Hip Replacement Surgery
To alleviate chronic hip pain it may be beneficial to undergo surgery to allow the patient to live a full and carefree life – providing the ability to do whatever they want without the constant threat of pain getting in the way. Professor Ali Ghoz offers a number of different treatments depending on individual needs and will go through the details on a patient-by-patient basis before any procedure.
Hip replacement surgery has proved very effective in treating chronic hip pain. It is typically recommended as a last resort when medications, walking aids and changes to lifestyle have not been helpful. Over 75,000 hip replacements are undergone in the UK each year, and they have the ability to significantly improve an individual's quality of life. On this hip replacement page, you can read information on hip replacement surgery, covering topics such as; how the hip works, the causes of hip pain, the surgical procedure itself, and recovery from hip replacement surgery.
Some of the advantages of the minimally invasive X-ray guided hip surgery:
- No muscle cutting
- Decreased pain after surgery
- Shorter rehabilitation period
- Shorter hospital stay
- Lower risk of dislocation
- Better positioning of implants
- Reduced risk of limping
- Faster return to daily activities
- Smaller skin scar
How the hip works
The hip joint - which is comprised of the ball at the top of the femur (thigh bone) and the acetabulum (rounded socket) of the pelvis - bears a high level of body weight. It relies on the ligaments for stability and the cartilage for cushioning. It is covered by synovial membrane, which serves to lubricate the joint in a healthy hip.
Common causes of hip pain and mobility
Among the common causes of hip pain are; osteoarthritis, a disease which involves the deterioration of the articular cartilage; rheumatoid arthritis, a disease which involves the inflammation of the synovial membrane; and traumatic arthritis, which typically follows a hip fracture or other injury.
Why have Hip Replacement Surgery?
There is no one ‘right time’ to have hip surgery – it depends on the individual and how the pain is affecting their lives. Professor Ali Ghoz always advises patients to take their time and really think about when it is right for them. If the pain is interfering with a patient’s daily routine then it might be time to do something about it.
Opting for hip surgery is a way to eliminate hip pain and the bespoke treatments carried out by Professor Ali Ghoz enable patients to rediscover an active life.
Is Hip Replacement Surgery for me?
The decision to opt for hip replacement surgery should be the result of discussions between an individual and their doctor. The findings of an orthopaedic evaluation can be an important part of this process, and a recommendation will take into account the age of the prospective patient, as well as general health, disabilities, and level of pain experienced.
In general, candidates for hip replacement surgery include people affected by hip pain in the following ways; everyday activities are inhibited; pain while resting; stiffness which inhibits leg movement; little or no relief from medications such as anti-inflammatories; bad side effects from medications; other forms of physical therapy have proven unsuccessful.
An orthopaedic surgeon will typically be central to evaluating a patient's hip condition and assessing whether hip replacement surgery is the best treatment path. They can also advise when different types of surgery, further courses of medication, or forms of physical therapy are the best option.
Evaluations made by an orthopaedic surgeon can include a review of an individual's medical history, a physical examination to determine the strength and mobility of the hip, and x-rays. Other tests such as an MRI or blood tests may also be undertaken.
Mr Reginald Holmes, doing really well just one week after a minimally invasive, total hip replacement.
He decided to come to see me after waiting for 2 years as an NHS patient, and he's delighted with the outcome and his investment.
What are the options?
Before the decision to go ahead with surgery is made Professor Ali Ghoz will go through non-surgical options – such as pain relief medication and exercises – with the patient but if it is thought that it is the right time for hip surgery then there are a number of replacement treatments available depending on the individual need of the patient.
Whether it is hip replacement or hip resurfacing replacement there are a few options when it comes to the type of bearing used in the ball and socket joint. These implants should last a lifetime (depending on the age of the patient).
Traditional hip bearings are comprised of a metal head moving on a polyethylene – or plastic – liner. Studies have shown that these liners take around 30 years to wear out so are ideal for an active life.
Metal on Metal Bearings
Metal on metal bearings have been developed with younger patients in mind. Their strength and durability give them the ability to last even longer so have more chance of lasting a lifetime.
Ceramic bearings have extremely low wear rates and are again ideal for the younger patient. With all these options surgical technique is critical and Professor Ali Ghoz has the skill and expertise to perform a minimally invasive procedure to suit the individual patients’ needs.
Approaches to Hip Replacement Surgery
When pain becomes too much to bear and is limiting an individual’s ability to maintain the life they want to lead, a total hip replacement is a highly successful option. It is never too late to replace a hip joint and with the improvements in surgical and anaesthetic techniques recovery times are now faster – with less pain – making for an easier recovery.
There are two approaches to total hip replacement surgery and Professor Ali Ghoz is comfortable performing them both using minimally invasive techniques that are individually customised to cater for the needs of each patient.
The minimally invasive direct anterior approach (sometimes referred to as DAA or AMIS) promises quicker recovery due to the fact that it uses intramuscular planes allowing exposure of the hip joint without detaching muscle from the bone.
A recent study has shown that dislocation rates are lower when the anterior approach is used, which means less need for corrective revision surgery:
The more common posterior approach to hip surgery requires splitting muscle and detachment of rotator muscles to perform the procedure from the back. There is therefore a slightly longer recovery time to be expected.
