What is a total hip replacement?

A total hip replacement (THR) is a surgical procedure carried out to replace damaged areas of the hip joint with metal and plastic material known as a prosthetic implant. It is usually recommended when the hip is severely damaged by conditions such as arthritis.

During the procedure, the surgeon makes an incision around your hip joint around 15 to 25cm in length. Both the top of your thigh bone (femur) which is shaped like a ball, and the socket where it sits in your pelvic bone (acetabulum) are then removed. The procedure usually takes between one to two hours to complete.

Benefits of a total hip replacement

The surgery is indicated to help relieve your hip pain when non-surgical treatments are no longer working. It may also help your joint move better and improve the quality of your life.

Risks and complications

While most total hip replacements are carried out without any problems, it is classed as a major operation. All operations carry some risks and potential for complications.

These will have been explained to you during your consultation with your healthcare professional and include the following:

Preparing for surgery

If you decide to go ahead with the operation, there are a few ways you are advised to prepare your body for the best outcome.

Stop smoking and drinking alcohol

It is recommended to stop or reduce your alcohol intake as these can increase your risk of complications. You should smoking at least four weeks before your surgery. You should also avoid consuming alcohol at least 48 hours before your operation.

Eat a well-balanced diet

Your body needs adequate nutrients to repair itself after surgery. A higher protein diet and ‘five a day’ or more of fruit and vegetables is recommended before and after your surgery.

Remain active

It is important to carry out daily exercise to keep your body strong and return to normal activities quicker after your surgery. Simple exercises such as walking, cycling or swimming up to 30 minutes a day are strongly recommended.

Reduce the use of any opioid drugs

If you are already taking opioids (i.e. codeine, tramadol and morphine), please talk to your healthcare team. You may benefit from reducing these beforehand in a safe manner as it will help pain management after surgery as well as improve your post-surgical outcomes.

Treat any existing health conditions

Contact your GP or relevant healthcare professionals if you have any existing conditions or infections that may impact your recovery. If you have any difficulties with managing your weight, blood pressure; blood sugar levels or anaemia (low level of iron in your body) then these should be managed before the operation as they can increase complications after surgery. Do not undergo any invasive dental surgical procedures (i.e. tooth extractions) three weeks before surgery and three months after as this can also increase your risk for infection.

Home preparations for your recovery

It is very important that your home circumstances are suitable for you upon discharge following your operation. Some people will find it helpful to arrange a family member or friend to stay with them. However, if you live alone, please have your house ready for your arrival back home.

Planned appointments prior to your operation

You will need to attend some appointments to help you prepare for your operation which you will receive letters for. These include pre-assessment clinic (PAC), a patient education class and occupational therapy (OT).

Pre-assessment clinic

Pre-assessment clinic is based at the Freeman Hospital (Clinic H) . It is staffed by a large team including nurses and anaesthetists who will complete tests and treatments to ensure you are fit to have your surgery.

Pre-operative education class

You should receive an appointment to attend the pre-operative patient education class by the orthopaedic therapy team. It is held in the physiotherapy department at the Freeman hospital. This is usually a group-based session where you will be given guidance on preparing for surgery and recovery. You will also be shown exercises and a demonstration of equipment.

Occupational therapy

You should receive a telephone appointment for a pre-assessment occupational therapy review prior to your surgery.

The purpose of this appointment is to prepare you for ways you can manage your daily activities at home after surgery as well as discuss equipment you will need following your surgery. There are some restrictions you are advised to follow after your operation.

These restrictions are usually to be followed for 6 to 12 weeks depending on your consultant. They ensure that you avoid straining your hip muscles as they are healing and reduce any complications such as dislocation.

You will be advised of the equipment that will help you. Any large pieces of equipment such as toilet equipment will be discussed during your telephone appointment. These can be arranged to be delivered to your home or collected from your local equipment loan stores.

It is highly recommended that you buy smaller aids. These are not provided by the hospital but are available to purchase locally or online at a small cost. The small aids we recommend include the following.

You are encouraged to practice using your equipment before admission so that you are better prepared for using after surgery. You will usually be reviewed by the occupational therapist after

your surgery. They will advise you on how to safely carry out your daily activities in line with your restrictions and address any concerns you may have with this.

Days prior to your surgery – things to remember

Fasting time

You need to stop eating solid foods six hours before your operation (no food after midnight). Feel free to drink water (clear fluids only) up until you arrive in the hospital.

