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Frequently Asked Questions

The Questions we are asked most often:

I found you on the website. Should I speak to my GP first or contact you directly?

Appointments can be made directly with the hip unit, although most insurance companies need a GP referral letter at some stage to authorise treatment.

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Will the cost of surgery be covered by my health insurance policy?

Depending on the details of the policy, the major expenses of the hospital and implants are usually covered in full.

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Should I be doing any special diet or exercise plan before the operation?

An active lifestyle and healthy diet is to be encouraged for everyone. However patients having hip surgery are in pain, which clearly limits their exercise ability. Swimming is probably the best exercise for patients in pain as the water supports the body whilst still allowing movement.

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Did you do anything special to prepare for surgery?

The main thing to prepare for is that you will be less mobile and using some kind of walking aid, either crutches or sticks, for 3 to 6 weeks after surgery. Precise details will be given at your pre-operative assessment visit, where you will be seen by a nurse, physiotherapist and occupational therapist.

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Which implant or procedure is the best?

Modern hip replacements and hip resurfacings work extremely well. The precise implant, bearing surface and surgical approach is tailored to each individual.

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My doctor said he is going to use a titanium implant; is that a good one?

Titanium is the preferred material for uncemented hip replacements. This is because bone grows very rapidly on to its surface, thereby permanently fixing the implant to the skeleton.

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When is the right time to stop waiting and have surgery?

Traditionally, patients in the UK are referred much too late for hip replacements because of the perceived risks. Hip replacement in the modern era is a highly effective, reliable procedure with very low complication rates. Ideally, surgery should therefore be performed when symptoms are interfering with lifestyle, such as work, childcare, or enjoyment of holidays or the outdoors. Surgery also produces a consistently well performing hip, so that future plans are not clouded by the possibility of the hip having one of its 'bad days'.

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What is the difference between MIS hip replacement and traditional surgery?

MIS involves use of special instruments and techniques to perform hip replacements through smaller incisions. The scars are shorter and the initial recovery may be faster. It is important to appreciate that hip replacement performed in the standard manner gives excellent long term results. Therefore any modification in surgical technique must not compromise these results for the sake of short term gain. It is for this reason that MIS THR should only be performed by surgeons with the appropriate training and experience.

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What are the risks of the procedure?

With modern surgical and anaesthetic techniques, complications of hip replacement are fortunately very unusual. Deep infection of a hip replacement is the most feared complication because the hip remains painful, and more surgery is required to cure the infection. Fortunately, infection occurs in less than 1% of hip replacements, and, should an infection occur, it can be eradicated in >90% of cases. Deep vein thrombosis, which is when clots form in the veins of the leg, is apparent in less than 5% of patients undergoing hip replacement. Swelling of the calf and thigh is normal after any hip operation, but if a clot has formed the calf is painful and red. Most clots are prevented by blood thinning injections given whilst in hospital. The main danger is that the clots break off and get caught in the lungs, causing breathlessness and, very rarely, death. Dislocation occurs after less than 2% of THRs, and is usually easily treated by manipulation of the joint back in to the socket under a general anaesthetic. Hip replacement occasionally leads to the operated leg being longer or shorter for various technical reasons. Patients often feel the leg has been made longer, but usually this is because the arthritis has made the leg short and surgery has done nothing more than restore the leg to its correct length. Finally, despite the advances in materials and technique, hip replacements are no more than mechanical devices that can wear out. They are very reliable devices however; one could not imagine a car that runs maintenance free for at least 15 years.

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Will I have a permanent 90-degree bending restriction?

No. This restriction only applies for the first 6 weeks after surgery, and the reason for it is to reduce the risk of dislocation to a minimum. Dislocation is a frightening and unpleasant complication that undermines a patient's confidence in their new hip. It occurs after less than 2% of hip replacements, and, in three-quarters of cases, does not recur. Dislocation precautions are followed for the first 4 to 6 weeks after surgery and include not flexing the hip beyond a right angle, use of a raise on the toilet seat, and not crossing the legs. These precautions are followed whilst scar tissue forms round the hip to further stabilise it.

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How long will a hip implant last?

The National Institute of Clinical Excellence (NICE) has decreed that only implants with a track record of failure of less than 1% per year should be used. Therefore after 10 years, 90% should still be working well. Whilst this performance would be satisfactory for a patient of retirement age, it would not be satisfactory for patients in their 40s or 50s as the hip may well wear out in their lifetime. It is for this reason that longer lasting bearing surfaces, such as ceramic, metal-on-metal, and harder wearing polyethylenes are preferred for younger patients.

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Do hip implants set off the metal detectors at the airport? Should I get a card or letter from my doctor to take with me to the airport?

Hip replacements usually do set off metal detectors. Airport staff are used to dealing with passengers with all manner of implants. Hand held metal detectors confirm the location of the implant and the absence of other overlying metal.

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What physical restrictions do you have after hip resurfacing surgery?

The metal on metal bearing wears out very slowly and is more resistant to dislocation. In theory, therefore, patients are more likely to return to their usual activities after resurfacing rather than after standard hip replacement, and there is some scientific evidence to support this claim. Whilst the bulk of the recovery after resurfacing takes place in the first 2 months, patients continue to improve for a full year after surgery. Patients should have no limitation of walking, cycling, golf and racquet sports, although more extreme activities should be discussed on an individual basis with the surgeon.

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How long will I be in hospital?

Depending on the type of surgery, anywhere between 3-10 days.

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How long before I will be able to drive and carry out normal physical activities?

Patients can start to drive six weeks after surgery. Some kind of walking aid, either stick or crutches, is usually needed for between 3 and 8 weeks. Most patients are almost back to normal after a couple of months, although the hip continues to improve for up to a year after surgery.

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