Studies have shown that after 12 months patients are able to function equally well with either approach used. Professor Ali Ghoz favours the anterior approach from a recovery perspective but believes the most important factor is to ensure a safe and full recovery to provide the individual patient’s pain solution.
Before Hip Replacement Surgery
After Professor Ali Ghoz has discussed the options with a patient and decided on surgery as the way to go they will need to attend a pre-admission clinic where a nurse will go over the procedure and post-operative details. Routine blood tests and an ECG will then be performed.
Patients are given an antiseptic soap at the clinic that needs to be used for the two days prior to the surgery. This reduces the risk of skin infection after surgery.
Preparing for Hip Replacement Surgery
There are several aspects of preparing for hip replacement surgery. Many preparations are related to the specific medical condition or history of the individual. They include medical evaluation and tests; the potential need to stop taking certain medications, in line with doctor's advice; weight loss, depending on a person's physical condition; and preparation of the skin, in the case of irritations or infections
One preparation which can help all hip replacement surgery patients is social planning. As walking aids will be needed and mobility severely restricted for several weeks after the operation, assistance is typically needed for those who live alone. Arrangements need to be made for help from family, friends or a care professional, with everyday tasks such as bathing, cooking and shopping.
During Hip Replacement Surgery
Professor Ali Ghoz’s minimally invasive procedures are carried out under a combined spinal anaesthetic and a light general sedation. This is entirely safe and is proven to reduce any possible complications during joint replacement surgery.
A urinary catheter is used as the drugs given for pain relief invariably result in patients finding it difficult to pass urine for 12-18 hours. Removing the catheter is a very straightforward process and not painful at all.
Pain relief after the surgery is down to the individual patients’ needs in accordance to the anaesthetist’s direction.
During surgery, the surgeon removes both the damaged bone and cartilage, before placing the new joint, and ensuring that optimal alignment and function are restored.
The materials used for the artificial hip joints will vary, but are typically made up of the socket component (usually plastic, although a metal outer shell can be used) and the ball component (usually metal). The type of prosthesis which is chosen will be determined by the needs of the individual.
The surgical procedure itself typically takes one to two hours.
Your stay in the hospital
Following the procedure, you will typically be moved to a dedicated recovery room for your recovery from anaesthesia to be monitored. From there, once you regain consciousness, you are taken to the hospital room. Patients typically stay in hospital for a period of a few days after surgery. Painkillers are typically administered, and light activities will commence soon after surgery in order to aid recovery.
What results to expect from Hip Replacement Surgery
Hip replacement surgery can help the overwhelming majority of patients in reducing hip pain and improving mobility. It should be understood that hip replacement surgery cannot be expected to improve mobility to a greater level than before the development of the hip problem. It should also be noted that artificial joints can experience wear, especially if the load which is borne by the hip joint is high, due to obesity or high impact activities.
The rate of complications following hip replacement surgery is recognised as very low - the chance of serious complications such as infection as a result of hip surgery is two percent or less. The most common complication after the procedure is blood clots in the pelvic region or legs. A surgeon may administer physical aids, such as leg coverings, or medication in order to prevent them. It is understood that pre-existing chronic illnesses in a patient could increase the chances of complications.
Recovery from Hip Replacement Surgery
Preventing thrombosis is the priority after hip replacement surgery and mobilisation and exercise are vital. To aid this, every patient is fitted with a calf compressor that promotes blood flow and prevents clots.
The sooner a patient gets out of bed and walks the less the risk of thrombosis so Professor Ali Ghoz encourages his patients to walk twice a day whilst in the hospital. The more exercise the better but patients are warned not to overdo things.
Although there may be some discomfort the key to a successful recovery after replacement surgery – even the minimally invasive techniques offered by Professor Ali Ghoz – is mobilisation. Physiotherapists will be able to show patients exercises to help recovery and ensure that hip replacement surgery is just the start of a new way of life.
Your recovery at home
Home care can be vital to the overall success of hip replacement surgery. Great care should be taken to follow the surgeon's instructions with regards to; wound care, including avoiding exposing the wound to moisture; and diet, which involves sticking to a balanced intake and plenty of fluids.
Avoiding problems after surgery
As noted above, it is vital to follow the surgeon's instructions during the recovery period in order to avoid complications. Should you feel leg or calf pain which is unrelated to the target area of your surgery, or swelling in the leg or foot region, a doctor should be notified as soon as possible.
How your new hip is different
In the weeks following surgery, you might feel some pain when making certain movements, such as bending down. These niggles can be expected to subside over time, and patients should notice a significant improvement compared to their hip prior to surgery. The new hip might set off metal detectors when going through security checks. In order to verify that they have an artificial hip, patients may be given a card by their hip surgeon.
I would like to record my thanks to Professor Ali Ghoz for his excellent treatment before, during and after my anterior hip replacement on 19th August 2021.
He was always ready to answer my questions patiently and with courtesy.
When there was a problem with an x-ray at the Cromwell Hospital, (the radiologist was called to the operating theatre), he personally arranged another x-ray appointment at a hospital local to me.
Professor Ghoz is a credit to the Cromwell hospital and his profession.
Mr Ali Ghoz is a top man surgeon and always makes me feel like a special lady. Its been along the journey for me after 2 new hip replacements and now planning a keyhole surgery on my knee so feel so at home down there and I know all the staff personally. Thank you every one for the tip top hospitality I have always received. What a great hospital and a great team. Many thanks to you all.