What is a total hip replacement?
A total hip replacement is an operation that replaces the worn out/arthritic parts of the hip joint (the femoral head and socket) with implants made of metal, plastic and ceramic. The purpose of the operation is to eradicate the pain caused by the arthritic hip joint. This artificial ball and socket joint allows a return to more normal hip activities
How is the operation performed?
The British and American Hip Societies recommend (“recommend” instead of “support” or is this too strong?) the posterior approach as the gold standard for hip replacements, this is supported in many orthopaedic medical publications as providing the best and most reliable results. Taking this approach the surgeon cuts through the buttock muscles to reach the hip joint and the versatility of this method allows for a rapid recovery after the operation. The operation is performed with the patient on their side and the resulting scar is situated on the outer side of the thigh over the hip bone.
Is total hip replacement surgery safe?
Total hip replacement is a common procedure with over 70,000 being performed in the UK each year. A huge amount of research has been undertaken to study how to make the surgery as safe as possible. A recent paper from the UK National Joint Registry has shown that total hip replacement has become much safer in the last 10 years thanks to advances in the surgery, anaesthetic and peri-operative care (See PDF Reducing THR Risk). Mr Webb utilizes all of the techniques that have been shown to be of benefit in reducing the risks of the surgery. Any risks will be discussed with you by Mr Webb before your operation
How long will a hip replacement last?
The most common reason for hip replacements needing further surgery is wear and tear of the components and associated loosening. Careful follow-up is aimed at detecting this at an early stage before it becomes symptomatic and thus allowing less major redo or revision surgery to be performed.
The Exeter Hip System that Mr Webb uses has the best long term results according to the UK National Joint Registry. More than 95% of hip replacements should still be going strong at 10 years. The rate they wear out does depend on your activity level but this should not prevent you from enjoying them to the full.
What are the major risks of hip replacement surgery?
Hip replacement surgery is safe but there are a range of possible complications.
- Anaesthetic complications
- Blood clots
- On-going unexplained pain
- Wear and loosening of the replacement and the need for further surgery (revision hip replacement)
- Heart and circulation problems
- Nerve and blood vessel injury
- Leg length problems
- Muscle and tendon problems
Mr Webb, his anaesthetist and the pre-operative assessment team will search for preventable causes of increased risk and address these on an individual basis.
Overall there is a good 9 out of 10 chance of everything going well (without significant complications). Further information can be found in the British Hip Society Information Booklet.
Is there an age limit for hip replacement?
As long as you are fit enough for the operation then there is no upper age limit.
Which tests will I need before the operation?
You will go through a consultation with Mr Webb in which you will be examined. Any relevant X-rays or scans will be ordered at this stage. Associated health conditions will be assessed and Mr Webb will discuss these with his anaesthetist in order to produce a bespoke peri-operative care plan for your operation. Extra investigations such as ECG or Chest X-rays may be necessary. You will also undergo a pre-operative nursing assessment several weeks before the operation. At this stage routine blood and urine tests will be performed.
Should I start or stop any medications?
As a rule continue to take your usual medications up to the day of surgery. Anti-coagulants (blood thinners) will need to be stopped in preparation for your surgery. You will be advised of the timing of this by the nurses at the pre-operative assessment clinic. The combined oral contraceptive pill and HRT need to be stopped for six weeks before and after surgery to reduce the risk of developing blood clots.
What are my options for anaesthesia?
Modern anaesthesia techniques are one of the key reasons that hip replacement surgery has become so much safer in the last 20 years. The key to success is the pre-operative assessment. The anaesthetist will discuss all of the anaesthetic options with you on the day of surgery. Most patients will be offered a spinal anaesthetic which numbs the legs and allows the operation to take place. This can be combined with a general anaesthetic that allows you to be fully asleep. You can choose to be fully awake during the operation and this will give you chance to catch up on watching a movie or listening to music etc.
How long will the surgery take?
Depending on the complexity of the case the operation will take between 1 and 3 hours.
Will I be in much pain after the surgery?
One of the main priorities following your operation is to control your pain relief. The hip arthritis pain will have gone but you will be sore from the surgery. A variety of different methods will be used to obtain good pain relief for you during this period. Getting mobile as soon as possible with the physiotherapists has been shown to improve overall comfort by preventing stiffness. Most of the surgical discomfort will have gone by two weeks.
How long will I be in hospital?
The average length of stay following hip replacement surgery is three days. In this time you will be assessed medically and have physiotherapy. Once you have passed the physiotherapy requirements for discharge, you can go home. A prescription of medicines will be provided and a discharge summary will be sent to your GP. Follow-up appointments will be arranged for you.
Will I need someone to stay with me when I go home?
It is ideal to have a friend or relative to stay with you for the first few days after discharge from hospital. If this is not possible, it is wise to arrange for someone to check on you on a daily basis to see if there is anything you may need. Some people choose to arrange a short period of convalescence following their surgery.
How long will I need crutches or sticks?
The precise length of time that a patient requires their walking aids depends on many factors including the complexity of the surgery, their general fitness and involvement of other joints. Most patients are using their sticks at the two week wound check but by the six week review are merely carrying a single stick in case of a stumble.
When can I go up and down stairs?
You will be checked that you are safe on the stairs before you are allowed to leave hospital.
When can I drive following my hip replacement?
The insurance industry standard expectation is that you will return to driving after six weeks. Patients may be physically able to do so before this stage and you should discuss this with your insurer.
How long will I have off work?
You will be provided with a three month ‘sick note'. The self employed and those who do not have physically demanding jobs often choose to return much earlier. You should however not work in the first two weeks to allow the wound to heal.
When will I be seen in clinic afterwards?
A nursing wound review appointment is arranged for two weeks after surgery. Mr Webb will see you at between 6-8 weeks and at one year post op. Further follow up will then be arranged to comply with British Hip Society guidelines. Further information can be found in the British Hip Society Information Booklet.
When can I return to sports?
You will be guided by the physiotherapists as to when to return to certain sporting activities based on the complexity of your surgery. Remaining active is vital to the success of your surgery, however overdoing your level of exercise might cause troublesome muscle soreness. A ‘little and often' is the motto of a happy recovery.
When will I be able to engage in sexual activity following hip replacement?
Patients can return to sexual activity when it feels comfortable. Activity is only limited by the general movement/position restrictions advised the physiotherapists following your surgery.