What happens before a hip replacement operation?
If one – or both – of your hips are causing you pain, and making it difficult for to move about and live a normal life, you may need a hip replacement. Once your GP has decided that this is likely to be the best course for you, they will refer you to an orthopaedic surgeon. The surgeon (or one of their team) will examine you, to make sure that surgery is likely to be the best option, and set a date for your surgery.
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A few weeks before your surgery is due, you’ll usually have an appointment at the pre-operative assessment clinic. Here you’ll probably meet your surgeon and members of their team. They will carry out a number of tests, such as blood and urine tests, and an electrocardiogram (ECG), so that they can be sure that you are well enough to have the surgery.
Make sure you take with you a list of all the medicines you’re currently taking. Your team needs to know about these so they can check that they won’t affect your health during the surgery, or react badly with any drugs you’re given. They’ll let you know if you need to stop taking any of these before the operation, if you need to change the times when you take them, and if there are any alternatives you should take instead.
You may also see an occupational therapist at this clinic. They will talk to you about how to manage at home in the weeks following the operation, any movements you shouldn’t do and will suggest any aids that might help you. Ask about any help available to help you cope at home after the operation – home help might be a possibility.
If there isn’t an occupational therapist available on the day, ask when you can see one. Their advice is important, and can help make your life easier while you’re recuperating.
You should also see a physiotherapist or an occupational therapist after your operation.
Follow Helen Pierce's Diary of a Hip Replacement for a first-hand account of what it's like to recover from a hip replacement
What is the hip replacement recovery time?
This will vary, depending on your overall health and fitness, and the way in which the surgery was carried out. According to Arthritis Research UK, most people are able to leave hospital within three to days of their operation. However, many hospitals now have an enhanced recovery programme (sometimes known as rapid or accelerated recovery), which can help patients go home even sooner.
An enhanced recovery programme involves making sure that patients are as healthy as they can be before the surgery, have the best care they can during the surgery and afterwards, during recovery. This usually involves including patients and their family in planning their own recovery and care, using minimally invasive surgery, and planning the patients’ fluids and diet.
Along with other factors these steps help patients get back on their feet quickly after the operation – sometimes on the same day - which can speed up their recovery. Patients on an enhanced recovery programme may be able to go home from hospital within one to three days of surgery.
Ask your surgical team if they have an enhanced recovery programme, and if you can be considered for it.
Get well sooner: all about enhanced recovery
There’s more positive news about hip replacement surgery. Research carried out for the National Joint Registry for England, Wales and Northern Ireland and published in 2013, found that hip replacement surgery has become much safer. The study, carried out by the University of Bristol for the National Joint Registry looked at the results of operations on 409,000 patients who had hip replacements from 2003 to 2011.
The research found that death rates in the first 90 days after surgery halved from 0.6% to 0.3%. This improvement was put down to a number of factors, including the use of spinal anaesthetic (which numbs you from the waist down, and doesn’t knock you out) and the posterior surgical approach (when the surgeon carries out the operation from behind, using an incision in your buttock).
Recovering well from hip surgery
Why do I need a hip replacement?
You may need to have a hip replacement if you have osteoarthritis, and the cartilage inside one of your hip joints has worn away. Rheumatoid arthritis can also affect your hips by triggering your immune system to launch an attack on the lining of your hips. Falling and damaging or fracturing your hip joint can also result in you needing a new hip.
Learn more about arthritis
What are the different types of hip replacement?
In a total hip replacement your surgeon will remove the top part of your thigh bone, including the ball part that fits into the socket in your pelvis. They will replace it with an artificial ball, smaller than the original. The next step is to roughen the pelvis socket, then fit a new socket component into it, ready for the new ball part of your hip joint.
These replacement parts can be made from different materials – plastic (polyethylene), metal or ceramic, and they can be used with each other. The most common pairing is a metal ball with a plastic socket. New parts of artificial joints are often attached to the bone using acrylic cement. Ask your surgeon which options they feel are best for you.
Hip replacements - what are your options?
How long will the new hip last?
Most hips last for at least twenty years, but can last for longer. In older people, because most of us aren’t as active as we were in our younger years, the hip can last for as long as we do. On the other hand, younger people may need a new hip at some point, especially if they are active.
