Total Hip Replacement Information for Patients
Indications
Total hip surgery is a commonly performed operation, which is carried out for arthritis of the hip joint. The purpose of the operation is to relieve pain from the hip and thereby improve mobility.
Before proceeding to a total hip replacement the symptoms of hip pain and reduced mobility may be improved by the instillation of Depo-Medrone and Marcain (local anaesthetic) into the hip joint. This is combined with a manipulation of the joint under a general anaesthetic as a daycase procedure as the injection has to be performed with the use of x-ray impaging under sterile conditions. This is a useful treatmetn tool in early osteoarthritis where there is some narrowing of the joint space but the joint space is still visible on diagnostic imaging. Following such a procedure the patient is asked to be restful for 24-48 hours. This will achieve pain relief and slightly improved mobility in about 60-70% of patietns subjected to this treatment.
There are several types of artificial hip joints that can be used and the type of hip replacement inserted should be decided upon by looking at the individual needs of the patient. Hip replacements may be either cemented or un-cemented. The ball and socket can be made of different materials to suit the needs and requirements of individual patients. These and other factors will be discussed with you should you consult with Mr Drabu.
The Operation
A standard total hip replacement may be carried out under either a regional (epidural or spinal) anaesthetic with sedation or a general anaesthetic depending on the patients’ medical needs. The Consultant Anaesthetist will discuss this with you in detail.
The scar for the operation is either on the side or the back of the upper leg or buttock area. The operation normally takes about one hour to perform and the operation involves removing the worn out ball and replacing it with a metal implant, which sits firmly within the medullary canal (marrow cavity) of the femur (thigh bone). On the top of this implant is the ball. The ball can be made of differing materials and can be of differing sizes. The bony socket (acetabulum) is prepared to accept an artificial socket (cup) and the lining of the artificial socket matches the size of the replaced ball perfectly. This liner can be of differing sizes to match the ball and can also be made of differing materials.
The patients normally stand the day after the operation and are often safe to return home by between two and five days from the date of surgery. They are normally walking with two sticks at this stage and often do not require any additional physiotherapy other than that which they have received during their stay in hospital.
By the time the patients leave, they should be able to safely negotiate stairs, walk with sticks but should not drive for approximately four to six weeks or until they are seen for follow up some six weeks after the operation. All patients are seen at six weeks for a check up and an X-ray.
Results
Mr Drabu has personally carried out more than 9000 joint replacements since 1988.
The results of such surgery show that long lasting pain relief and a return to good mobility achieved in his patients will be discussed at the time of consultation
Most tried and tested hip replacements used here can last in over 80% of active patients for between fifteen to twenty years allowing the patients to lead normal pain free lives. Patients can return to normal activities should they wish following such surgery.
The ability and likelihood of returning to a high level of physical activity may depend upon the type of hip implant used (see Hip Resurfacing), the quality of bone and muscles around the hip joint and the patients themselves and their motivation to return to such activities. [/one_half]
At less than eight months after your operation on my hip… I was skiing non stop from top to bottom of the mountain. A very bit thank you from a very satisfied customer”.
Mr H, London
Complications
All surgery can be associated with certain risks and the possible complications. These complications, if they arise may not affect in any way the result of the hip replacement. However, these risks and complications need to carefully considered and discussed with Mr Drabu before proceeding with such surgery.
The risk of a complication arising is very small, but the following are possible risks:
Infection
A deep hip infection is extremely rare especially in the environment of a private hospital where no emergency surgery is carried out. Should such and unfortunate complication occur, the need to revise the infected hip will need to be considered (see revisions). The risk of a deep hip infection is below 1%
Dislocation
A dislocation is when the ball comes out of its artificial socket. This is a rare complication, but can occur in the first few weeks after the operation if the patient bends or twists awkwardly putting their leg in an unadvised position. Should this happen, the patient often needs to be re-admitted to hospital to have the leg manipulated back in to place under an anaesthetic
Thrombosis
Thrombosis is a clot in the leg. We normally try and make every effort to prevent this complication arising by encouraging early patient mobility and by the use of adjunctive treatments such as foot pumps to encourage better blood flow through the legs, anti-thrombotic agents and TED (support) stockings.
Leg Length
It is not always possible to achieve exact equality in the length of the operated leg compared to the other leg. However, despite the risk, correct leg lengths are achieved in the majority of patients.
Nerve injury
The sciatic nerve runs close to the back of the hip joint and can be bruised during the course of any hip operation. This may lead to a temporary weakness in the foot. However, recovery is possible within a matter of weeks or months following surgery without recourse to any specific treatment.
[/message]The risks and complications associated with any form of surgery can be discussed with Mr Drabu who will be happy to explain the results in his patients since 1988 in further and greater detail.
Your Surgeon and the Operation
Although a hip replacement operation is quite a common operation you should always ensure that your surgeon is sufficiently experienced in such surgery. Mr Drabu would be happy to discus details of his expertise and experience and results in this field and answer any questions or concerns you may have.
” …thank you for relieving me of such excruciating pain and giving me my life back”.
Mrs P, Coulsdon (Bilateral total hip replacement)