Why should I have a hip replacement?
Hip joint damage due to injury or arthritis results in pain and stiffness and can affect quality of life. Hip replacement surgery involves replacing the joint thereby alleviating symptoms.
The hip is a ball and socket joint. The ball at the top of the thigh bone (femoral head) moves in the socket of the pelvis (acetabulum) on a lining of cartilage. The cartilage prevents the bones from rubbing together. If the cartilage is worn, the bone is exposed and the joint can become stiff and painful resulting in difficulty mobilising.
What should I do before my surgery?
Following consultation with Mr Hoad-Reddick and X-Ray investigation, total hip replacement may be suggested as the best form of treatment and the
appropriate choice of prosthetic will be discussed. At this appointment you will receive a booklet from Mr Hoad-Reddick What you need to know
about your joint replacement; containing more information.You can also download it here.
Once you have decided to proceed with surgery, please contact the HR Orthopaedics office on 0161 722 0007 to arrange a convenient date for your
surgery.
If you are insured, you will need to contact your insurance company and obtain an authorisation number which you should take with you on admission. Your insurance company may ask you for a Procedure Code which is W3712. Prices for self-funding patients can be given on request and more information is on our information page for self pay patients.
The hospital will contact you to attend for preoperative assessment approximately two weeks prior to surgery. At assessment, blood and urine tests will be performed along with a heart trace (ECG) to ensure you are healthy enough to undergo anaesthetic and surgery. The pre-operative nurse will advise whether you should stop taking any of your medication.
You will see a physiotherapist and occupational therapist, if possible on the same day as your preoperative assessment; you will be given advice on mobilization, postoperative exercise and rehabilitation. Home circumstances will be assessed and any necessary measures to assist you on discharge can be arranged.
You will be required to fast for a period of time before your operation; this will be confirmed in writing along with your admission details.
What happens on the day of my surgery?
You will be admitted to hospital usually the same day as your operation. Mr Hoad-Reddick will explain the procedure again and consent forms will be signed. The operated leg will be marked and an expected position on the surgery list will be given, and is decided depending on medical conditions of all patients that day.
An anaesthetist will see you to discuss your anaesthetic and postoperative pain relief.
Following surgery you will be taken to the recovery unit until your condition is stable. You will have an intravenous drip in your arm to administer fluids or drugs, you may have a catheter in-situ; these are both usually removed at twenty four hours following surgery.
Once stable you will be taken to the postoperative unit for close monitoring before returning to your room on the ward. The physiotherapist will visit you on the unit to institute basic exercises.
What happens during hip replacement surgery?
The ball at the top of the thigh bone (femoral head) will be removed and replaced with a ball on a stem which is inserted into the thigh bone. The hip socket will be hollowed out to make a shallow cup and an artificial socket will be placed inside. The two halves of the joint are then put back together (the ball into the socket).
Surgery will take between one and two hours. Mr Hoad-Reddick uses the Corail hip system, an uncemented hip replacement manufactured by DePuy Johnson & Johnson with excellent long term results and prosthetic survivorship rates. Alternatively he may use the Tirlock hip system.
What risks are associated with hip replacement surgery?
The majority of patients undergoing hip replacement surgery will encounter no significant complications. There will be an opportunity to discuss the risks, benefits and outcomes of hip replacement surgery when you come to clinic before your operation. 19 out of 20 patients are delighted with the outcome. 1 in 20 may experience dissatisfaction due to a variety of potential complications:
Infection: To reduce infection risk, surgery is performed in a specially ventilated clean air operating theatre and most patients are given a short course of antibiotics at the time of surgery. Despite these measures, deep infection can occur and, in 1:100 cases, this may necessitate removal of the artificial joint and antibiotic treatment until infection has cleared.
Blood clot (DVT): Occasionally a blood clot can form in the deep veins of the leg causing pain or swelling in the calf. In a minority of cases, this can break away and travel to the heart or lungs and become a risk to life. The overall risk of fatal lung clot is 1:600. To reduce this risk you will be given calf pumps to increase the blood flow and an anticoagulant drug to inject into your stomach for twenty eight days following surgery, in keeping with current recommendations from the National Institute for Clinical Excellence (NICE).
Leg length: Care will be taken at the time of surgery to avoid shortening or lengthening of the leg. If Mr Hoad-Reddick feels your hip is unstable during the operation, he may choose to lengthen your leg marginally to stabilize the hip; this is rarely required.
Residual pain: In the majority of cases, hip replacement significantly improves pain and mobility; residual pain can occur and in most cases will resolve in time.
Neurovascular injury: Very rare occurrence of damage to vessels or nerves in the region of surgery.
Dislocation:An artificial hip is at risk of dislocation in the early postoperative period and physiotherapy advice will be given to avoid the hip 'at risk' positions. Dislocation (when the hip comes out of the joint) would result in a return to the operating theatre to put the hip back in place. This risk is significantly reduced by adhering closely to the strict post-operative guidelines and compliance with physiotherapy.
Fracture:This can occur in rare cases when the stem of the implant splits the femur / thigh bone when it is inserted. If this occurs, a wire will be placed around the femur to hold the bone together around the implant.
Implant failure requiring revision surgery: Recurrent dislocation, fracture or wear of the implants over time can necessitate revision surgery.If you are contemplating surgery, you will be given a leaflet. 'What you need to know about your joint replacement surgery' in clinic. Patients will be in hospital for 3-4 days, on crutches for 3-4 weeks and make a functional return to normality within approximately 3 to 4 months.
What happens after my hip replacement surgery?
Exercise and mobility are an extremely important part of rehabilitation and require full patient participation for optimal recovery and outcome. You will commence physiotherapy with the aid of a walker if necessary, progressing onto crutches - crutches should be used for 3-6 weeks post-op. An inpatient physiotherapist will see you each day during your stay at the hospital, teaching you to climb stairs safely and giving advice on mobilising and hip 'at risk' positions. 24 hours following surgery a routine check X-ray and blood test will be performed. Routine post-operative review with Mr Hoad-Reddick will be carried out at six weeks, three months, one year with an x-ray on arrival, three years with an x-ray on arrival and five years with an x-ray on arrival. Ultimately Mr Hoad-Reddick will decide on how many follow-up appointments will be required as some patient may have more or less than the routine amount.
When can I go home?
The majority of patients will be ready to return home three to four days post-surgery dependent upon wound healing and ability to mobilize safely once home. The nursing staff will advise on wound care and dressings. Mr Hoad-Reddick uses glue and a buried stitch; as such there are no stitches to be removed. For further information please downloadour wound care booklet.
After being discharged you will be sent a clinic appointment by post. This will be with Mr Hoad-Reddick six weeks following surgery and a physiotherapy review the same day if possible.
You can return to driving once safely off crutches and mobilising without a limp; this is usually at six weeks postoperatively.
When can I return to my normal activities?
It is crucial to your recovery that you refrain from certain normal activities post operatively.. Below is a guideline on what you can expect following surgery.
When lying down or sleeping you must lie on your back and not on your side for 6 weeks post surgery.
6 weeks post surgery:
- Put own socks on in an upright position
- Exercise bike with seat high
- Swim (except breast stroke)
12 weeks post surgery:
- Swim breast stroke
- Sit on low chair
- Sit in bottom of a bath
- Play Golf
- Squat
- Cross Legs
Ask Mr Hoad-Reddick:
- Gardening (ie. kneeling down)
- Return to impact sports