Shower/bath

Please use the antimicrobial wash provided (octenisan wash). This should be for five days before your operation (including in the morning of your operation). Do not use any talcum powders, body lotions, perfumes or makeup after your bath/shower.

Shaving or waxing

Avoid shaving or waxing of your legs, underarms, bikini lines etc. for three weeks prior to your surgery. You must also not have any skin breaks, grazes or open wounds. This is because any area of your body with open skin breaks or wounds may increase your risk for infection into your new joint.

Medications

Follow the instructions from pre-assessment clinic regarding any medications. You must stop any medications exactly as advised by pre-assessment clinic before your operation.

Infections

If you have had diarrhoea, nausea and vomiting 48 hours before your surgery date, or if you have cold or flu-like symptoms please contact us for advice as to whether it is appropriate for you to come in (contact details are provided at the end of this leaflet).

Please be aware If you do not follow the instructions above then your operation may be cancelled, and you will be given a date in the future.

What to bring to the hospital with you?

You should bring:

• Your admission appointment letter.
• Day wear for 1 day such as loose fitting shorts, skirts or shirts that are easy to put on.
• Night wear for 1 night such as a night dress, shorts or pyjamas.
• Flat supportive shoes or slippers that are well fitting and comfortable to walk in. Shoes without a back are not recommended. New slippers may not fit if your feet become swollen after surgery.
• Toiletries such as face cloth, toothbrush or deodorant.
• Mobility aids that you use such as walking sticks, crutches or wheelchair.
• Medications you regularly take in the labelled boxes with you.
• Books or music player to keep yourself occupied.

Do not bring:

• Any controlled pain medication such as Morphine or Oxycodone (tablets or liquid). This is due safe storage keeping. There are available supplies of these.
• Any valuable items.
• Please do not wear make-up, nail varnish, acrylic or gel nails on the day of your surgery.
• Please also remove all piercings, jewelleries etc.

Admission to hospital

You will usually come into hospital in the morning of your operation for 7am unless you are advised otherwise.

You will arrive to one of the elective surgical units at the Freeman Hospital. This will be either ward 4, ward 19 or the Day Treatment Centre. Please check your letter to confirm this.

• Ward 4 is located on level 3 in the Freeman Hospital
• Day Treatment Centre is located at the front right of the Freeman Hospital Site (the centre is signposted from the main care park entrance).
• Ward 19 is located on level 7 at the Freeman Hospital. This is the main elective orthopaedic ward, and you are likely to be transferred to this ward after your operation.

Please note the following regarding visiting:

Visiting hours

Ward 19

• 1pm to 5pm and 6pm to 8pm.
• Only 2 visitors will be allowed at a time.
• No visitors will be allowed during mealtimes. Mealtimes: 12pm to 1 pm, 5pm to 6pm.

Ward 4 and Day Treatment Centre

Visiting on Ward 4 or the Day Treatment Centre is not permitted unless prior arrangements have been made with the nursing team.

When you arrive, you will be seen by a member of your surgical team, your anaesthetist and a nurse. They will all carry out essential checks prior to your operation and discuss the anaesthetic and surgical plan with you.

Anaesthesia for total hip replacement surgery

Most patients have their total hip replacement carried out under spinal anaesthesia. This is an injection in your lower back that makes your legs numb for the operation so that you cannot feel pain during surgery.

You will be offered some sedation to help you relax during the operation, but you will not be fully asleep. You can also request to listen to music in theatre or you may be able to use a Virtual Reality (VR) headset during your operation.

We would recommend this approach unless there is a reason not to. This anaesthetic allows patients to make a rapid recovery with fewer side effects, and promotes early mobilisation.

Once all checks and assessments have been completed, you will be escorted to the operating department to undergo the surgery and then transferred to the recovery area for a short period of time where you will be monitored closely. You will then be taken back to the relevant ward/discharge unit where you will remain for the rest of your stay.

Recovery on the ward/discharge unit

When you arrive on the ward/unit, the nursing team will regularly monitor your vital signs such as your blood pressure, pulse and oxygen levels as well as your wound dressings and pain levels. To ensure a safe and rapid recovery, you should expect the following:

• You are encouraged to eat and drink soon after your operation to ensure your body takes in nutrients.
• You will usually get dressed into your normal clothes as soon as possible
• You will get out of bed as soon as it is safe to do so by a physiotherapist or nurse
• Routine pain relief and other drugs you may take will be given. If you need extra pain relief medicines, please ask.
• You will be discharged once you have completed all assessments and goals by your medical and therapy teams.

