Hip Replacements

Hip Replacements information

You have decided or are considering undergoing total hip replacement surgery. I have discussed with you in clinic that hip replacements are successful for relieving severe pain and disability associated with arthritis. I have discussed the risks and benefits of this kind of surgery. This leaflet is aimed to remind you of the important points discussed. Any further questions from yourself are welcome and should be raised prior to surgery.

Do I have to have a hip replacement?

No. Other treatments include losing weight, pain killers, lifestyle modification, walking aids, physiotherapy and injections into the hip. These treatments are not always suitable for everyone and will have been considered as a first option already by myself.

What is a hip replacement?

A hip replacement replaces both the ball and socket of your hip joint. The materials used are a combination of metal, ceramic and plastic. This allows the hip to last 10-20 years. The components are held in place by either scratch fit allowing the bone to integrate with the implant (uncemented) or with special medical cement.
Technology in hip replacements has advanced tremendously. However we cannot yet replicate the natural engineering of the hip you were born with. Some patients notice that this makes their hip feel different to a natural hip, but this is not painful and patients become used to this different sensation. Others completely forget that they have an artificial hip.
The socket is replaced with either a plastic or ceramic joint surface fixed into an uncemented metal shell or cemented into place. The femoral component sits inside the femoral shaft capped with a metal or ceramic head.
Whilst the majority of patients receive a hip replacement for arthritis, a minority receive a hip replacement due to a fracture of their hip joint. They have not had time for their hip to stiffen as with the arthritic hip and extra precautions need to be taken to prevent hip dislocation. Your physiotherapist will explain this in greater detail.

How do I get ready for surgery?

Following your consultation, you will be contacted by the pre-admission team. They will arrange for blood tests and other investigations to ensure that you are fit for surgery.
You will be given a date for your operation. If you cannot attend on that date please let me know immediately by calling my private secretary (Nuffield – Alex Appleyard 0113 3882138 / Yorkshire Clinic – Barbara Bell 01274 550859) so that an alternative date can be arranged. Before surgery, you will be provided with a special shower liquid soap to wash your hair and body and nasal spray to reduce the number of bacteria on your skin, thereby reducing your chance of infection. If you normally are prescribed Warfarin, Rivaroxaban, Clopidogrel or other blood thinners, you will be asked to stop this 5 days before surgery to reduce your risk of bleeding. You may continue your aspirin. If you take any medication for Rheumatoid disease, please discuss this with me prior to surgery. This may need to be stopped both pre and post op.
If you feel unwell in the days leading up to surgery or have any cuts, spots or infections on the same limb as that being operated on, please get in touch with my private secretary (Nuffield – Alex Appleyard 0113 3882138 / Yorkshire Clinic – Barbara Bell 01274 550859) as soon as possible. We may need to delay your surgery. This is in your best interests.

Following your operation

You will receive intensive physiotherapy whilst in hospital which needs to be continued by yourself at home. Your physiotherapist will explain in detail the hip precautions to follow and the occupational therapist will help you in terms of training and equipment to help you cope at home with your new joint particularly in the first few months. Once your doctors, nurses, physiotherapists and occupational therapists are happy you may return home. A normal hospital stay will be between 2-3 days. You will not return home until we are confident you are safe to cope independently or with support. Please make arrangements for your discharge before you come into hospital. If possible, it is best to have someone stay with you or for you to stay with family or friends for a couple of weeks on discharge.
Whilst in hospital, it is normal that you will receive blood thinning injections until discharge. You will then take a 5 week course of blood thinning tablets at home. These are aimed to reduce your risks of developing a blood clot in your leg or lung.
Occasionally, patients are concerned about their progress at home. You will receive a follow up appointment at 6 weeks, but if you are concerned you have a more immediate problem such as a leaky red wound, we would rather you phone the ward (Nuffield – Ingleborough Ward 0113 3882309 / Yorkshire Clinic – 01274 550817) to arrange to speak to somebody qualified to give advice.
You will be off work for approximately 6-12 weeks by which time most patients are walking with one stick. You may start to drive around 6 weeks when you can safely and confidently perform an emergency breaking manoeuvre. It is your responsibility to know whether you are or are not safe to drive. Let your insurance company know you are planning on starting to drive again. You need to follow the physiotherapist’s hip precautions to avoid dislocation lifelong and need to use aids such as the toilet seat raise for 3 months. Full recovery normally takes 12 months. Short haul flights are possible after 6 weeks and long haul after 3 months.

What can I expect to achieve with surgery?

Most patients are delighted with the results of surgery. Most patients forget that they have a false hip, but it is normal to feel a different sensation compared to a normal hip.
90% of patients have a dramatic reduction in pain following recovery. You are encouraged to resume an active lifestyle but are strongly advised against activities that produce high impact such as running and jumping. You will need to follow the hip precautions you have been taught including during times of prayer. Sports such as golf, cycling, swimming and walking are encouraged. Other acceptable activities include bowling, doubles tennis, table tennis and dancing.
Hip replacement surgery is major surgery, sometimes associated with complications. We cannot guarantee to meet all your expectations of surgery. There must be a realistic expectation by yourself of what the operation can achieve.

Specific Risks of Hip Replacement

The Good news!

Hip replacement surgery is very successful at dramatically improving pain. Functionally, we would expect you to improve also. Whilst we have to inform you of the major risks of surgery, hip replacements are far safer now than 10 to 20 years ago. They have also lasted much longer than initially expected. Over 86,000 hip replacements are performed in the UK each year.

You have been given this booklet now to give you the opportunity to discuss any aspect of your care with myself, the pre-admission staff, or the anaesthetist before you undergo the procedure.