Hip Replacement

Hip Replacement


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Questions and Answers on a Hip Replacement

What is a hip replacement?

Hip replacement is a surgery that changes your original hip to an artificial one. The surface damage (arthritis) is the reason for pain from the joint and this is what we aim to improve with hip replacement. Generally there may be wear and tear in other surrounding areas that may contribute to your pain such as tissue pain, back pain and sacroiliac joint pain. These other pains do not get better with hip replacement surgery.

Do I need a hip replacement?

Most people who have hip pain will have groin pain that often goes to the knee. Some may have pain outside the hip and others may have pain in the buttock region. The pain often comes on with activity but in advanced stages of arthritis of the hip it would be there all the time and gets worse with activity. Your sleep may be disturbed by the pain. There is often associated stiffness in the hip felt most commonly when you try to reach your foot, get in and out of car or bath etc.

If you or your doctor suspects that you may have arthritis they would often arrange an x-ray of the hip to make a diagnosis.

If you wish to be seen I can arrange the appropriate investigations after your examination from the clinic.

What do you do when you see me in clinic?

Often I will talk to you to get more information, examine you on a couch and get an x-ray, if not already done. Occasionally I may use other tests such as an MRI scan or an injection to specify where the problem may be and whether its location can be made sure with the injection.

What are the risks and complications of the procedure?

There are risks and complications for every procedure. A hip replacement is not an exception.
They are

Infection risk is less than 1:100

Bleeding bad enough to need a blood transfusion is uncommon (1:100) if anemia is treated before surgery

Injury to nerve or blood vessel are very rare

Fractures are uncommon and is a treatable complication with additional fixation

Thrombosis and embolism risk is reduced by the use of stockings, calf pumps, medicines to thin the blood, avoiding dehydration etc. The risk however cannot be eliminated.

Medical complications such as chest infection, heart attack, stroke, confusion. If you get these we will treat them. The likelihood of getting these complications depends on how fit you are before surgery.

Fatal complications are very rare (1:300 or less in most normal patients but it varies depending on your fitness)

Dislocation risk is 1:100 or less

Leg length discrepancy – initially some patients feel the leg is longer because of the tissue tension.

It is important to have tissue tension to reduce the risk of dislocation. Often this feeling gets better in 6 months to a year as the tissues get used to it.

Further surgery or revision surgery if the metal work fails one day for one reason or another. The current standard is 95% patients are likely to have their hip in place at 10 years
Persistent pain – as explained before pain coming from sources other than the bad sur-face of the hip will not go away.

Scar pain scar can sometimes be painful.

The surgery of hip replacement is very successful in appropriately selected patients. The chance of leaving the patient worse off than they were before surgery is 1% or less. The risk of complications depends on how fit you are before surgery.

How long does it take to do the operation?

The operation itself takes about 1 hour but the duration for whole of the journey from your ward bed to back there is much longer.

If I have arthritis can you not do something different to preserve my hip and avoid surgery?

I often get asked this question.

The answer is yes – there are number of options of non-operative treatments

Improving pain with painkillers and using walking aids as well as modification of activity

In some cases of inflammatory arthritis a steroid injection in hip joint may improve symptoms especially if surface damage is not too bad.

Physiotherapy is not affective when there is arthritis

Glucosamine and chondroitin sulphate tablets help some patients and I generally say as long as you can afford it and it does not cause any side effects you can take them.

Injection of stem cells in the joint is not useful or proven to be useful so far.

Creating cartilage and cartilage transplant are not effective so far.

Key hole surgery or arthroscopic hip surgery works in some cases and I can advise about this when we have a complete assessment

Resurfacing hip surgery works in some individuals and there is a long term surveillance needed for these patients. I will advise you if you are suitable in the consultation.

What do you do in a hip replacement surgery?

Generally most patients would have an injection in the back (spinal anaesthetic) however this is very much decided by the consultant anaesthetist and discussed with you on the day of your surgery. Often spinal anaesthetic is given with a bit of sedation to make you sleepy.

After anaesthetic, you will be placed on your side. The procedure usually starts after preparing the area in the operation theatre. I make a cut on the side of your hip going towards the bottom. The hip is then dislocated and the ball of the hip is removed. The socket is changed to an artificial one and fixed with or without cement, depending on the type of the metalwork. Then the thigh bone is prepared to accept the appropriate stem on top of which the ball is secured. The hip is put back together and an articulate ball and socket are then at work. The wound is careful-ly closed with sutures.

Usually most hip replacements take 60 to 90 minutes for the actual procedure but the whole journey takes a lot longer.

How long is the scar for hip replacement?

Generally 6-8 inches but it does depend on size of the patient and complexity of the surgery.

How long am I in hospital for? And what happens after the operation?

Everyone attends a special clinic a few weeks before surgery called Pre-Assessment Clinic.

They will do a number of tests and swabs etc.

Most patients are admitted to the hospital on the day of the surgery and stay in hospital between 2-4 nights, generally 3 nights.

During your stay you have regular review, pain control and physiotherapy. Appropriate equipment is provided to the patients to take home. This will help you after discharge.

The hospital will arrange for you to have your stitches removed and also make the appropriate physiotherapy sessions as an outpatient appointment. You will be given a number to contact in case of emergency or problems after discharge. The hospital will arrange an outpatient appointment to come back to see me or a Specialist Physiotherapist at 6-8 weeks after the surgery.

How long will I have pain for after the procedure?

The first day after the operation is not great, you will need frequent painkillers and this means you will have disturbed sleep and sometimes painkillers may make you feel sickly. After the first 24 hours of the operation the pain starts to get a lot better day by day. It is usually manage-able with oral painkillers by the time you are discharged.

Most patients will have bruising and swelling that will go down the leg, buttock and back over the next few weeks. Often 4-5 week after the operation the majority of patients are much better and can often go on to taking occasional painkillers, as needed. The pain is a lot better 6 weeks to 3 months after the operation and most patients will have minor aches and pains for up to a year after the operation. This is how long the scar takes to mature.

When can I drive after the operation?

You can usually start driving after 6 weeks. It is however a self-certification. I cannot certify you either way. If you think you can control the vehicle, do emergency stop, etc., you can start driving.

When can I start gym or other sport activity?

Most patients take 6 weeks to get over the initial pain and swelling. You will have a physiotherapy appointment as well. Usually depending on your fitness before the procedure, you can start doing some activity at around 6 weeks post-op, gradually increasing it to the level you wish to achieve over the next few weeks and months.

Is there anything I cannot do?

There is a list of movements that can cause dislocation in an artificial hip. The physiotherapist will guide you about them and how you can get around them. Some sport or fitness activities that involve extreme movements are best avoided. Commonly most people ask about breast stroke in swimming and generally it is best avoided for the first 3-6 months, until the wound healing is good enough. In some cases where the hip is small and the metalwork is small, it is best avoided altogether.

Very high impact activity such as parachute jumping, bungee jumping, etc. are also best avoided because the bone may break around the metalwork.

Some routine activities like shoe laces and picking things from the floor or gardening are al-lowed but best performed in a specific way – the physiotherapist will take you through these activities