FAQs

This is the million-pound question. My aim is to be there to guide you through that decision making process. The factors to take into account are:

1. How bad are my symptoms now?
2. What are they stopping me from doing?
3. What can I do simply to improve things?
4. Should I be putting up with these symptoms at this stage in my life?
5. What are the risks of surgery?
6. How does having a hip replacement fit into my life now?
7. Are there work or family issues that will affect this decision?
8. What does my life look like if I have surgery?
9. What does it look like if I do not have surgery now?

Only you will know the answers to these questions and therefore the decision is yours to make. I hope that by answering your questions and explaining the process and likely outcomes you will feel you have all the information you need. You don’t ever need to make a decision straightaway and I encourage you to take the time you need to make a decision. Most patients will arrive at the clinic having worked through these questions in their mind informally already and this can make the decision a simple one.

We have good evidence to support hip replacements lasting well up to roughly 15 years, with roughly 97% lasting this long. More recent evidence uses some estimates but we believe that roughly 85% of hip replacements will last 20 years and 65% will last 25 years. This is based on hip replacements that were done a long time ago with poorer quality materials. It is reasonable to assume that our current hip replacements will last well beyond 20 years but we don’t yet have the evidence to prove that. I mainly use the Exeter hip replacement which has some of the best long term results and a high proportion will last up to and beyond 30 years.

It is my standard practice to leave 3 months between performing a hip replacement on one side and then the other side. This is to reduce the risk of complications – in particular, the risk of needing a blood transfusion and the risk of developing blood clots. It also allows time to properly recover from the first procedure before embarking on a 2nd major operation. I am aware that some surgeons will offer to perform both hip replacements simultaneously, but I do not believe this is best for patients unless there are some very specific circumstances that would make it safer to have only one anaesthetic. I am happy to discuss this on a patient-by-patient basis.

There are different types of hip replacement. Most commonly I perform a hybrid hip replacement, which requires bone cement in the femur. This would normally take between 55 and 75 minutes. Some hip replacements will be fully cemented and these will take between 65 and 90 minutes. When a hip replacement is uncemented it will take between 45 and 65 minutes. In simple terms, it takes as long as is necessary to do a good job. On top of this is the anaesthetic time, setup time and recovery time, so it may be 3 or 4 hours from when you leave your room until you are back and ready for visitors.

I use dissolving sutures below the skin edge that means there is nothing to remove. I also believe that this give much better scars in the long run. On the surface of the wound will be wound glue, steristrips and a waterproof dressing. At 2 weeks post-surgery this dressing can be removed either in the hospital clinic or at your GP practice by a nurse. Occasionally, you will have another dressing applied and this can then be removed a few days later.

This is for you to discuss with the anaesthetist and to decide what works best for you. In practice, most of my patients will have a spinal anaesthetic. This is an injection in the back that makes you numb below the belly button and unable to move from the waist down. On top of this, you will usually have some sedation. This allows you to drift off to sleep without being ‘put to sleep’. You can, however, be as awake or asleep as you would like. Many patients worry about what they will hear or feel, but I can reassure you that under a spinal anaesthetic with sedation this will not be a concern. This would be my preference if I was having a hip replacement.

Some patients may be more suitable for a general anaesthetic (GA) and this is also a very effective type of anaesthetic. Some patients do find the effects of this take longer to wear off than the spinal anaesthetic and therefore can recover a little more slowly in the first few days.

I use a variety of materials in a hip replacement:

• Socket (acetabulum) – this is either Titanium alloy plus highly engineered polyethylene (plastic) or highly engineered polyethylene and acrylic bone cement.
• Stem (into the thigh bone) – most commonly this will be stainless steel but occasionally Titanium alloy.
• Ball – this is almost always a high-quality ceramic ball.

On the day of surgery, I want you to be as healthy as you can be. This is to ensure that your risks are as low as they can be. There are some things that we cannot control, such as medical problems like having diabetes or a blood clotting disorder. There are other things that we can control – cuts and scratches on your legs are a good example as these are a potential entry point for infection. These cuts will heal and therefore your surgery could happen in two weeks with lower risk. Other examples include chest infections or water infections (urinary tract infections/UTIs). If you know that you have something that might delay your surgery, the sooner you let us know, the easier it is to make new arrangements. Cancelling surgery on the day is very disruptive for you and prevents another patient being treated in that slot.

