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Hip Replacement Surgery

Hip Replacement Surgery is a surgical procedure in which the damaged or worn parts of the hip joint are replaced with new artificial parts. Nowadays Hip Replacement Surgery has become a commonplace procedure.
The prosthesis (artificial hip) used in modern Hip Replacement Surgery is extremely durable and can expected to last over 30 years. Hip Replacement Surgery will improve mobility, relieve pain and improve function of the hip joint thus improving your quality of life.

Hip Replacement Surgery
To understand a total hip replacement you should first understand a little about the structure of the hip joint. The hip joint is a ball and socket with the ball component attached to the top of the femur (the long bone of the thigh). The socket is part of the pelvis. The ball rotates in the socket to permit you to move your leg backward, forward, sideways and in a twisting motion.

Below is a picture of a healthy hip. The cartilage covers the ends of the thighbone and pelvis. This allows the ball to glide easily in any direction inside the socket.

In a hip requiring Hip Replacement Surgery, the worn cartilage no longer serves as a cushion. As the damaged bones rub together, they become rough, with a surface like sandpaper. This rubbing results in pain with almost any movement and steadily decreasing mobility.

In a total hip replacement the ball replaces the head of the thighbone. The stem component of the ball, which is made of a metal alloy, is inserted into the marrow of the thighbone. A cup made out of a durable plastic material replaces the worn socket in the hip. The prosthesis is held in place by either new bone growing into it or by bone cement.

Before Admission to Hospital
Before hospital admission we would suggest:
You will receive a confirmation letter, a patient pre-surgery enquiry form, and information written specifically for Hip replacement patients
A visit your dentist to correct outstanding problems before hip replacement surgery is advisable.
Arrange for someone to help you around the house for a week or two after coming home from the hospital, to do the shopping and cleaning etc.
Arrange your home to provide easy access to toilet facilities and bedroom. Perhaps bring the bed down stairs, buy in some ready made meals. Place the TV remote control, radio, telephone, medicine, tissues, reading book, waste basket, and pitcher and glass next to the spot where you will sit in the early days resting while you recover.
Remove all rugs and mats which might cause you to trip in the early days.
Place items you use every day at arm level to avoid reaching up or bending down.
Stock up on kitchen supplies and prepare food in advance, such as frozen casseroles or soups that can be reheated and served easily
Take to hospital some slippers, trainers or walking shoes, loose comfortable clothing, dressing gown or bath robe, personal toiletries, eye glasses, dentures, reading materials or anything to help you relax such as a personal walkman and music
Bring phone numbers of people you may want to call
Bring a small amount of money for telephone calls and items such as a magazine
Any medication and a list of any medicines that you have been taking
Bring along any medical reports, MRI’s or x-rays that may be in you possession.

Anaesthesia for Hip Replacement Surgery?
Hip replacement can be undertaken with either a general or epidural (spinal) anaesthetic. Most patients in the UK receive a general anaesthetic although whilst asleep a spinal anaesthetic may also be used. The anaesthetist will discuss the type of anaesthesia used with you prior to surgery. You will first be sedated through an IV in the pre-op area. This relaxes you and minimizes any discomfort of the anaesthetic procedure.
With epidural anaesthesia, a narrow catheter is placed between two bones of your spine. A controlled flow of anaesthetic goes through the narrow catheter, anaesthetising your body from the abdomen down so you will not feel anything during surgery.
If you are undergoing general anaesthesia, you will first be put to sleep by IV medication. A mask or a breathing tube then gives an anaesthetic gas with is monitored by the anaesthetist.

Postoperative pain and its Management
Normally following your surgery you will experience little or no pain. If following the surgery you are experiencing pain, inform the nurse who will administer analgesia or pain killers. Such tablets are usually required regularly for a week or two.

The Hospital Admission.
Prior to surgery
You will undergo a number of tests and x-rays, you will receive a clinical examination and have a consultation with the consultant orthopaedic surgeon.
The Night Prior to Surgery
Often in the UK patients may be admitted to hospital where morning surgery is planned. Otherwise admission to hospital is early in the morning of the day of surgery. In this situation you will be asked not to eat or drink anything after midnight.

The Day Of Your Surgery
You will meet a registered theatre nurse who will care for you until you are moved to the operating theatre. If you did not see the anaesthetist on the evening prior to surgery they will visit you on the day of surgery. The anaesthetist will review your history and discuss with you the proposed type of anaesthesia. An IV will be started and sedative medication will be administered, Epidural anaesthesia may be started at this time.

The Hip Replacement Operation
Your surgery generally takes 1½ to 2½ hours. Do not be surprised if the time for your surgery passes by. The theatre schedule is flexible to allow for some procedures to overrun.