Managing your pain

You should expect to experience some level of pain, however severe pain is not something you have to put up with. The amount of pain will be different for everyone and is better controlled if you take your pain relief regularly. This will help you recover rapidly and complete your exercises as comfortably as possible.

• You will routinely be prescribed Paracetamol and Morphine Sulfate solution (Oramorph) as this is most effective pain relief following surgery.
• Relaxation and distraction can also help such as listening to music, reading books, watching movies and breathing exercises.

Side effects of pain relief medications

Please be aware that some pain relief medication may have side effects.These may include nausea and vomiting, constipation, headache, dizziness, feeling sleepy and sometimes mild confusion. These side effects can be reduced by anti-sickness drugs, drinking plenty of fluids, taking laxatives and appropriate rest.

Physiotherapy after surgery

You will be seen by a member of the physiotherapy team as early as 3 to 4 hours after your operation. They will show you how to walk correctly using an appropriate aid (usually elbow crutches or a walking frame). Once you are safe with this, you will then practice completing some steps or stairs if this is necessary for your discharge home.

Typically there is no further physiotherapy required after your have been discharged from hospital. Most patients return back to their everyday activities on their own. You will be provided with some hip exercises that focus on restoring strength and mobility to your hip joint.

However, If you have a particular exercise activity or hobby you would like to return back to, please discuss this with your physiotherapist as further support can be given.

Guidance for managing steps and stairs

Follow the general guidance below. Always go one step at a time.

For going upstairs

• Stand close to the step.
• Step up with your un-operated leg first followed by your operated leg and then your walking aid(s).

Using 1 crutch and 1 rail

Using 2 crutches

For going downstairs

• Stand close to the step.
• Place your walking aid(s) down first followed by your operated leg and then your un-operated leg

Using 1 crutch and 1 rail

Using 2 crutches

Total hip replacement exercise program

There are some exercises recommended to carry out following your operation. You are advised to carry these out 3 to 4 times a day for up to 10 repetitions each. Start off with small number of repetitions and gradually build as pain allows. You should carry these out until your hip feels comfortable.

Hip flexion

• Stand straight and hold onto a stable support.
• Lift the operated leg forward. Stand straight throughout – do not lean backwards or forwards.
• Do not let your knee go above your hip (no further than 90 degrees)

Hip extension

• Stand straight and hold on to a stable support.
• Bring your leg backwards keeping your knee straight.
• Do not lean forwards.

Hip abduction

• Stand straight and hold on to a stable support.
• Lift your leg sideways and bring it back keeping your trunk straight throughout the exercise.

Heel raises

• Stand straight and hold on to a stable support with your feet together.
• Lift up both your heels so that you are standing on your toes.

Discharge from Hospital

You will be discharged from the hospital usually within 24 hours after your operation once you are medically fit and safe to do so. It will usually be the same day or next day after your operation.

You may go for an x-ray and your bloods may be checked before discharge. This will depend on your consultant and medical team.

You will be encouraged to plan your discharge such as transport to your discharge destination and arrange family, friends or carers to support your recovery.

Prior to discharge, your nurse looking after you will check that you have completed all the appropriate assessments and discuss the necessary appointments you will need to attend after discharge.

What follow-up appointments should I expect:

• Wound check – You will require a wound check at two weeks after surgery. You will need to arrange this with your GP practice nurse.

• Follow-up arthroplasty review – You will receive a follow-up check in 6 – 8 weeks by your orthopaedic team (usually the arthroplasty nurse specialist). You will receive a letter in the post for this appointment.

You will be given appropriate telephone numbers of who to ring should you have any questions or concerns during your recovery at home.

General care at home

Wound care

You will have a waterproof dressing over your incision site. Keep the waterproof dressing clean, dry and covered until your wound review. Your clips or stitches needs to be removed between 10 to 14 days after your operation.

When you take a shower, please protect the dressing. The dressing over your wound has a bacterial barrier to help reduce the risk of infection.

If you have any issues with your dressing then please contact fracture clinic or ward 19 (contact details can be found at the end of this leaflet).