Once the wound is fully healed, it can be helpful to massage the scar. It is usually sensible to leave this until 3-4 weeks post-surgery. Patients are often advised to use Vaseline or something similar. I do not recommend Vaseline for scars. I would recommend a simple moisturiser. It is the act of massage rather than the product used that makes the difference. Some patients will use something like Bio-oil. This is completely fine but can be expensive and probably is no better than a moisturiser other than feeling nicer.

You can shower the day after your surgery as your dressing will be waterproof. As long as the seal is maintained around the dressing, it will remain waterproof. Once your dressing is removed at 2 weeks after the surgery it will be fine to shower. Showering is easier if you have a walk-in shower rather than a shower over a bath.

It is my routine to prescribe injections to thin your blood while you are in hospital and tablets for the first month after you are discharged home. Obviously, this is judged based on each patient's particular circumstances and we will discuss this in your clinic visit.

Most of my patients will go home the day after their surgery. Sometimes, it may be necessary to stay 2 to 3 days depending on your individual needs/circumstances. Once you are fit to go home, it really is the best place for you.

The best exercise after a hip replacement is walking. Not everyone ‘needs’ physiotherapy to recover well, but every patient will have physiotherapy while in hospital and will have further physiotherapy organised if required. Some packages for insured or self-pay patients will include a fixed number of sessions and this will be clarified in advance of your surgery.

This is something that will be particular to each patient and their situation. Generally, though, by 2 weeks, most patients will be taking mainly paracetamol with occasional doses of something stronger (typically codeine) as required.

Swelling is very common after hip replacement surgery and it can take weeks to months to settle down. You will normally find that your leg is less swollen first thing in the morning and gets more swollen as the day goes on. This is nothing to worry about at all. Rarely, swelling can be caused by a blood clot (DVT). You will have been on medication to reduce the risk of this. If your swollen leg is painful and/or red, doesn’t getting easier when you spend time with your feet up, or you are very worried about a clot you should get it checked out. The best ways to do this are either via your GP practice or your local emergency department. There are protocols in place for assessing and treating people with possible clots that are streamlined to ensure you get treated and scanned as quickly as possible. I would want you to get in touch with my secretary if you are in doubt and I would certainly want to know the outcome of any investigations so that I can help manage the problem.

This is very individual to each patient. Some of my patients will stop using crutches within the first 2 weeks. Others may still be using one crutch outdoors at 6 weeks. If you have lost a lot of strength and condition in the muscles around the hip due to the pain of your hip problem, then it may take closer to 6 or 7 weeks to feel comfortable without them. It is important to remember that we are all different and you shouldn’t worry about still using crutches at 6 or even 8 weeks. You will continue to improve up to a year from your surgery and 6 weeks really is only the start of your recovery.

All jobs are different and place different demands on your body and your hip. Wherever possible, I would recommend taking a minimum of 6 weeks off work. It can be tempting with office-based/remote work to return sooner. You will be surprised at how tired normal day-to-day things make you and how this can affect your concentration. Within the first 6 weeks there is a chance that the quality of work you produce will be reduced and you would be better to return when you are really ready. 6 weeks can feel like a long time off, but in the grand scheme of things, it is a small part of your recovery.

After your surgery you will initially need to sleep on your back as it will be very uncomfortable to sleep on your side. I would recommend practising sleeping on your back prior to surgery to get used to it. Having had some hip surgery myself, I know that post-op I was uncomfortable on my back for the whole night. One thing in particular that I struggled with was sore heels. I can recommend a pillow under you calves to reduce the pressure on your heels. Otherwise, this website offers some simple tips https://www.sleepfoundation.org/sleeping-positions/how-to-sleep-on-your-back.

Historically, surgeons would ask their patients to sleep on their back for at least 6 weeks after a hip replacement. I am happy for my patients to sleep on their side when they feel comfortable. In practice, this is often not before 4 weeks after surgery. If you sleep on your operated side, it will be tender and you may only manage 20 minutes initially. If you sleep on the other side, you will find that a pillow between your knees usually make it more comfortable.