After Your Surgery
After surgery is completed you will be moved to the recovery area in “high dependence” or “intensive care” for a short time, if you have any medical history of heart problems you may well be held in intensive care for a little while. This is just a precautionary measure. Whilst you are in intensive care especially trained nurses will closely monitor you.
You will then be transferred to your room where your family will be allowed to be with you.
You will received several sessions of physiotherapy during your stay in the hospital, this will prepare you to be in good shape for your return home. The physiotherapist will practice getting out of bed, getting up stairs and toileting arrangements before you go home. Once you get home continue to take any prescribed medication and follow the doctor’s instructions regarding the medication. Follow the physiotherapist exercises and instructions for your hip. Regularly undertake the exercises which were provided and take regular short walks several times a day.
Wear an apron for carrying things around the house. This leaves hands and arms free for balance or to use crutches. Use a long-handled “reacher” or stick to turn on lights or grab things that are beyond arm’s length. After surgery, clots may form in the veins of the leg as a result of immobility. This could lead to a post-operative complication known as a Deep-Vein Thrombosis, Pulmonary Embolism or Varicose Veins. For this reason you will usually receive a form of low weight heparin to ensure that thrombosis doesn’t occur. This will be supported by the use of supportive stockings, inflatable boots (worn whilst in bed), and early walking and mobilisation. Unless you have had a thrombosis or are at high risk these anticoagulant drugs are usually stopped when you leave hospital.

In-Patient Recovery
You will have:
A dressing over the hip and mid thigh area,
A foam wedge pillow between your legs. This is to help keep your new hip in place during early healing.
You may have a drain from the surgical site. This drainage tube collects any bloody fluid that has accumulated under the skin and muscle. This tube is usually removed the day after surgery.
A bar or trapeze will be hanging over the bed. Use it to help lift your body when you change positions.
An intravenous infusion.
Your blood pressure and temperature taken.
A urinary catheter or urine bag is often used to monitor the amount and concentration of your urine. This is usually removed 1 or 2 days after surgery.
You can normally drink fluids and eat soon after your return to the ward.
It will normally take 3-5 days to become mobile following your Hip Replacement Surgery. You should usually be able to walk independently with sticks at this time. Please remember that each person is different so times will vary, if you are older or in poor physical condition, have other joints affected by arthritis. Or you are not very mobile it may take longer to recover from your surgery.
Please note that after Hip Replacement Surgery you are not permitted to drive for 6 weeks until safe to undertake and emergency stop and control the care well.

Rehabilitation and Physiotherapy
Your participation in physical therapy is essential to the success of your surgery. The more committed and enthusiastic you are, the quicker your improvement and recovery will be.

A physiotherapist will visit you before surgery and again afterwards on the day after surgery and will start to instruct you on the exercise program. You will receive physiotherapy each day following the surgery.
These sessions are normally one on one with a physiotherapist.

Exercises to Prepare for and following Hip Replacement
To help you to prepare for your hip replacement surgery you may practise the following exercises at home. The purpose of these exercises is to strengthen muscles, which will be useful in your rehabilitation. These exercises should be performed at least twice a day in repetitions of 10 for one month before surgery.

1. Heel Slide
(done lying on your back)
Slide your heel along the surface, bending the knee towards your chest
Hold for 3 seconds
Then slide the heel downward, straightening the knee.

2a. Hip Abduction
Begin with your legs together.
Slide a leg out to the side then return the leg to middle.

2b. Hip Abduction
(lying on your side)
Lift your top leg up towards the ceiling, keeping the knee straight and toes pointed.
Your bottom leg should be kept bent to maintain your balance. Bring your leg back down.

3. Quad Sets
With a rolled towel under your knee, press downwards, tightening the knee and raising the heel approximately 1 inch off the surface.

4. Short Arc Quad Sets
With a bolster under your knee, raise the foot and straighten your knee.
Hold for 3 seconds. Lower your foot slowly

5. Straight Leg Raise
Raise your leg toward the ceiling, keeping the knee straight.
Your opposite knee should be bent, with your foot flat on the surface to protect your back from straining.

6. Ankle Pump
Pump the ankles, pulling your toes up, then point them downward
Continue this up and down movement

7. Knee Extension
Begin with your feet flat on the floor. Slowly raise your foot straightening the knee. Hold this position for 3 seconds keeping the back of your thigh on the chair. Lower your foot to floor.
This exercise can be done with a small rolled towel under your thigh

8. Dorsi/Plantar Flexion
Begin with both feet flat on floor. Raise your toes up keeping your heels on the floor.

Reverse, raising both heels with your toes on the floor.
Continue alternating, raising first the toes and then the heels.

9. Gluteal Sets
Recline on your back, supported by your elbows. Keep both legs straight.
Squeeze your buttocks together as tightly as possible. Hold for five seconds and relax.

How do I find out more?
To fins out more information about pre- and post-operative exercises contact a local physiotherapist.

