© Mr Amer Karim (2016)
Mr Amer Karim
MBBS(London), DIC(Orth Eng), MD(Res)
FRCS(Trauma & Orth), FRSA(UK)
Consultant Trauma & Orthopaedic Surgeon
Full British Training & Specialist Certification
Hip Replacement Surgery
About the hip:
The hip is a ball and socket joint that allows your leg to move in all directions and to rotate. The surfaces of both the ball an the joint are lined in a special tissue called "articular cartilage" this substance, provides an extremely smooth surface for the joint to glide.
What is arthritis?
Arthritis is a process where the protective articular cartilage is worn away. This causes pain and stiffness when walking and even at rest in severe cases.
Arthritis can be hereditary (inherited from your parents and grandparents), or post traumatic (following an injury to the hip or an infection in the hip).
When pain and disability are having an effect on your life, that is when you should consider a replacement.
What is a hip replacement?
Hip replacement surgery is an extremely successful operation that has been performed for over 50 years now. Millions of people have benefited from them and it continues to be one of the most common and successful operations performed today.
The procedure involves removing the arthritic joint in the hip and replacing both the ball and socket with an artificial one. The components are made of metal, ceramics or plastic depending on the type of replacement and they can either be cemented in place or be press fitted into the bone.
The specific details regarding the various types of replacements as well as pros and cons of each type will be discussed with you in more detail at your consultation with me, when I will also be able to show you physical samples and x-rays of the replacements.
How long will my hip last?
95% of hip replacements last at least 10 years and some have lasted over 30 years. It all depends on the prosthesis used initially and how much you use your hip.
When can I drive or return to work ?
Most patients can drive within 2 weeks and return to work within 6 weeks of the surgery if you have a sedentary job. The exact timing of your return to function will depend on your progress after the surgery.
Are there any risks?
With any operation there are risks, hip replacement surgery is very safe. The chances of these complications are low, usually less than 2%, however if they do occur, they are serious and so you should be aware of them:
Bleeding during or after the surgery (you may also require a blood transfusion)
Neuro / Vascular Injury
Blood clots in the legs (DVT) or lung (PE)
Haematoma (blood collection in the muscles)
Heart failure, heart attack or stroke
Non-union of the fracture
Dislocation (ball coming out of the socket)
Leg length discrepancy
The procedure is made as safe as possible through experience and I have performed hundreds of these operations without incident.
Will I have restrictions after surgery?
I do not recommend that you participate in high impact or contact sport after a hip replacement, such as running, squash, singles tennis. You will also be restricted from bending your hip more than 90 degrees and crossing your legs for 6 months after the surgery (to allow the muscles to heal and prevent a dislocation)
However, after this time, you can return to swimming, cycling, dancing, playing golf, doubles tennis, walking, gardening and gym work.
Most patients can return to work about 6 weeks after their surgery and drive within about 2 weeks.
What happens before the operation ?
Before the surgery, you will be reviewed by the anaesthetist to ensure that you are medically fit enough to undergo the operation. I will also discuss the risks and benefits of the operation with you in detail and get you to sign a consent form. You will be given ample opportunity to ask questions at every stage of the process.
There are 2 types of anaesthesia available, a spinal or a general anaesthetic. Your anaesthetist will discuss the benefits and risks of each so together you can make a decision on which will be the best for you.
What can I do to prepare for a replacement?
General exercise: Keep as fit as possible, commence exercises on your hip (if not too painful)
General health: Stop smoking, stop alcohol intake, eat healthily and try and lose some weight
Foot and skin care: You must take good care of your skin, feet and nails before a hip replacement (to reduce the chance of infection). See a podiatrist and get your feet and nails looked after. All skin conditions must be healed. Any signs of a skin, foot or nail infection on the day of surgery will result in your operation being cancelled.
Dental care: It is advisable to visit a dentist prior to your surgery to ensure that your teeth are in good condition and there is no evidence of infection that could spread to your hip joint.
You will be admitted to hospital the day before your surgery. This will give you time to settle in and for your observations and laboratory tests to be performed. You may also have a new x-ray taken of your hip if your previous x-rays are over 6 months old. You will also be asked to wear medical leg stockings, these help reduce the incidence of clots in the legs after the surgery.
On the day of surgery, you will be asked to have a shower with medicated soap in the morning (to help reduce the rate of infection), before getting into a surgical gown. You will then be brought to the theatre for your operation.
After the operation, you will be left in bed for the rest of the day to rest. The next morning, you will commence physiotherapy as soon as possible. It is important to start to move the hip straight away to promote blood flow, prevent stiffness and to help the healing process.
Physiotherapy and discharge from hospital?
The physiotherapists will work with you everyday to get your hip moving and to make sure you can mobilise safely with the help of a frame initially, and then crutches. You will not be discharged home until you are safe and your wound is dry.
Rehabilitation after Surgery?
Upon discharge, it is advisable to stay with an able family member who can assist you while you continue your recovery. You should walk often and commence physiotherapy at home. Your wound stitches will be removed in about 2 weeks and you should keep the wound dry and covered up until then.
It usually takes 6 to 8 weeks for you to return to your normal function after a replacement, however it may sometimes take up to 12 months to fully recover from the surgery.
You should then continue your physiotherapy at home, everyday for life !!
I will see you in my outpatient clinic 2 weeks after the surgery to check the wound and remove the stitches. I will then arrange regular long term follow up in my clinic on a 3 monthly and then 6 monthly basis to monitor your progress, depending on your performance.
Should you wish to see me sooner or if you have any other questions, please phone my secretary and she will book you in at a time of your convenience.
Want more information ?
More information can be found on my website: www.amerkarim.com