Going through surgery can be a worrying and unsettling time for most patients. Mr Webb aims to provide all his patients with the relevant information, putting their minds at rest and providing answers to their questions. On the following pages we have provided some of the most common questions and answers that Mr Webb and his team receive. You will also find useful links and further reading material.
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Am I a candidate for a hip replacement?
Hip arthritis occurs when the smooth lining cartilage of the joint becomes thinned and damaged. Eventually, the cartilage can be lost altogether and force the hip joint to have bone-on-bone contact. These changes can be caused by a variety of conditions:
- Osteoarthritis (by far the most common)
- Inflammatory arthritides including rheumatoid, psoriasis-related, inflammatory bowel disease-related, ankylosing spondylitis, gout, SLE.
- Post trauma and hip fracture
- Avascular necrosis of hip (loss of blood supply to the bone)
- Following childhood hip condition (Dyplasia, Perthes and SUFE)
- Many other more rare causes
Preparing for surgery
Things you can do:
- Stop smoking: Smoking is strongly associated with infection following joint surgery. Stopping obviously also has many other more important health benefits as well.
- Keep weight under control: Maintaining a healthy weight reduces the risk of infection and other complications following joint replacement surgery. It also may reduce the pain felt from the arthritic joint.
- Heath check: As part of the preparation for your hip replacement you will go through a pre-assessment health check with both Mr Webb and the nursing staff to ensure you are safe to proceed with surgery. In addition you should ensure that any long term conditions you may have (e.g. diabetes) are under good control. You should consult your GP about these conditions prior to surgery.
- Avoid alcohol for 48 hours prior to your surgery.
Home preparations
The pre-operative assessment team includes nurses, physiotherapists and occupational therapists. They will ask for details regarding your home set-up to help you plan for your recovery from the surgery.
- They will ask you for information about your type of residence, number and type of stairs, bathrooms, height of chairs and beds.
- They will advise you if any changes are required in order to make your recovery safer and will provide you with the appropriate mobility and activities of daily living aids; they may recommend a raised toilet seat, a sock-aid, grabber and a chair raise, for example.
- They will advise you on setting up a recovery hub in your home. This should be based around a comfortable chair with a phone, reading material, television, tablet and medication all within easy reach.
- They will also encourage you to try plan your meals ahead of time and consider grocery deliveries during your convalescence.
Final preparation
- Have a shower or bath on the day before surgery and moisturize your skin.
- Avoid hair removal or shaving in the area of your body where the surgery will take place. This will be performed in the operating theatre by the surgeon in order to reduce the risk of infection.
- Have a bag packed for your hospital stay. This should include:
- Dressing gown and comfortable pyjamas
- Slippers
- Washbag and toiletries
- Comfortable change of clothes and footwear
- Your usual medications
- Arrange for a family member or friend to support you after you are discharged from hospital.
What to expect after surgery
Hip replacement surgery can dramatically improve or even completely remove arthritic hip joint pain in the long term. There is however a recovery period and the following information is provided to help this period pass as smoothly as possible.
After surgery
Owing to the use of spinal anaesthesia you should be alert in the recovery room following your surgery. Nursing staff will keep regular checks on your pulse, blood pressure, temperature and blood oxygen levels and pain control. You will soon be transferred back to the ward.
The feeling and movement return to your legs within a few hours. The nurses ensure you have good pain relief and you are allowed to eat and drink.
Depending on the time of day your operation takes place, you may get up the same day or early the next under the guidance of the physiotherapists. They will then guide you over the next few days through the important goals of getting in and out of bed; rising from sitting to standing; getting on and off the toilet; walking with a frame and then progressing to sticks or crutches and climbing up and down stairs.
You will have blood tests and X-rays on the first day following surgery and these will be checked by Mr Webb.
You will be discharged from hospital once you have passed all the physiotherapy requirements safely and are medically fit. This usually takes place 1 to 2 days after surgery.
Continued Recovery
The long term success of the hip replacement will be helped by your taking care with your recovery in the first few months and in particular the period immediately following surgery.
- Your wound will be covered by a dressing and you will be given instructions regarding its care by the ward staff before discharge. As a rule, you should not need to change your dressing until you are reviewed by the expert clinic nurses approximately 2 weeks after surgery. This appointment will be made for you before you are discharged.
- The skin wound should be mostly healed by this two-week stage but a further dressing for protection will be used. Mr Webb uses a combination of wound closure techniques to minimize the risk of infection. This entails the final skin closure with an absorbable suture (under the skin), glue and paper sutures. Another bonus of this method of skin closure is that it avoids the need for painful suture removal.
Exercise
Your physiotherapists will prescribe a series of exercises that you should perform on a regular basis after returning home. The key to success is frequent gentle exercise and activity. Don’t try to overdo the amount of activity you perform in the early stages otherwise you might get increased muscle pain. If this happens, ease back and take painkillers but do not stop activity altogether, otherwise you will become stiff. Plan regular short walks and mild activities. Continued mobility is vital to a full recovery.
Follow-up appointments
A follow-up appointment to see Mr Webb will be made for approximately six weeks after surgery. By this stage you should be seeing some good progress in your recovery. Your wound will be healed although still a bit uncomfortable as the sutures under the skin start to be absorbed by your body. You will be given further advice about your rehabilitation.
Insured and self-pay patients will also have regular out-patient physiotherapy sessions during the recovery period.
Mr Webb will also review you one year following surgery.
Advice during rehabilitation
Mr Webb is available for advice (contact via secretary) during the recovery period and beyond. If the questions pertain to the exercises and mobility then the physiotherapists are also available for advice.
Life with a hip replacement
Once you have recovered and rehabilitated from your surgery you will be able to fully enjoy your hip replacement. You should remain active and vigilant to protect the hip replacement and your general health in the long-term.
At any point following your surgery Mr Webb (via his secretary) is available to answer any questions or worries that may arise. His priority is your wellbeing and your peace of mind.
Frequently Asked Questions
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.
The British and American Hip Societies support the posterior approach as the gold standard for hip replacements, based on many Orthopaedic surgical publications. The operation is performed with the patient on their side and the hip joint is reached by parting the buttock (gluteal) muscles. This versatile approach allows the operation to performed safely and prepares the patient for a rapid recovery. The surgical scar is situated on the outer side of the thigh over the hip bone.
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.
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 and over half at 25 years (Evans et al)
The rate they wear out does depend on your activity level but this should not prevent you from enjoying them to the full.
Hip replacement surgery is safe but there are a range of possible complications.
Risks include:
- Anaesthetic complications
- Blood clots
- Bleeding
- Fracture
- On-going unexplained pain
- Dislocation
- Wear and loosening of the replacement and the need for further surgery (revision hip replacement)
- Heart and circulation problems
- Infection
- Nerve and blood vessel injury
- Leg length problems
- Stiffness
- Muscle and tendon problems
- Late fractures of the thigh or pelvis bones following falls
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.
As long as you are fit enough for the operation then there is no upper age limit.
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.
The pre-op assessment team will advise you on your usual medications leading up to 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.
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 ‘lighter’ general anaesthetic that allows you to be fully asleep. You can choose to be fully awake during the operation and listen to music etc.
Depending on the complexity of the case the operation will take between 1 to 2 hours.
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.
The average length of stay following hip replacement surgery is between 1 and 3 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.
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.
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.
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.
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.
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 patient information section of the British Hip Society website. (britishhipsociety.com)
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.
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.
