Total Hip Replacement
What is it?
An artificial ball-and-socket joint designed to replace a damaged or worn-out hip joints.
Why am I having it?
This procedure is performed for a painful, worn hip joint, where symptoms have failed to respond to non-operative treatments such as pain-killers and physiotherapy.
What is the artificial hip made of?
Mr Waters tends to use modern implants that become incorporated into the bone (uncemented) and ceramic, metal and polyethylene bearing surfaces tailored to the individual patient.
What will actually happen?
Firstly you will undergo “pre-assessment”. These are routine preoperative investigations including blood tests, blood pressure measurement and x-rays. The hospital will contact you regarding this. You will usually be admitted on the day of surgery and be starved for 6 hours prior to the operation (you will be allowed water up to 2 hours before). The anaesthetist will talk to you about the anaesthetic which may involve a spinal anaesthetic with sedation and/or general anaesthesia. During surgery, an incision will be made over the side of the hip and buttock approximately 10cm in length which will be covered by a dressing.
How long will I be in need to stay in bed?
If the operation is in the morning the physiotherapists will endeavour to get you up and starting to mobilise the same day. Otherwise, you will be up and be walking the following day. Bring comfortable leisure clothes, tracksuit etc. The waterproof dressing means that you can shower the following day.
How long will I be in the hospital?
Most patients will be able to leave hospital between 1 and 3 days.
What else happens after the operation?
You will usually be able to your full weight through the leg straight away. The physiotherapists will help you and give you crutches or a frame if need be. We will always ensure that you can mobilise safely and get up and down stairs before you are discharged. Therapy will also continue, as necessary, for several sessions as an out-patient.
What precautions must I take after a hip replacement?
The main precaution is avoiding flexing your hip beyond your waist while twisting your knee inwards. This is to avoid dislocation. Sometimes it may feel more secure to sleep with a pillow between the legs in the early stages. Mr Waters does not enforce any other “traditional” precautions such as sleeping on your back, raised toilet seats etc.
How long will I need off work?
This is variable and depends really on the nature of your work. As a general rule, you will be uninsured to drive for four to six weeks following the operation. If you have an automatic car and surgery is on the left leg then you may be able to return a little sooner. Most people would probably require a similar time off work. However, working from home would be possible after a couple of weeks.
What are the risks of the operation?
All surgery carries an element of risk. Hip replacement surgery is a very successful pain relieving and function-restoring operation in approximately 99% of cases.
These are main risks and the methods employed by Mr Waters in order to avoid them.
• Infection
Joint replacement surgeons are fanatical about avoiding this, as an artificial joint cannot fight off infection. You will be given antibiotics at the same time as the anaesthetic and your skin will be coated with a special antiseptic solution prior to surgery. A special ultra clean operating theatre is used for all joint replacement procedures.
If, despite all this, there is any suspicion of infection (i.e an inflamed wound) you will be given further antibiotics. Very rarely you may need to return to the operating theatre for the wound to be cleaned. Deep infection of the joint is very uncommon and may require its removal.
• Venous thromboembolism (DVT, pulmonary embolism)
Clots may occur in the veins of the leg following surgery. In most cases, this does not cause any problem and a clot travelling to the lung is extremely rare (less than 1/1000)
You will be given special stockings to wear and we may give you special foot-pumps to keep the blood in the veins moving. At present, the guidelines suggest that you receive blood-thinning injections for 10 days followed by aspirin for 28 days. If you are already on blood-thinning medication or have other risk factors then the protocol will change.
• Dislocation
Although very uncommon, it may occur while the tissues are healing following the surgery, if the hip is moved beyond its range. The risk reduces considerably from six weeks following surgery. You will be shown which positions to avoid but it really is an extremely rare occurrence.
• Leg-length inequality
The most important requirement is a stable hip that moves correctly with all the muscles around it at the right tension. Occasionally this may mean the affected leg is slightly longer or shorter following surgery. Most people are unaware if there is a slight difference and in fact, the leg may already be slightly shorter as a result of arthritis.
• Nerve injury
The sciatic nerve travels down the back of the hip. It is always identified and protected during the operation but rarely it can be bruised. This may give rise to weakness in the foot which may need support while it recovers.
• Fracture
There is a small chance of a crack occurring around the hip during the procedure. This is usually of no consequence. A protective wire may be inserted around the bone and occasionally you may not be able to fully weight-bear for a short period but there is unlikely to be any long-term consequence.
• Failure to improve the symptoms
In a small number of patients, the original hip pain may also have been associated with another condition such as arthritis of the spine even though the hip itself is diseased. In these patients, some pain may persist following the surgery.
Any more questions?
Please contact us if you have any other questions about this or any other procedure.
