 59.0%
2 Total Average Medical Services $5,336 $1,977 $1,755 $2,351 68.1% $0 31.9%
Hospital and Medical Services Average for Total Hip Replacement Admissions $28,190 $1,977 $24,331 $2,351 68.1% $0 5 31.9%

Total Hip Replacement Procedure_13.gif

Points to Note:

  • Charges are based on HCF claims for a sample size of 1,496 overnight admissions with an average length of stay of 7.6 days in private participating hospitals (private hospitals that have an agreement with HCF for accommodation, theatre and hospital related services) – covered under Medicare item 49318.
  • As a private patient in a non-participating hospital you may incur an out of pocket expense for the hospital component (accommodation, theatre and hospital related services).
  • These charges are for comprehensive product only. Check the level of your benefit under your hospital product.

1 These medical services are in-patient services only.


2 The medical charges are based on averages and each episode of care is different, i.e.

you may not have all of these medical services, and/or you may also have other medical

services not indicated here e.g. diagnostic procedures. Therefore, the total average

medical service charge ($5,336) differs from the sum of the individual average charges

as shown.


3 Doctors who do not use the HCF no-gap arrangement have a higher average out of

pocket charge, as their charges are higher than those doctors who use the no-gap

arrangement and incur nil out of pocket charges to the patient. Therefore, the sum of the

average benefits plus the average out of pocket charge you pay will not equate to the

charge as shown in the table.


4 Doctors’ charges vary so always ask your doctor whether he/she will participate in

HCF’s No Gap Arrangements.


HCF Medicover Schedule of Benefits lists all services for extra benefit in excess of the

Commonwealth Medicare Benefits Schedule (CMBS) fee, which providers, registered

under the HCF Medicover No Gap arrangement will receive as full payment for

services provided. This also applies to unregistered providers should they charge within

the schedule of benefit listed. This arrangement ensures that our members incur no out of

pocket expense.


5 This percentage indicates the total coverage of hospital and medical services for all total

hip replacement admissions. The percentages shown for each type of medical service

are much higher as they are calculated for those services only and not the entire

admission, which includes all medical services and the hospital services. In an admission

you may have one medical service with an out of pocket expense, which then excludes

the whole admission from being fully covered. Hence the significant difference in

percentage for individual types of medical services as compared to the total admission

fully covered.

For your information, the average charges for claims paid for Total Hip Replacement Rehabilitation admissions for the financial year 12/13 are provided below:

On Average

Charge Medicare Pays HCF Pays 3 If your doctor DOES NOT use HCF’s No Gap Arrangement YOU PAY % of all admissions where your doctor DOES NOT use HCF’s No Gap Arrangement 4 If your doctor USES HCF’s No Gap Arrangement YOU PAY % of all admissions where your doctor USES HCF’s No Gap Arrangement
Total Average Hospital Component (accommodation, theatre and hospital related services) $8,141 $0 $8,091
1 Medical Services Component
Pathology Services $194 $87 $106 $22 0.6% $0 99.4%
Specialist Consultation $741 $442 $299 $0 0.0% $0 100.0%
2 Total Average Medical Services $864 $495 $368 $22 0.4% $0 99.6%
Hospital and Medical Services Average for Total Hip Replacement Rehabilitation Admissions $9,005 $495 $8,459 $22 0.4% $0 5 99.6%

Points to Note:

  • Charges are based on HCF claims for a sample size of 244 overnight admissions with an average length of stay of 12 days in private participating hospitals (private hospitals that have an agreement with HCF for accommodation and hospital related services).
  • As a private patient in a non-participating hospital you may incur an out of pocket expense for the hospital component (accommodation and hospital related services).
  • These charges are for comprehensive product only. Check the level of your benefit under your hospital product.

1 These medical services are in-patient services only.


2 The medical charges are based on averages and each episode of care is different, i.e.

you may not have all of these medical services, and/or you may also have other medical

services not indicated here e.g. diagnostic procedures. Therefore, the total average

medical service charge ($864) differs from the sum of the individual average charges as

shown.


3 Doctors who do not use the HCF no-gap arrangement have a higher average out of

pocket charge, as their charges are higher than those doctors who use the no-gap

arrangement and incur nil out of pocket charges to the patient. Therefore, the sum of the

average benefits plus the average out of pocket charge you pay will not equate to the

charge as shown in the table.