Pain relief medication

You will be discharged home with a short course (five days) of strong pain relief medication (such as morphine). As your pain lessens, you can reduce taking these. Remember to also take other pain medication you will have been prescribed (such as paracetamol and ibuprofen) regularly.

If your pain is not well managed at home or if you are still struggling with high levels of pain, you should contact your GP surgery to get further help.

Surgical stockings

Depending on your consultant, you may be advised to use surgical stockings for six weeks following your surgery to improve blood circulation in your leg. You will receive an extra pair of stockings upon discharge.

Going to the toilet

For the first two weeks after surgery it is common for bowel movements to become irregular. This can be because of pain relief medication combined with less physical activity and a change of routine. This will resolve itself as you get back into your usual routine at home. Eating high fibre foods including fruits, vegetables and wholemeal bread can also help manage. If necessary, try taking a mild laxative for a few days until you return to your normal routine.

Blood thinner medications

You will be advised to take blood thinning tablets or injections following your surgery. This is to reduce the risk of developing blood clots in your body.

If you are already on blood thinners, you discharge letter will state when you should start back on these.

Swelling management

Swelling of your leg is very common and may last for several months. Pressure changes and reduced activity may cause your operated leg to swell, especially when it is just healing. By the end of the day lots of people also complain that their ankle is more swollen.

To reduce swelling, take proper rest in-between activities and you may also find it helpful to lie on your bed for an hour in the afternoon.

General advice around return to activity

Once you get home, you should increase your activity levels gradually. It is not unusual to feel tired, and your sleep patterns may take a while to return to normal.

Walking

Start with walking short distances around the house and garden in the first two weeks then increase as you feel able.If you are using crutches, you should wean yourself from these as soon as you feel steadier on your feet as long as it does not cause you to limp. Start by weaning yourself down to one crutch on the opposite side of your surgery.

Washing and dressing

You may use a shower when you feel safe to do so. Please do not have a bath for 3 months.

When dressing, sit on the side of the bed or in a suitable chair to support your balance. Always dress your operated leg first and undress it last, using the small aids are recommended.

Avoid tight clothing including belts and tight underwear. Loose garments are generally more comfortable and are a lot easier to put on.

Sleep

Difficulty sleeping is a common complaint after a total hip replacement. This can often be due to pain or sleeping in a position that you are not used which can contribute to restless nights.

The recommended position is to sleep on your back with a pillow between your legs. Make sure you do not cross your legs. You can also sleep on your non-operative side with a pillow between your legs and one behind your back, but this is dependent on your consultant so check with your clinical team. When you’re sleeping on your side, avoid bending your hip past 90 degrees.

Getting in and out of a car

You should ensure the car is parked away form the kerb as this increases the height of the car seat as you get in from the roadside. Recline both the car seat and backrest. You may also find it helpful to place a plastic bag on the seat to make this smoother.

Slowly lower yourself into the car using support of the car frame and your walking aid. Once sat down, lean back to bring both your legs in or one in at a time.

For getting out, the car seat should be in the same position. Similarly lean back to bring both your legs or one out at a time. Slowly stand up using the support of the car frame and have your walking aid nearby.

Driving

It is recommended that you do not drive for six weeks after your operation, but your consultant can advise you on this. When you are ready to start driving, make sure you can reach and use the pedals without discomfort. Have a trial run without the engine on. Try out all controls and go through the emergency stop procedure. Start with short journeys and when you do a long trip stop regularly to get out and stand up and stretch.

Please be aware that if you drive soon after your surgery and have an accident, insurers may consider you liable for damage so you should check with your insurance company first before driving.

Flying

You should avoid taking long haul flights for three months after your surgery to reduce the risk of developing blood clots in your body.

When going through security, be aware that the sensitivity of metal detectors varies, and your artificial joint may cause an alarm. Tell the screener about your artificial joint before going through the metal detector.

Sexual activity

Return to sexual activity depends on your condition but you may be able to resume within several weeks after surgery. It is important to be careful not to stress the joint while the tendons and ligaments are healing. The most vulnerable period is the first six weeks following your surgery.

Return to work

This depends on the type of activities involved in your job and general recovery. In most cases it is usually safe to return to light work or an office-based job within six weeks of the operation. If your job involves heavy duties, you may need to be off work for several more weeks. If your employment has an occupational health department, they can advise you on this or alternatively discuss with your clinical team.

