1. WHAT IS ARTHRITIS?
The ends of the long bones are covered with a smooth glistening substance called cartilage. Over the years the cartilage may be slowly damaged revealing the rough bone surface underneath. We say that the joint has become arthritic.
2. WHY IS ARTHRITIS PAINFUL?
The precise cause of pain in arthritic joints is not known. Nerve endings in the damaged bone may be stimulated. Pain can also come from inflamed soft tissues around the joint.
3. HOW IS THE DIAGNOSIS OF ARTHRITIS MADE?
As a general rule, the pain from an arthritic hip is felt in the groin area. The pain can also be felt in the buttock, outer aspect of the thigh or in the knee. Often patients will also complain of difficulty putting on shoes/ socks and have difficulty getting in and out of cars. X rays of arthritic hips show loss of the cartilage in the joint, cysts are often visible and spherical appearance of the ball of the hip joint may become distorted as shown in image 1.
4. WHY DO I HAVE ARTHRITIS IN ONLY ONE HIP JOINT?
Each side of the body is slightly different. It might be that the ball of the hip joint is rounder on one side than the other, the lining of the bone ends may be thicker on one side, or the cartilage may be more worn through injury on one side. Alternatively, the socket of the hip joint may be better formed on one side.
5. HOW LONG WILL MY HIP REPLACEMENT LAST?
It is likely that you will never have to have your hip replacement redone during your lifetime. With the Exeter Hip Replacement, 93% of the stems will last more than 30 years. With recent improvements in surgical techniques, I think that this figure will now approach 100 %. It is possible that in about 10% of cups will require revision over a 20-30 year period.
6. IS A HIP REPLACEMENT A SAFE OPERATION?
Millions of traditional hip replacements have been undertaken worldwide. It has become well established that traditional hip replacements consisting of the plastic socket and stainless steel stem are extremely safe and well tolerated by the body. There is no evidence of increased risk of cancer around the hip replacement and allergic reactions are rare.
7. IS THE COMPLEXITY OF HIP REPLACEMENT ALWAYS THE SAME FOR EVERY PATIENT?
When the hip joint becomes very worn out, there is a chance that the bone of the pelvis becomes damaged. If this happens, bone grafting will be required to build up the deficiency. Some patients may have been born with abnormal hip joints, and similarly may require bone grafting surgery to form a solid base for the implanted socket.
8. HOW CAN I HELP MYSELF BEFORE THE HIP REPLACEMENT?
A hip replacement is a big operation and it is therefore important to be as fit as possible before the surgery. Mr Lawrence recommends a good healthy diet with lots of fruit and vegetables to increase your vitamin C levels which will speed up the healing process. Keep as active as possible so that your muscles remain in good shape. Try not to put on any weight before your surgery, as this will make the operation slightly more difficult and may increase the complication rate slightly. Stop smoking!
9. WHAT KIND OF ANAESTHETIC WILL I HAVE?
As a general rule, most patients have a spinal anaesthetic. This involves injecting an anaesthetic agent into the skin of your back and then a needle is introduced into the fluid surrounding your spinal cord. Further anaesthetic and morphine is then injected to anaesthetise and temporarily (6 hours) paralyse the lower part of your body. Once the anaesthetic has taken effect, you will normally be given some sedation or a light general anaesthetic and many patients wake up quite refreshed and pain-free.
The main benefits of the spinal anaesthetic include shortening the recovery period from the anaesthesia, pain relief for 6 hours following surgery and earlier active movement of the lower limbs.
On occasion, it is not possible to place the spinal needle into the right spot, in which case, a general anaesthetic will be given. On other occasions, patients are worried by the thought of the spinal anaesthetic and prefer a general anaesthetic and this will then always be given.
The amount of pain felt immediately after a hip replacement varies from patient to patient and depends on their pain threshold, personality, and expectations. For the first 48hrs after surgery, once the spinal anaesthetic has worn off, the pain can be difficult to control and morphine-like drugs are often required. Unfortunately, one of the side effects of morphine is nausea and vomiting and some patients appear to be more sensitive to morphine than others. As a general rule, by the third postoperative day, most patients realise that the arthritic pain from the hip joint has gone and are aware only of an ache from the surgical incision.
