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Orthopedics |
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Hip Resurfacing
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What's involved?
As you grow older the cartilage in your hip joint can get worn away, making
the joint painful and stiff.
Hip resurfacing involves replacing the diseased or damaged surfaces in the hip
joint (that is on top of the thigh bone and inside the socket of the hip bone)
with metal surfaces. The operation is called metal on metal hip resurfacing.
The operation is recommended if you are under 65 with
advanced hip disease and would otherwise out live a conventional hip
replacement operation. Less bone is removed for hip resurfacing, making it
easier to repeat the operation or to have a further total hip joint replacement
in later years. Hip resurfacing operation can help improve quality of life;
however it is not suitable for everyone.
What are the alternatives?
Surgery is usually recommended only if non-surgical
treatments, such as taking medicines to reduce pain and inflammation or using
physical aids like a walking stick, do not help you.
Preparing for your operation
Your doctor will discuss how to prepare for your operation.
For example, if you smoke you may be asked to quit, as smoking will increase
your risk of getting a chest or wound infection and slow your recovery.
What to expect in hospital
Before surgery you will talk to your surgeon about the
operation and you will be asked to sign a consent form. This confirms that you
understand the risks, benefits and possible alternatives to the procedure and
have given your permission for it to go ahead.
You will be asked to consent to placing your name on the National Joint
Register, which is used to follow up the safety, durability and effectiveness
of resurfacing devices.
If you are having a general anesthetic, you will be asked to
follow fasting instructions. Typically, you must not eat or drink for about six
hours before a general anesthetic. However, some anesthetists allow occasional
sips of water until two hours beforehand.
The operation
Hip resurfacing is a major operation that usually takes up to two hours.
The operation is usually performed under a general anesthetic. This means that
you will be asleep during the procedure and will feel no pain. It can also be
done using epidural or spinal anesthesia (a local anesthetic injected into the
lower back) that completely blocks feeling from the waist downward but you will
be awake.
Once the anesthetic has taken effect, your surgeon will make a cut (usually
about 15 to 30cm long) over your hip and thigh. The length of the cut may be
shorter depending on the technique your surgeon is using.
The worn surfaces of the thigh bone and hip socket are
carefully removed and covered with metal surfaces. Your surgeon will then close
the wound with stitches or clips and cover it with a dressing.
What to expect
afterwards
You will be given painkillers to help relieve any discomfort as the anesthetic
wears off. If you have an epidural anesthetic, you may not be able to feel or
move your legs for several hours after your operation. You won't have any pain
either.
A special pillow may be placed between your legs to hold the new joint still
and help prevent dislocation.
On the first day, you may have to wear special pads, attached to an
intermittent compression pump, on your lower legs. The pump inflates the pads
and encourages healthy blood flow in your legs and helps to prevent DVT. You
may also have compression stockings on your legs. These help to maintain
circulation.
Starting from the day after your operation, a physiotherapist will usually
visit daily to help you with exercises designed to help your recovery.
People generally stay in hospital for around five days but you may need to stay
for up to 10 days. After this time, you will be able to walk with sticks or
crutches.
Before going home, your nurse will give you advice about
caring for your stitches, hygiene and bathing.
After you return home
Continue to take your painkillers if you need to, as advised by your
surgeon.
You may be asked to continue wearing your compression stockings for a few weeks
at home. They are difficult to put on and take off and you will need someone to
help you with this.
The exercises recommended by your physiotherapist are a crucial part of your
recovery, so it's essential that you continue to do them.
You will be able to move around your home and manage stairs. You will find some
routine daily activities, such as shopping, difficult for a few weeks. You will
need to ask for help.
There are certain movements that you should not do in the first eight weeks.
For example, you should not bend your hip more than a right angle or twist your
hip inwards and outwards. Your physiotherapist will give you further advice and
tips to protect your hip.
Follow your surgeon's advice about driving and returning to
work. Generally you shouldn't drive for at least six weeks. If your work
involves a lot of standing or lifting, you may need to stay off for six to
eight weeks.
What are the risks?
Hip resurfacing is a commonly performed and
generally safe procedure. For most people, the benefits are far greater than
the disadvantages. However, in order to make an informed decision and give your
consent, you need to be aware of the possible side-effects and the risk of
complications.
Side-effects
These are the unwanted but mostly temporary effects
of a successful procedure. After surgery, the area is likely to be
uncomfortable for several weeks. There may also be some temporary pain and
swelling in the knee and ankle.
Complications
Complications are when problems occur during or after the procedure. Most people
are not affected. The main complications of any operation are bleeding during
or soon after the procedure, infection and an abnormal reaction to the anesthetic.
Some of the complications specific to a hip resurfacing surgery are listed
below.
- The operation site can get
infected, but antibiotics are given during surgery to help prevent this.
- The operated leg may be a
slightly different length. Sometimes a raised shoe on the shorter side is
necessary.
- Tiny cracks can be made in
the bone while fitting the new surfaces. These usually heal, but sometimes
can result in fracture. This can be treated but may slow down your
recovery.
- Nerves or blood vessels in
the leg can get damaged during the operation, but this is very rare.
- It's possible to develop a blood
clot in the veins of the leg (deep vein thrombosis, DVT). Sometimes this
clot can break off and cause a blockage in the lungs. It's usually
treatable, but it can be a life-threatening condition. You will be given
medicines and/or compression stockings to wear during the operation to
help prevent DVT.
- The metal surfaces can become
loose and may require further surgery.
Ask your surgeon to explain how these risks apply to you.
The exact risks will differ for every person. This is one of the reasons why we
have not included statistics here.
Special Note: Send us the enquiry for the treatment of any type of
disease and get your answers.
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