Orthopaedic Clinic: Hip and knee
TOTAL HIP REPLACEMENT
The hip joint is a ball and socket joint made up of the head of the femur (thigh bone) and acetabulum (socket) which are covered in articular cartilage and lubricated by synovial fluid. Osteoarthritis of the hip is a condition where there is loss of articular cartilage of the head of the femur and of the socket, causing damage to the bone surfaces which in turn causes pain. The pain is usually felt in the groin, but also may be felt on the side of the hip, the buttock and sometimes into the knee.
Osteoarthritis is most common in people in their 60s and 70s and may be caused by a variety of factors including general wear and tear, trauma, inflammatory disorders or rheumatoid arthritis. The result from the loss of cartilage leads to bone rubbing on bone.
Depending upon the severity of arthritis and the age of the patient, treatment may consist of non-operative or operative methods or a combination of the two. The first line of treatment may include moderating activity, hip injections, losing weight. If however this first line treatment fails surgery may be the correct option.
A total hip replacement is a major operation and making a decision to undergo surgery is usually reached when the pain of arthritis prevents patients leading an active life, interferes with sleep or becomes so debilitating it prevents most normal activity. Total hip replacement surgery is a reliable and effective means of relieving pain and giving patients back an active life and is considered widely to be one of the most successful surgical procedures.
THE PROCEDURE
Hip replacement surgery involves cutting away the arthritic bone and inserting a prosthetic joint. Both the head of the femur and socket are replaced, usually using a metal ball on a stem which is implanted into the femur and a plastic socket which is inserted after removing the arthritic surface. The stem is usually made of cobalt-chrome or titanium; the ball is made of polished metal or ceramic and the socket is usually a combination of a plastic liner and cobalt-chrome or titanium backing.
Total hip replacement surgery at The New Victoria Hospital is carried out in an operating theatre with a special laminar airflow system which reduces the chance of infection.
Following surgery
AFTER THE OPERATION
- Most patients will get out of bed the day after the operation with the assistance of a physiotherapist.
- The physiotherapist will see you each day and you will be taught:
- Exercises to get your hip stronger and more flexible – to be done daily with the physiotherapist and then independently.
- How to walk with 2 elbow crutches – you will be allowed to walk independently with crutches when the physiotherapist thinks you are safe to do so.
- Techniques to sit down and stand up from the chair.
- Techniques to get in and out of bed.
- How to go up and down stairs.
- How to use 1 elbow crutch in the house if required or 2 sticks if able/progressed enough.
GENERAL ADVICE
There is a small possibility in the first 6 months that the hip might dislocate as the tissues take this long to fully heal. Therefore you should avoid the following:
- Bending your hip beyond the amount bent in a normal sitting position (i.e. 90º)
- Crossing your legs
- Twisting movements
- Bending down to pick things up from the floor. (The hospital can supply you with a device called a Helping Hand for this)
- Lying on your side in bed for the first six weeks.
GETTING IN/OUT OF THE CAR
- Put the seat back as far as it can go.
- Go bottom first into the car, then lift yourself further in.
- Manoeuvre each leg in carefully, then turn to face the right way. (A plastic bag on the seat may help), but ensure this is removed before being driven away.
- Do not step foot first into the car.
- For the first 6 weeks avoid unnecessary car journeys.
BATHING & WASHING
- Wait at least 12 weeks or until advised by your consultant before attempting to have a bath.
- Make sure you have someone with you. (A bathboard to help with this is available from the hospital).
You may need help with feet washing – do not bend down to do this.
DRESSING
- Always remember your operated leg goes in first when dressing, and comes out last when undressing.
- Dressing is most safely done whilst sitting.
- Do not bend down to your feet or bring your operated leg up towards your chest.
- Use your aids i.e. helping hand, long handled shoehorn to help.
- Wear slip on shoes where possible, with a back to them.
GARDENING
- Do not bend to ground level and avoid prolonged standing for 3 months.
- Use long handled tools but avoid digging. Do not kneel.
SEX
- Sexual intercourse may be resumed as soon as you find it comfortable.
- Initially you will need to lie on your back and avoid twisting.
STAIRS
- Going downstairs: Crutches first, then your operated leg, followed by your un-operated leg.
- Going upstairs: Exactly the reverse – un-operated leg, then operated leg, followed by crutches.
- You can use 1 crutch and the banister or both crutches.
CONCLUSION
Once home you should continue with the exercises and progress with your walking by going for regular short walks at least three or four times a day, with your walking aids.
You should continue to follow the precautions indicated above and use the walking aids advised until the tissues around your new hip have had time to heal, and for the bone to repair. Usually this will be for six to eight weeks but your surgeon will advise you if there is any change.
EQUIPMENT
You will be provided, at a small charge, with all the necessary equipment i.e. raised toilet seat, chair raises, bathboard, crutches, long handed grabber (helping hand) long handled shoe horn. You will need someone to fit some of these items for you when you get home.
If you already have equipment or adaptations at home, please could you inform your Physiotherapist as soon as possible. We are happy to loan equipment free of charge for your stay in hospital.
