Joint Reaction

Hip

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Performed by  –   Alastair Davidson,   Azal Jalgaonkar,  Richard Hargrove,   Jonathan Hull,   Seb Sturridge 

This is keyhole surgery that enables us to look inside and treat a painful hip joint to improve pain and preserve the joint. Common symptoms that suggest there may be a problem inside the hip include pain in the groin, thigh or buttock; and mechanical symptoms such as clicking, catching and stiffness in the joint. Pain is commonly due to a torn cartilage, or ‘labrum’ that can be debrided or repaired.

What to expect

The procedure will be as a day case. You will require a general anaesthetic to relax your muscles so hip can be distracted with traction, to enable us to see inside it and introduce instruments to smooth off rough surfaces and remove loose pieces of cartilage that may be causing a problem. We use between two and four small (5mm) keyholes on the outside of the thigh.

On the day of surgery

Before surgery your consultant and anaesthetist will meet you in your room. The operation usually takes around 90 minutes to complete, but you may spend 30 minutes or more recovering in theatre before you return to the ward.

After a Hip Arthroscopy

You will wake up in recovery lying on your back. The hip area to be a little sore but there should be no severe pain. You will need to use crutches for a day or two and shouldn’t drive for ten days or so. There will be exercises to do with the physiotherapist but any impact exercises are not advised for a month. Because we need to pull hard on the leg to distract the hip during the operation, there may rarely be some numbness in the groin or thigh that should resolve within a few days or weeks.

Outcome

Most patients will benefit from hip arthroscopy, but there may be some conditions after which the improvement is only short-term and further surgery may be required. ‘We may ask your permission to enter information about your hip operation onto a national register managed by the British Hip Society. This is to help assess the outcome of your surgery and compare it with many other patients in the UK. It is completely confidential.

You will receive an email from the registry at 6 and 12 months post-op with a simple questionnaire to return. ‘

Keyhole appearance of torn labrum (rim) with some surface damage inside the hip socket

Keyhole appearance of torn labrum (rim) with some surface damage inside the hip socket

Performed by  – Hugh Chissell,   Alastair Davidson,  Azal JalgaonkarRichard Hargrove,   Jonathan Hull,   Andrew Perry, Seb Sturridge

A Total Hip Replacement (THR) is an excellent solution for a painful hip joint. It is one of most successful surgical procedures of the 21st century with over 95% of patients reporting good outcomes.

What to expect

Surgery is to improve pain, and therefore mobility and independence. Replacing a damaged hip involves making an incision along the outside of the upper thigh usually about 15-20 cms long. Whilst the incision is not in a particularly discreet area, the scar left by the procedure usually heals very well.

On the day of surgery

Before surgery your consultant and anaesthetist will meet you in your room. Surgery is usually under a spinal anaesthetic with some sedation so you can be asleep. The operation usually takes around 60 minutes to complete, but you may spend 30 minutes or more recovering in theatre before you return to the ward. You will wake up in recovery lying on your back. Your legs will still feel numb and weak until the anaesthetic wears off about 4 hours later. You will have some pain but this is often much less than you might expect, and the pain of the arthritis will have gone.

After the operation

The Physiotherapist will help you with some bed exercises, and progress you to standing and walking with crutches as you are able. Once you can move confidently with crutches you will be taught how to manage stairs so that when you leave hospital you will able to manage independently. Patients generally take two to five days to reach a point when they are fit to go home, depending their general fitness and their procedure.

After Discharge from hospital

Post-op physiotherapy will be arranged either at the hospital or at a local physiotherapy practice. This will continue for a few weeks during which you will see a constant improvement in your mobility as you gain strength and confidence. After a minimum of 4-6 weeks you may reduce down to one crutch while you are at home, but we would advise you stick to two when you are out of the house.

Lifespan of a hip replacement

Joint Reaction only use the best quality hip implants with a proven track record. It is important to understand that a hip replacement is artificial and will, eventually, wear out. During the lifespan of the THR you should live as normal a life as possible, but we would advise against running and high impact sports as these may cause the hip to wear faster.

Total Hip Replacement
Total Hip Replacement

Performed by – Jonathan Hull

Hip resurfacing is an alternative to full total hip replacement in younger male patients with arthritis. The procedure has been undertaken for over fifteen years and results are now showing that although hip resurfacings may not last as long as full replacements, they provide good function and are robust. The operation removes less bone than hip replacement and, if and when it does wear out, changing the resurfacing to a replacement is generally straightforward.

