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What is a total hip replacement?

Steps in total hip replacement
Hip replacement has been a very successful operation, reducing pain and improving mobility for millions of patients. The procedure involves removing the worn out femoral head, implanting an artificial socket into the pelvic bone and attaching an artificial ball to the top of the thigh bone with a stem.

From this simple concept of an artificial "ball and socket joint" has grown a large industry offering hip replacements of widely varying designs, and made of various materials.

When should I have my hip replaced?

For each individual patient the decision to have a hip replacement depends upon the balance of risks against benefits. You need to think about how much the hip is interfering with your quality of life, how much better these problems would be with an artificial hip and how you view the risk of complications.

Although there is some evidence that patients with less sever disease recover quicker and better [Timing of total joint replacement affects clinical outcomes among patients with osteoarthritis of the hip or knee. Fortin, P. R., Penrod, J. R., Clarke, A. E., St-Pierre, Y., Joseph, L., Bélisle, P., Liang, M. H., Ferland, D., Phillips, C. B., Mahomed, N., Tanzer, M., Sledge, C., Fossel, A. H. and Katz, J. N. Arthritis & Rheumatism (2002),46: 3327–3330. http://onlinelibrary.wiley.com/doi/10.1002/art.10631/pdf ], this should not be used to hurry patients into surgery. The NHS has adopted decison support tools which are designed to help patients considering total hip replacement.

The best time to have a hip replacement is when you feel you have tried the simple alternatives and have a good understanding of the likely and unlikely outcomes of the procedure.

For active patients presenting with a hip fracture that cannot be repaired, or where repair has failed, then a total hip replacement is a good option. It can he difficult to adjust to an artifical hip joint after a fracture because the hip joint was normal before the injury. This makes the new joint feel abnormal and uncomfortable, not such a good swap compared to patients having the operation for painful stiff arthritic joints. The main benefit of total hip replacement for fractures is avoiding those complications associated with poor bone healing after some types of fracture.

Which type of hip replacement is best... for my needs?

There is no convincing evidence that any design of hip replacement gives significantly better functional results. However, some aspects of design may be varied to mitigate specific patient related risks:

  • Long life expectancy - Risk of implant wear - Small diameter ceramic articulation
  • High impact activity - Risk of ceramic fracture - Second generation polyethylene articulation
  • Poor bone density - Risk of bone fracture - Cemented implants
  • Poor muscle control - Risk of dislocation - Larger diameter articulation
  • Nickle Allergy - Risk of reaction - Uncemented nickle free implants

The durability of different designs of hip replacement does vary. This is usually measured by the percentage of cases failing (or surviving) at 10 years; unfortunately this means the information is always at least ten years out of date. When compared with the average life expectancy of the population we may be better working to a 15-20 year target.

Technological advances that have yet to prove themselves at the ten year mark should be viewed with caution. Not all new products, regardless of extensive lab testing, turn out to give improved results in real patients.

Like most surgeons I have selected a small inventory of "A rated" implants to cover the needs of the majority of patients. Practice and experience in using these implants, along with careful observation of the reported results, reassure me that these are appropriate for my patients.

How do I prepare for a hip replacement?

There are several things to consider when planning your hip replacement, each hospital produces their own handbook covering the following aspects:

  • Optimise your health: Loose weight, Stop smoking, Control blood pressure/diabetes.
  • Get fit for rehabilitation: Pre-operative exercises, Learn to use sticks.
  • Health screening: Height, Weight, Blood Pressure, Blood Tests, Swabs for MRSA, Medication review, Allergies.
  • Admission Pack: Ward routine, Dietary requirements, What to bring, What not to bring!
  • Discharge planning: Lift home, Roster of family and friends.
  • Preparing your home: Food in the freezer, Seating, Remove tripping hazards, Downstairs toilet/commode.

Cheltenham Nuffield Hospital: Hip Replacement Page

Gloucestershire Hospitals NHS Foundation Trust: THR Handbook

What will happen during my stay in hospital?

The exact pathway of care depends upon the hospital, however there are many similarities. Individual patients may need special care due to other illnesses, allergies or dietary requirements. Please note that hospitals work most efficiently and safely when variations from standard care are kept to the minimum necessary.

Most patients are asked to attend on the day of surgery. Upon arrival there will be some final paperwork and a last chance to ask any questions. The site and side of the operation is marked with a pen on the skin, where it will be visible during the operation.

Your visit to the operating theatre will include double checking your paperwork, then anaesthetic, surgery and a stay in the recovery area until you are ready to go back to the ward. Before returning to the ward the staff will ensure your pain is well controlled and adequate pain killers are prescribed.

As soon as possible you will be up out of bed and walking with a frame. Some patients may elect to participate in an accelerated discharge pathway - aimed at sending patients home after 2-3 nights. Physiotherapists, physiotherapy assistants and the nursing staff will help you progress from a frame to crutches or sticks.

How long will I be in hospital?

Each patient should be treated as an individual, and discharge arrangements based upon achieving milestones:

  • Recovery from anaesthetic - Drips down, Blood count satisfactory, Pain controlled, Normal bladder and bowel function
  • Wound healing - Minimal leakage, Minimal inflammation
  • Safely mobile - Progression from a frame to sticks, Safe on stairs
  • Appropriate medication - Anticoagulants, Restart normal medications

With help from the nursing and physiotherapy team most patients go home after 3-4 nights. If you have other medical problems or other joint problems it may take longer.

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