Total hip replacement performed through the front of the hip, working between the muscles rather than through them. Mr Balakumar uses intraoperative X-ray guidance to verify implant position during the procedure.
(03) 9573 9659
Total hip replacement is one of the most reliably successful operations in modern surgery. Mr Balakumar performs this procedure as the final step in an escalating series of treatments, offering joint preservation options wherever they are appropriate and recommending replacement only after thorough consideration of the individual clinical picture.
A total hip replacement involves removing the damaged surfaces of the hip joint and replacing them with prosthetic components. The femoral head and acetabulum are resurfaced with implants that reproduce the low-friction mechanics of the normal hip. The procedure covers a spectrum of operations, from resurfacing and partial replacement through to total joint replacement.
The approach refers to the direction from which the surgeon accesses the hip joint. Three main approaches are in widespread use: anterior (from the front), lateral (from the side) and posterior (from the back).
Mr Balakumar performs the direct anterior approach as his primary technique. This approach works through a natural interval between muscles supplied by different nerves, meaning no muscles are cut or detached. A key advantage of the anterior approach is that the patient lies on their back during surgery, allowing intraoperative X-ray guidance to verify implant position, cup angle and leg length in real time.
There has been considerable marketing around the anterior approach, with claims of significantly faster recovery and superior outcomes. The peer-reviewed literature does not support a consistent long-term advantage of one approach over another in experienced hands. The 10-year outcomes of hip replacement are comparable across all approaches. What matters more than the approach is the accuracy of implant placement and the experience of the surgeon performing the procedure. Mr Balakumar is trained in all three approaches and adapts his technique based on the individual patient’s anatomy and the complexity of the case.
Mr Balakumar uses implant components with well-established national joint registry data. His preference for the bearing surface is ceramic, which has a theoretical lifespan of 30 to 40 years and a strong long-term track record. He uses ceramic on polyethylene for most patients, and ceramic on ceramic in younger patients where an even lower wear rate is desirable.
Mr Balakumar does not use metal-on-metal bearing surfaces. The concerns around metal ion release and ALVAL reactions are well founded, and these components have not been implanted in his practice. The uncemented femoral component he uses has 97 per cent ten-year survivorship data from the Australian Orthopaedic Association National Joint Replacement Registry.
No one needs a hip replacement. It is a choice made for improvement in function. The primary candidates are patients with osteoarthritis that is painful and functionally limiting, and that has not responded to non-surgical management. Osteoarthritis can be primary, from general wear and tear, or secondary, arising from an underlying mechanical problem such as dysplasia or impingement. In patients under 60, a secondary cause is more common.
When joint damage is too advanced for preservation, hip replacement becomes the appropriate option. The body will naturally attempt to fuse an arthritic hip over time, which may reduce pain but leaves significant stiffness. Most patients are better served by replacement before that point is reached.
A modern hip replacement is designed to last 20 to 25 years, and many patients achieve considerably longer. The idea that a replacement must be revised after 10 years is a common misconception. With current technology and appropriate patient selection, the majority of patients do not require revision within 20 years. Factors that affect longevity include activity level, body weight and the accuracy of the initial implant positioning.
Most patients are walking with a frame on the day of surgery or the following morning. Hospital stay is typically one to three nights. By six weeks most patients are walking without aids and returning to low-impact activities. Return to driving is generally appropriate at six weeks for a left hip and a little longer for the right. A physiotherapy programme begins in hospital and continues after discharge.
Risks of total hip replacement include infection (approximately 1 to 2 per cent), blood clots (deep vein thrombosis or pulmonary embolism), dislocation, leg length inequality, nerve or vessel injury, early loosening and the eventual need for revision surgery. Mr Balakumar discusses all risks in detail at the consultation.
(03) 9573 9659
Mr Balakumar is one of a small number of surgeons in Australia with formal training in both paediatric and adult hip surgery. His fellowship at Harvard’s Children’s Hospital in Boston, under some of the world’s leading specialists in hip preservation, gives him a depth of expertise that is difficult to find in a single practice.
His approach is the same whether the patient is 6 months or 65 years old – thorough assessment, honest options, and no pressure toward surgery until the clinical picture clearly supports it.
(03) 9573 9659
A procedure in which the femur is cut and repositioned to correct abnormal alignment around the hip or knee. Used in both paediatric and adult patients as part of joint preservation surgery.
The gold standard surgical treatment for hip dysplasia in adolescents and adults with preserved joint cartilage. Mr Balakumar trained in this technically demanding procedure at Harvard’s Children’s Hospital Boston.
An alternative to total hip replacement in which the femoral head is capped rather than removed. Suitable for a carefully selected group of younger, active patients with end-stage hip arthritis.
An open procedure allowing complete access to all surfaces of the hip joint. Used for complex conditions that cannot be adequately addressed through arthroscopy alone.
Melbourne Orthopaedic Group is home to a team of experienced orthopaedic surgeons, providing comprehensive care for sports injuries and orthopaedic conditions. Whether it’s joint replacement or sports injuries, our specialists provide comprehensive orthopaedic care.