Moving about following your total hip replacement surgery?
Instructions will be given as to how to:
How to Climb and Descend Stairs?
Bed positioning
Bed transfer
Chair positioning
How to use a walker
Toilet Transfer Using a Raised Toilet Seat
Getting in and out of the Bath
Getting in and out of the Shower
Getting in and out of your Car
Slacks and Underwear
Socks and Stockings
Reaching for Objects
Safe Positions for Intercourse
Unsafe Positions For Intercourse

Frequently Asked Questions – Hip & Knee Surgery
Do I need a referral from my doctor?
It is usually suggested that you bring a doctors referral letter although the doctor can write to your GP for the medical details after the initial consultation.

Would it help if I brought my MRI’s, x-rays, etc with me?
If you can obtain them from the hospital at which they were taken, they are useful. However further investigations and x-rays can be undertaken. Any MRI’s should also be brought.

Should I inform the doctor if there is anything unusual in my medical history?
Yes although this is covered in the pre-surgery enquiry form, which the doctor will have read it is always helpful to mention any major points again.

Will I have the opportunity to ask questions?
Yes of course, you will find that the surgeon is quite open to questions and will explain everything in detail.

Can my partner attend the consultation?
Yes that they are welcome to attend; the surgeon is quite open and has nothing to hide.

Can I bring a relative or friend?
Yes relatives and friends can come to the hospital. Usually only one would stay whilst you are having surgery and perhaps for the first day of recovery.

Will I need a blood transfusion?
Generally for hip surgery it is possible that blood will be needed. However this is now unusual for knee surgery.

What is the blood screening policy?
European policy on filtration and testing of blood is very strict. The hospital is equipped with its own accredited laboratories.

I wish to fly shortly after my surgery is this safe?
The small risk of thrombosis is greatest whilst in hospital but remains raised for some week afterwards. Flying is usually best avoided for a few weeks following surgery, particularly for longer journeys. Taking aspirin, wearing supportive stockings or anticoagulation tablets may help.

What type of anaesthesia is used?
Where possible patients receive epidural anaesthesia, the anaesthetist will discuss the type of anaesthesia used prior to surgery f you have a preference please state this to the anaesthetists or surgeon.

Could you tell me a little more about the intensive care facilities?
Most hospitals undertaking joint replacement surgery have High dependency units or Intensive Care Facilities.

How long will I stay in Intensive care?
Usually patient are returned to the ward or high dependency after a couple of hours. However if you have any history of heart problems are overweight or have other risk factors we may keep you in intensive care for a longer period, this is a perfectly normal procedure.

What make of prosthesis is used?
A range of tried and tested and CE certified prosthesis may be used. This depends upon the severity of the deformity, type of arthritis, age of the patient and surgeon and hospital preferences. This should be discussed with your surgeon prior to the procedure.
What is the expected life implants?
These prosthesis are usually very durable and should last 15 years or more depending on the individual circumstances.

I understand that there is cemented as well as cement-less fixation, which is the surgeon likely to use?
In hip and knee replacement we always try to work with cement-less unless the indications are for cemented i.e. the bone structure is week etc
The reason for not using cement is that the tough alloy used in the construction of the prosthesis is both porous and rough (on the outside) where it meets the bone, this enables the bone to grow and fix itself to the prosthesis. After a short while the bone grows over the prosthesis and the two become firmly fixed together. With cement there is always a possibility of the cement breaking down or working loose. This does not always occur in active. Overweight or elderly patients.

Is the Continuous Passive Motion machine used to exercise after knee surgery?
YES in addition to the morning physiotherapy sessions in the afternoon you may be placed on a CPM machine. This assists early knee motion but is not a replacement for undertaking your own exercises and should not delay you mobilisation and return to walking.

What charges are not included in Private Hospitals?
Phone calls, accommodation for friends or family

I am not very mobile can you assist with wheelchairs?
Wheelchairs are not usually required. Crutches are used initially and will be supplied by the hospital. However before hospital discharge patient often are able to walk using only sticks..

How long is the duration of stay?
Average expected durations of stay are as follows
hip resurfacing – 5 days
hip replacement – 6 days
knee replacement – 5 days
hip or knee revisions – 10 days

Hip resurfacing for young active people!
Resurfacing hip replacement commonly using the Birmingham Hip may be suitable in some patients. The details of this procedure are described separately. Refer to “resurfacing hip replacement” and “Hip resurfacing for young active people”

© OrthopaedicsOpinionOnline 2011
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Disclaimer: The views expressed in this article are not necessarily those of Orthopaedic Opinion Online or the author. The information is provided for general background reading only and should not be relied upon for treatment. Advice should always be taken from a registered medical practitioner for individual circumstances and for treatment of any patient in any circumstances. No liability is accepted by Orthopaedic Opinion Online, or the author in respect to the information provided in respect of the content or omission or for any reason or as a result of treatment in individual circumstances. This information is not for use in the USA.