4 Doctors’ charges vary so always ask your doctor whether he/she will participate in

HCF’s No Gap Arrangements.


HCF Medicover Schedule of Benefits lists all services for extra benefit in excess of the

Commonwealth Medicare Benefits Schedule (CMBS) fee, which providers, registered

under the HCF Medicover No Gap arrangement will receive as full payment for

services provided. This also applies to unregistered providers should they charge within

the schedule of benefit listed. This arrangement ensures that our members incur no out of

pocket expense.


5 This percentage indicates the total coverage of hospital and medical services for all total

hip replacement rehabilitation admissions. The percentages shown for each type of

medical service are much higher as they are calculated for those services only and not

the entire admission, which includes all medical services and the hospital services. In an

admission you may have one medical service with an out of pocket expense, which then

excludes the whole admission from being fully covered. Hence the significant difference

in percentage for individual types of medical services as compared to the total admission

fully covered.

HOW DO I PREPARE FOR A TOTAL HIP REPLACEMENT?

To optimise your procedure and recovery phase there are some activities you can do in the weeks leading up to your surgery:

  • Exercises: deep breathing and coughing (especially if a smoker), foot, ankle and knee strengthening. Discuss these with a physiotherapist as it is important to also perform these after surgery
  • If you are a smoker and you cannot give up completely, try not to smoke in the weeks leading up to your operation, to reduce the risk of post-operative complications such as chest infections
  • Making your home safe: remove long cords that you could trip on, if you have rugs on the floor roll these up
  • Place a non slip mat in the shower and organise a high shower chair
  • Rent or buy a long handled grabber for picking up things whilst you can’t bend or squat
  • Organise a cleaner or family for a couple of weeks (no sweeping, mopping, vacuuming for several weeks)
  • Place commonly used items within arms reach, especially if limited home support.
  • Prepare some meals and freeze them for days you are too tired to prepare a meal
  • Check out grocery stores and chemists in your local area who will home deliver
  • If you live alone arrange an alert signal with your neighbour / family in case of emergency (eg. they should check on you if your blind is not up by 9am)

Your doctor will probably ask you to cease taking any aspirin and anti-inflammatory medication ten days prior to surgery to ensure they are out of your bloodstream, allowing bleeding and clotting times to return to normal.

Any infections should be treated and cleared up prior to surgery as infectious organisms anywhere in the body, including on the skin, can travel through the blood stream to the joint replacement and cause problems. You shall be notified of your fasting times prior to theatre. If surgery is scheduled for the morning, fast from 12 midnight otherwise if surgery scheduled for the afternoon you are expected to fast 6 hours prior to admission time.

Your affected leg and hip will be shaved or clipped whilst in hospital and you will be given an antiseptic soap to use prior to surgery.

Your doctor will have his/her own specific preparation requirements. These instructions should be strictly followed.

WHAT DO I TAKE WITH ME TO THE HOSPITAL?

  • Any recent, relevant x-rays or scans
  • Do not bring any valuables with you
  • Leave all jewellery at home (wedding ring acceptable)
  • Bring only enough money for items such as newspapers and magazines
  • Slippers or flat rubber soled shoes for walking in the hallways
  • Loose fitting clothing for the trip home
  • Make sure that you bring any medication that you would usually take during the day, under some circumstances you may still be able to take these
  • Personal grooming items such as hairbrush, comb, toothbrush, deodorant etc.
  • Undergarments and a robe

2. Day of procedure

WHAT HAPPENS TO ME AT THE HOSPITAL?

When you arrive at the hospital, the receptionist will do all the associated paperwork for your admission to hospital.

On arrival to the ward a nurse will orientate you, ask your medical and surgical history, list your medication and ask about any known allergies.

The Anaesthetist will visit you. He /she may order you a pre-med (something to relax you prior to transfer to theatre) discuss your anaesthetic options as below and also your pain management options for the post-operative period.

There are two types of anaesthetic that may be used:

  • General – You are asleep throughout the procedure
  • Epidural – Numbing from the waist down, however you will be awake throughout the procedure

An intravenous line will be put into the back of your hand so that you can be given fluids and antibiotics for prevention of infection. A small injection, usually in the abdomen is given to thin the blood and prevent clots forming. This will be done approximately half an hour prior to surgery.

WHAT CAN I EXPECT DURING THE PROCEDURE?