Xray of completed hip resurfacing

Xray of completed hip resurfacing

The two metal components

The two metal components

What happens in surgery?

Hip resurfacing involves making an incision along the outside of the upper thigh, usually about 15-20 cms long. The scar left by the procedure usually heals very well.

Once the incision has been made the surface of the diseased femoral head and the lining of the cup into which it fits are removed and replaced. The new joint surfaces are made of highly polished cobalt-chrome alloy. The operation usually takes around 60 – 90 minutes to complete.

After a Hip Resurfacing Procedure

Almost all hip operations are done under spinal anaesthesia which completely numbs you from the waist downwards. Sedation is given as well so that you are not aware of the operation being performed. The sedation wears off very quickly and you will be fully awake within 5-10 minutes of the operation finishing. Once the spinal wears off after a few hours, you will have some pain but this is usually easy to control, and the pain of the arthritis will have gone completely.

On the day after the operation you will have an x-ray to check the new hip is well positioned, and the physiotherapists will start you off on some bed exercises. You should be able to stand up and take a few steps with the physio. Over the next few days you will do progressively more, steadily improving your movement and walking so that you should be able to move confidently with crutches, including ascending and descending stairs, by day 3 or 4. Most patients will be ready for discharge by the fourth post-operative day.

Post-op physiotherapy will be arranged and can be done either at the hospital or at a local physiotherapy practice. This will continue for a few weeks and during this time you will see a constant improvement in your mobility as you gain strength and confidence. After a minimum of 4-6 weeks you may reduce down to one crutch while you are at home but we would advise you stick to two when you are out of the house.

You should regain almost full and pain free movement of the hip within 2-3 months of surgery. You should be able to return to active sport after three months.

Lifespan of a Hip Resurfacing Procedure

It is important to understand that the hip resurfacing is artificial and will eventually wear out or loosen in the bone. You should try to live as normal a life as possible, and may return to sports including running activities if you wish.

Results from the biggest series of hip resurfacings in the UK have found that many patients return to vigorous activity such as squash, ballet dancing and football without seeming to harm the hip. Long term studies have shown that 5-10% of hip resurfacings have been revised to hip replacements by ten years, but 90% + clearly last longer than this. One of the rare causes of failure is allergy to the metal ions released from the implant (so-called Metal on Metal disease). This can cause soft tissue damage and fluid collection around the implant and we monitor this by annual follow-up and xrays for the life of the hip resurfacing. This is done in the NHS metal on metal clinic and may require blood tests and scans if there are symptoms.

Mr Hull is now the only Joint Reaction surgeon undertaking hip resurfacing as the total numbers being performed are now not sufficient to justify more than one of us doing them.

Performed by  –  Azal Jalgaonkar,  Richard Hargrove,   Jonathan Hull,    Andrew Perry,  Seb Sturridge

Hip replacements can eventually loosen in the bone and become painful. This may be due to wearing down of the bearing surfaces within the hip or infection. Typically patients will feel pain in the groin or thigh, which starts gradually and is often worse on first standing up. This can be treated by removing the old implant and replacing it with a new one – revising the hip replacement.

What happens in surgery?

A revision operation is usually more complex than a first time hip replacement. The old components need to be removed and new, usually larger, ones will be put in their place. Sometimes the bone has been worn away and will need replacing with artificial or grafted bone, obtained from a registered bone bank. Bone graft is perfectly safe from infection risk and encourages what is left of the original bone to re-grow. The type of replacement used will vary and special components will sometimes be needed. Generally, we try to avoid using bone cement with revisions.

Revised Hip Replacement

If infection is the cause of the loosening two operations may be necessary. The first to remove the implant and any infected tissue. The second operation, some 6-8 weeks afterwards, to insert the new definitive hip. During the interval between operations you will be able to go home but will need crutches to get about. Patients generally find it surprisingly easy and comfortable during this time.

After the operation

As the operation is more complex you will be closely monitored in the first day or two, sometimes on the High Dependency Unit. You will probably require a catheter and will generally have to have a post-operative blood transfusion.

The recovery period is likely to be longer than the first replacement, mainly because the muscles take longer to heal as they have been repaired for a second time. You will need to use crutches for longer and it may take up to a year for optimal recovery to be achieved. There is a higher risk of dislocation, fracture, thrombosis and infection following revision surgery, but the overall results are still good with at least 70% of second hips lasting at least 10 years.

Revision Hip Replacement