Return to usual exercise and sports

You should avoid high impact activities such as runnning or jogging. Low impact sports such as cycling, swimming and golf can be resumed in gradual manner usually after six weeks. You should avoid public swimming pools for six weeks to reduce risk of infection. You should also be mindful of your hip restrictions (particularly twisting and bending) for sports such as golf. Please speak to your physiotherapist, consultant or specialst nurse if you would like further guidance.

Common complaints

Joint clicks

This is normal especially during the early phase of healing. It is usually a sign of your joint adjusting to the implants and the swollen tissues moving over each other differently than before. You should not let this worry you. This should improve as healing continues.

Warm scar

Even when the scar has healed there is still healing going on deep inside. This healing process creates heat, which can be felt on the surface. This may continue for up to six months.

Useful contact numbers

If you have any concerns or questions regarding your preparation for surgery or recovery, please contact the appropriate numbers in the list below.

Appointment booking centre (for queries of outpatient appointments)

Tel: 0191 282 4444

Monday to Friday 8.30am to 5pm

Pre-assessment clinic (Freeman Hospital – clinic H)

Tel: 0191 244 8180

Monday to Friday 9am to 5pm

Pre-operative education and surgical prehabilitation team

Tel: 0191 242 4246

Tuesday, Thursday, Friday 8am to 4pm

Fracture clinic (Royal Victoria Infirmary) – Dressings and wound concerns

Tel: 0191 282 1431

Monday to Friday 8.30am to 5pm

Arthroplasty nurse helpline

Tel: 0191 223 1453

Monday to Friday 8am to 4pm

Ward 4 (Freeman Hospital)

Tel: 0191 213 7004

Monday to Friday 7am to 7pm

Helpline out-of-hours – Tel: 0191 213 7019

Day treatment centre (Freeman Hospital)

Tel: 0191 213 7444

Monday to Friday 7am to 8pm

Orthopaedic physiotherapist (Freeman Hospital)

Tel: 0191 244 8219 or 0191 917 7240

Monday to Friday 8am to 4pm

Orthopaedic occupational therapist (Freeman Hospital)

Tel: 0191 213 7677

Monday to Friday 8am to 4pm

General recovery concerns

If you are worried you are developing a problem or have any concerns about your recovery, please contact the arthroplasty nurse helpline or Freeman hospital ward 19 (out of hours) who will be able to offer support, advice, or organise further reviews if necessary.

You may also contact the department by phoning the Freeman Hospital on 0191 233 6161 and asking for your consultant’s secretary.

Loan equipment

Equipment should not be returned before your hip restrictions have ended. This can be up to 12 weeks.

Any crutches which have been issued from the ward should be brought into clinic when you have finished using them.

Any other pieces of equipment should be sent back to your local loan equipment service. If you live in Newcastle, please contact 0191 282 3484. Contact details for other areas are provided at the end of this leaflet. If your area is not on the list then your occupational therapist can advise you.

Other numbers:

If you have any queries regarding your equipment or concerns around how you are managing at home after surgery, please refer to the following numbers:

• North Tyneside loan equipment stores: 0191 643 7050
• North Tyneside social care contact centre: 0191 643 2777
• South Tyneside loan equipment stores: 0191 424 6000
• Let’s talk team: 0191 424 6000 (option 3)
• Gateshead loan equipment stores: 0191 497 1599
• Gateshead social care direct: 0191 433 7033
• Durham loan equipment stores: 0132 552 4531
• Durham social care direct: 03000 267 979
• Sunderland loan equipment stores: 0191 561 4438
• Sunderland social care and support: 0191 520 5552
• Northumberland loan equipment stores: 01670 730 595
• Northumberland social care Onecall: 01670 536 400
• Teesside – Middlesbrough loanequipment stores: 01642 224 205
• Teesside social care first contact: 01642 527 764
• North Yorkshire Loan Equipment Stores: 01423 226 240 (including Colburn, Knaresborough and Scarborough)
• North Yorkshire Social Care: 0300 131 2131

PALS (Patient Advice and Liaison Service) for help, advice and information about NHS services. You can contact them on free phone 0800 032 02 02, email [email protected]

Useful websites

If you would like further information about health conditions and treatment options, you may wish to have a look at the NHS website at www.nhs.uk

If If you would like to find accessibility information for our hospitals, please visit www.accessable.co.uk