Total hip replacement
Hip replacement is a very common operation, with around 100,000 hip replacements done in the UK alone each year.
Total hip replacement surgery replaces the natural joint surfaces of the hip with artificial ones. It is most commonly needed because of damage done to the joint by a degenerative disease like osteoarthritis, but there are other rarer causes, including osteonecrosis, where the femoral head loses its blood supply and crumbles away, and inflammatory arthritis, such as rheumatoid arthritis or psoriatic arthritis.
The new prosthesis removes the pain and stiffness caused by degenerative disease, and it can be a life-changing operation to have.
I carry out over 200 hip replacements a year, which is far higher than many. You can review data from my operations on the National Joint Registry website should you like, and this can certainly be a helpful resource when choosing a surgeon.
When people first come to see me, they tend to complain of groin pain, pain on the lateral side of the hip or pain that goes down the front of the thigh. This pain is often troublesome and affects them standing or walking. When it gets really bad, it can even hurt when sitting still or in bed at night. Certainly, if it's starting to hurt them in bed at night and disturb their sleep, that is a strong indication for surgery.
By the time I see somebody, they will usually have had an X-ray arranged by their GP. This is helpful, as it may show evidence that it actually is degenerative arthritis. If they haven’t previously had an X-ray, I’ll arrange for them to have one at the end of the consultation and then I’ll see them again 20 minutes later with the benefit of that up-to-date X-ray.
I will talk with them about their symptoms as well as their general health. I’ll explain how the hip replacement surgery is carried out, what risks are involved and what they should expect for their recovery.
Before any surgery, it is important a person has all the information needed to make an informed decision, and I will always make sure that we talk through any questions they may have.
Because of the number of hip replacement operations I carry out, the process at Circle is incredibly streamlined. We use an enhanced recovery pathway, where patients are pre-assessed. Their expectations are very clear to them and we give them a comprehensive book called ‘Stryker Joint Pathways’, which has lots of guidance about exactly what to do before they come in, while they're in and when they're getting better. We try to educate them in advance of surgery so that there are no surprises.
People normally come in on the day of surgery, early in the morning. This is known as ‘Day Nought’. They will then usually be able to go on Day Two, so it's not a long stay in hospital. We try very hard to tailor things around their own wishes and expectations when they are with us.
In younger patients, we use a very advanced, uncemented prosthesis with the head made of a special composite material called Oxinium. This is a composite between a metal and a ceramic, where the metal is surface transformed into a ceramic where it's going to articulate with the plastic part of the socket. This creates a really high-performing bearing (it’s currently the best performing bearing in the National Joint Registry and the Australian Joint Registry). It is so good that if I needed a hip replacement, I would want that one.
For older patients, or where I feel that the bones may have some osteoporosis that would need the additional support of cement, I use a very well-established prosthesis called the Exeter Hip. This gives superb results and is incredibly forgiving, even in osteogenic or osteoporotic bone.
I see private patients back in clinic at 6 and 12 weeks to check their recovery. Usually by 3 months, many people are feeling really good. Funnily enough, I used to tell people that by 6 weeks they would be pleased they'd had it done and would be better than they were before. My GP friends, who were seeing my patients to take out their stitches, tell me that most people they see are feeling that way after only two weeks.
Obviously, recovery times vary for each person, but people are certainly noticing significant improvements by two weeks. Within 6 weeks, most are as good or better than they were with their arthritis. Within 3 months, we start to take away the little anti-dislocation precautions we put in place originally, or trim those down to a minimum. Most patients, by then, are really good. Talking with them at this stage I find that many of them have booked a foreign holiday, just to celebrate being better.
A hip replacement is a very good operation, one that can make a significant difference to people’s lives. Seeing the results this surgery gives to my patients is incredibly fulfilling for me; it is actually the favourite part of my job.