10. HOW LONG WILL THE INCISION BE?
As a general rule, the incision will be the length required to have good visibility of the hip joint at the time of the hip replacement. Patients with padding over the hips will have a longer incision than thin patients. The length of the incision does not have any impact on the speed of recovery, and generally speaking, the complication rates with longer incisions are lower than with keyhole style incisions.
11. HOW IS THE PAIN CONTROLLED AFTER SURGERY?
For the first six hours after surgery, the spinal anaesthetic gives good pain relief. Thereafter for 48 hrs or so, the patients can administer there own pain relief using PCA (patent controlled analgesia). Morphine can be administered by the patient via a little pump attached to the back of the hand as and when required. Safeguards are in place to prevent the patient from overdosing.
After the first 48 hours, pain is usually controlled by simple painkillers such as Co-codamol and Brufen. Take the medication regularly to avoid pain.
After one week to 10 days, most patients start weaning themselves off the painkillers.
12. HOW MUCH HELP WILL I NEED AFTER THE OPERATION?
Most patients, by the time they leave hospital, will be self-caring and will be able to walk 50+ yards without difficulty. Very little assistance will, therefore, be required once you leave hospital provided that you are fit. Some help is often required when the support stockings are put on or taken off since they are tight fitting. Elderly and frail patients will obviously feel weak after the surgery and will need more help than younger more robust patients.
13. HOW QUICKLY WILL I RECOVER AFTER SURGERY?
The usual length of hospital stay ranges from 4-10 days. Young patients recover more quickly and usually leave the hospital after 4-5 days. More elderly patients leave the hospital after 6-7 days. By the time you leave the hospital, you will be able to walk 50 yards comfortably and will be able to climb stairs. With each passing day, you will be able to walk further and further. By 6 weeks, you will be enjoying short walks outside. Many patients by 3 months will be able to walk an unlimited distance and will start enjoying gentle sporting activities such as golf.
14. WHEN CAN I GO ON HOLIDAY AFTER SURGERY?
As a general rule, most patients will start having enough energy for a holiday after 4-6 weeks. If a long haul flight is desired, Mr Lawrence recommends support stockings and aspirin to avoid blood clot formation.
15. WHEN CAN I DRIVE AFTER THE HIP REPLACEMENT?
Most patients want to start driving after 6-8 weeks. As a general rule, it is safe to start driving when you can walk without a stick and no longer have much pain.
16. HOW ACTIVE CAN I BE AFTER THE HIP REPLACEMENT?
In principle, there are no restrictions on the activities that you can undertake after the hip replacement. Mr Lawrence has a number of young patients that have returned to 5 aside football, marathon running, tennis, skiing, long-distance cycling. Golfers return to playing golf usually about 4 months after the operation. Rambling, swimming and gym work can normally be enjoyed after 6 months.
Some activities are very high impact such as Karate and squash and these activities should be avoided.
17. WHAT SHOULD I AVOID DOING AFTER THE HIP SURGERY?
I think that the most important thing to avoid after the operation is deep bending or crouching. As a general rule, your hip should be very stable after the hip and you are unlikely to dislocate it. Convention has it, that you should sleep on your back for 6 weeks, have a pillow between your legs when sleeping for six weeks, use toilet seat raises for3 months, and sit in a high chair for 3 months.
18. ARE THERE ANY BENEFITS OF HIP RESURFACING?
In my opinion, the risks of resurfacing using metal on metal implants outweigh the benefits. I believe that there are potential long-term complications associated with the production of metal wear debris. There is evidence that heavy metals such as cobalt and chromium enter the bloodstream. This may reduce the body's resistance to infections (reduced immunity). Some patients may also develop allergic reactions to metal particles and in some cases, the genetic material in cells around the hip replacement may become damaged.
The main advantage of hip resurfacing relates to the lower dislocation rate allowing patients to return to more vigorous activities, however, there are safer alternatives.