If your replacement hip becomes loose after years of wear, or becomes dislocated, you may need to have the operation done again – known as revision surgery. This can be more complicated than the original operation, and may not be suitable for everyone. However, it can last for years in most people who can have revision surgery.
Hip replacements - what you need to know
How long will I have to wait for a hip replacement operation?
The government’s rule on Referral to Treatment (RTT) operational standards say that 95% of non-admitted patients should start consultant-led treatment within 18 weeks of being referred. This means that 92% of patients who haven’t started their treatment yet should wait a maximum of 18 weeks.
In practice this may not always be possible. There are various steps you can take that may help to reduce your waiting time, for instance, looking at waiting times for your operation at other hospitals. You may find a hospital that has a shorter waiting time, but this may mean that you can’t have the surgeon you want to do your operation. You can find out about individual hospitals’ waiting times on the NHS Choices website, by clicking on the ‘Services near you’ button near the top of the page.
A number of issues are likely to influence your decision about whether to go for a shorter waiting time and a different surgeon, or to wait for the surgeon and team that you’d prefer. It can help talk these over with your family and medical team before deciding to change hospitals.
Visit this NHS page for up-to-date information on waiting times
|More advice from Dr Mark Porter...
What about private treatment for hip replacement?
Having your hip replacement surgery carried out privately will reduce your waiting time. A market study published in 2013 on the costs of paying privately for your hip replacement found prices ranging from £7,610 to £14,980. For the most up-to-date figures you’ll need to make your own comparisons, including the cost of accommodation for yourself and anyone who is coming with you.
Does your health insurance cover hip replacement surgery?
Is going abroad for treatment a good idea?
You may be able to have your treatment abroad and claim the money back from the NHS. If you are interested in this, the phrase to remember is the EU Directive route. The EU Directive on cross-border healthcare was passed in 2011. It means that all European Economic Area (EEA) citizens have the right to buy healthcare services in the EEA. This includes hospital run by the state, and private healthcare providers.
This means that you can buy healthcare in another EEA country and then apply to the NHS to pay you back. There are some important points to remember.
You must need to have the treatment on medical grounds, and it must be treatment you could have through the NHS. And the amount you can claim back is limited to the amount of money it would have cost the NHS to carry out the treatment.
Talk to your GP and your consultant or surgeon about this before you make any decisions. They may be able to give you useful information and advice. You need to know whether, with your condition and state of health, it is a good idea to travel abroad. You also need to know what will happen if you have complications and have to stay in hospital longer than necessary. You may need to get approval for the treatment abroad before you go – ask your GP about this too.
You can find out information on treatment in different countries in the EEA, by getting in touch with their National Contact Point. You can find a full list of this information at http://ec.europa.eu/health/cross_border_care/docs/cbhc_ncp_en.pdf .
You might also want to consider the S2 route to having medical treatment in another European country. This is similar to the EU Directive, but means that you may have to pay some of the costs yourself. And you will have to apply for funding before you for your treatment before you travel.
There is also useful information on the NHS Choices website
It is really important that you research this subject thoroughly, or it could turn out to be more expensive than you planned for. How much will travel/health insurance cost you? What happens if you need to be flown back to the UK for further treatment? How much will it cost for someone to travel with you and stay in a hotel?
What will Brexit mean for the over-50s?
Hip replacement recovery tips
Your physiotherapist will give you advice on how to look after yourself and your new hip. Your medical team will aim to get you up and about and eating as quickly as possible, especially if you are on the enhanced recovery programme. Once you’re back at home you’ll have therapy to support your recovery and follow-up checks. Part, of the progamme is to encourage you to take an active part in your recovery.
Here are a few general pointers, to give you an idea of what you need to do – and not do – for the first few months. You will need to be very careful with your new hip for the eight to twelve weeks following your operation. The last thing you want to do is dislocate your hip.
You will have to sleep on your back, with a hip abduction wedge (this will help to keep your legs stable), in between your legs for the first six weeks.
Don’t bend your hips to more than 90 degrees
Don’t cross your legs (both these positions could dislocate your hip)
Carry on with the muscle-strengthening exercises your physiotherapist has recommended.
If all goes well, you should be able to drive a car again after six weeks (as long as your surgeon agrees), if you are working, you may be able to go back to work after six to twelve weeks, and may be able to have sex after six to eight weeks.
Tips for recovering well from hip replacement surgery
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