If you live on your own it is common to worry about whether you will cope after hip replacement surgery. My opinion is that if you live on your own already, you will be more than able to cope with recovering from a hip replacement, as long as you have prepared properly. This might include ensuring you have done a big shop in advance or arranging for a friend or relative to do some shopping for you. You will have the opportunity to discuss your recovery with a member of the team in advance who will speak to you about specific adjustments you can make around your home. It is important to remember that you are coping at home with a hip that doesn’t work properly and causes you pain. Very quickly, your new hip will be far better than your current one.

If there are any problems pre or post op, you first point of contact should be Lydia, my secretary. You can also contact the hospital ward from which you were discharged. If there is an emergency problem, I work at both the BRI and Southmead and the emergency departments at each hospital are excellent. If I know that you are in either hospital I can make arrangements to see you there or ensure that the orthopaedic staff there have all the details they need for your initial management.

This may depend on whether your hip replacement is being performed under the NHS, insurance or self-pay. One appointment is consistent throughout and this is a follow-up appointment 6-8 weeks after surgery to ensure you are making good progress and to take you through exactly what was done. At this appointment I will review your scar, show you your xrays and answer any questions you have about your recovery and plans for the future.

It is important to me to try to see any new patient referrals within two weeks where possible.

Generally, self-pay and insured patients will have their surgery within 6 weeks of their clinic appointment assuming that their health allows for this.

I prefer my patients to leave it 6 weeks before bathing or swimming.

There are no formal rules on driving. I advise my patients that they must feel safe performing all emergency manoeuvres, getting in and out of the car, and be able to sit comfortably before they are safe to drive. It is sensible to inform your insurance company in case they have their own guidelines. Most of my patients feel comfortable to start driving between 4 and 6 weeks after surgery.

The NHS guidance for this is that you should not take a short-haul flight (<4hours) within 6 weeks or a longer-haul flight (> 4hours) within 12 weeks. This is only guidance and not a rule. You should check with your airline and with your travel insurance company if you are traveling against this guidance.

Ideally, I would want you to leave any sports for a minimum of 3 months to allow all the healing and scarring to take place around the hip. For a return to the gym, I would suggest a minimum of 2 weeks but 6 weeks would be better. The best early exercise is simply walking and doing normal day-to-day activities. Within the first six weeks, any exercise in the gym should be limited to body-weight only. If you are a keen cyclist, I would suggest a static bike at 6 weeks, initially with minimal resistance. Return to a pushbike should be at around 3 months.

This is a complicated question to answer. Simply put, the reason for having your hip replaced is to get rid of your pain and get you back to doing the things you want to do. There will be some positions that put your hip at greater risk of dislocation (ball coming out of the socket). We will discuss this face to face in the clinic and you will also be given guidance by our physiotherapists.

There isn’t good evidence to support this but it would be common sense to assume that a hip will wear out quicker the more it is used. However, the point of having a hip replacement is to get rid of your pain and allow you to do all the things you should be doing at this stage in your life. We never know where we will be in a year or 5 years’ time, so it is my view that we should make the most of what we have now rather than worry about what might be some time in the future.

The simple answer is yes. For some patients, this is a really important form of exercise and one of the goals of hip replacement surgery (after getting rid of your pain) is to allow you to return to the activities that you love. In more detailed terms, there are ways that you can run to minimise the potential problems running could cause. The main issue is the heavy impacts that come with running and the potential for increased wear of the hip replacement. My advice is to run at a higher cadence (more steps per minute) and for your foot to strike the ground on the midfoot rather than with a heel-strike. The best longer distance runners run at roughly 180 steps per minute while us mortals often run at 160 per minute with very inefficient running styles. Here is a link to a useful guide https://paretoathletics.com/blogs/journal/the-midfoot-strike-the-ultimate-guide-to-better-running-form

I am not sure that there is any good evidence on this subject but clearly it is important. A lot of this will come down to confidence plus trial and error. Some of the issues faced will be different for men and women. I would suggest taking at least 6 weeks to recover first and maybe 12 weeks would be ideal, from a healing point of view. I think keeping it simple to start with is probably the best advice I would give.

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