Hip replacement is successful and predominantly performed as an elective operation in the Western world. Originally developed last century, the hip replacement is a highly reliable device that can both restore function and relieve pain.
Hip replacement is normally indicated in patients who develop osteoarthritis of their hip. Arthritis is a degenerative condition in which the hip wears out. The symptoms include pain situated in the groin, buttock, lower back and thigh to the knee and sometimes below. These symptoms can be aggravated by weight bearing exercise such as walking, driving and sport and also can be particularly bad at night, keeping the patient awake. The hip becomes stiff and the patient finds it difficult to put shoes and socks on, cut toenails, cross their legs and get onto a bike.
Initial treatment includes making the diagnosis which can normally be done by clinical examination and a plain x-ray.
Initially I recommend conservative treatment. If conservative treatment does not work, and x-rays show severe arthritis, then the best option is to proceed to hip replacement.
The good news is that hip replacement is highly successful and 95% of patients will get rid of their pain and return to full activity including sport. Recovery and rehabilitation is rapid after hip replacement. Mr Middleton specialises in minimally invasive surgery and an enhanced recovery programme. This enables the patient to feel fitter and stronger earlier, spend less time in hospital and return to normal activities more quickly.
The normal stay in hospital for a hip replacement is four days. The operation is performed under a spinal anaesthetic either with sedation or a light general anaesthetic. This reduces the complications such as chest infection and the patients wake up and recover quickly as soon as the operation is over.
The day after the operation the physiotherapists get the patients out of bed and get them walking, initially on a frame, then on crutches and then on sticks. Usually by day three or four the patient can get out of bed unaided, can dress themselves, walk up and down the ward and do a flight of stairs. At this stage they are normally ready for home. I recommend a daily walk with walking aids such as crutches or sticks which can be dispensed of normally in the first few weeks as soon as the patient is feeling confident and the limp has gone.
At six weeks following the operation Mr Middleton reviews the patient in Out Patients and if all is satisfactory removes any restrictions on the patient’s activity and they can normally return to driving and office based or light manual work. Sport, gardening and manual work is not normally recommended until three months following surgery.
Mr Middleton specialises in hip replacements and is one of the most experienced hip surgeons in the country. He has been involved in developing the latest techniques and treatments in hip surgery and trains other surgeons both in the UK and abroad in these techniques.
Choice of the type of hip replacement is important. There are many different designs on the market. Mr Middleton chooses the best implant suitable for the patient in order for them to achieve their goals of being pain free and returning to activity. He uses both cemented and uncemented hip replacements. He favours the use of implants with proven excellent outcome. For most patients he recommends the use of a large head with an advance bearing surface. The large head increases the range of movement of the hip, reduces the risk of dislocation of the hip or the hip coming out of joint. The advanced bearing surface can be ceramic, highly cross linked polyethylene or metal, reduces any wear of the hip and therefore could increase the life span of the hip replacement.
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