Once in theatre, anaesthetic will be administered. You will be covered in sterile drapes so that only the leg to be operated on is showing. The entire hip area will be swabbed with an antiseptic solution.

A majority of hip surgery is done with the patient lying on their side, so once you are asleep you may be positioned in a special brace that stabilises your pelvis and keeps you on your side throughout the operation.

An incision will be made above the hip joint. The ball at the end of femur is removed with a specialised bone saw to prepare it for the femoral component. The component looks like a highly polished ball on the end of a long stem. A hole is drilled in the centre of the femur and the stem is inserted. In some cases but not all, the femoral component may be cemented into place using special, fast drying, bone cement.

The hip socket is re-shaped and the damaged cartilage removed with a special tool at the end of a drill. The acetabular (cup) component is put in place.

Once the new ball and socket are in place, the joint capsule that produces the synovial fluid that lubricates the new joint is closed. As the different muscle layers are sewn together, a drainage tube made of perforated plastic is laid between them. Drainage of the wound helps the healing process and also assists in preventing infection.

The wound is then closed and dressings are applied.

3. Aftercare

WHAT HAPPENS AFTER THE PROCEDURE?

Following the surgery, you will be taken to recovery where you will be closely monitored by nursing staff. Your vital signs and pain management will be checked on a continual basis until you are fully conscious.

Once you return to the ward,

  • you will be lying on your back with your affected leg abducted (extended outwards) to prevent dislocation. You often have a pillow placed between your legs to prevent your leg rolling in
  • pain management may include a PCA (Patient Controlled Analgesia), which is a machine that allows you to deliver a dose of painkiller as required. The anaesthetist sets the dose and the lock out period so you. cannot overdose yourself . Other pain relief options include an epidural or regular pain relief administered by nursing staff (not a common option)
  • you will be wearing TED stockings to prevent clots forming
  • you will have a tube into your bladder to drain your urine
  • a tube coming from your wound to drain away excess fluid
  • the line in your hand will be connected to IV fluids
  • the wound will be covered with a dressing, which will be replaced on a regular basis

The intravenous fluids, urinary catheter, wound drain and PCA are usually removed over the next 24 – 48 hours.

It is important to start moving around as soon as possible because it not only helps to prevent clotting but also helps to increase flexibility and decrease any muscle loss in the new hip. You will begin by being asked to wiggle your toes shortly after the surgery and a physiotherapist will visit you to show you a variety of hip exercises. You should be up using a walking frame 2 days after the surgery and will graduate to crutches and then a walking stick after a few days.

You will be in hospital for 7-10 days and will be ready for discharge when you can walk about 30 metres, get in and out of bed on your own, access the toilet and shower successfully and get up and down stairs.

It takes about 3 months to recover from a Total Hip Replacement and during this time you will be advised to avoid the following:

  • Driving a vehicle
  • Bending your hip past 90 degrees
  • Bending down to pick something up from the floor
  • Crossing your legs either at the knees or ankles
  • Using pillows between your legs when lying on your back
  • Lying on your operated hip

Contact your doctor if you experience any of the following symptoms:

  • Redness, swelling or warmth around the wound
  • Leakage from the wound
  • Severe hip pain that cannot be eased with medication
  • Sudden sharp pain, clicking or popping sound in the hip joint
  • Loss of control over leg movement

Having an artificial joint in your body makes you susceptible to infection in the future. Ensure you always tell other doctors or dentists, as you may need to have preventative antibiotics if having other procedures attended in the future.

WILL I NEED REHABILITATION ?

Sometimes your Specialist may refer you to a Rehabilitation Unit for improved mobilisation and increased independence in self - care. This may occur as an inpatient. The average length of stay is 12 days for an inpatient. Rehabilitation involves care under a specialised team including a Rehabilitation Specialist, Rehabilitation Nurse, Physiotherapist and Occupational Therapist. This team works together to ensure you reach your goal with mobilisation and independence, enabling you to return to your normal activities of daily living.

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Disclaimer: Information is provided by HCF in good faith for the convenience of members. It is not an endorsement or recommendation of any form of treatment, nor is it a substitute for medical advice, and you should rely on the advice of your treating doctors in relation to all matters concerning your health. Every effort has been taken to ensure the accuracy of this information, however, HCF takes no responsibility for any injury, loss, damage or other consequence of the use of this information.