Thanks for asking me to help you with your hip problem. You have now decided to have your hip replaced or resurfaced and will be scheduled for surgery. My secretary will contact you with a date and the hospital will arrange your pre-operative checks.
Unfortunately, any surgery carries a risk of an unwanted complication occurring and these are explained in the information sheet which I gave you in the clinic as well as on your consent form.
Your surgical team will take as many precautions as possible to reduce these risks, but there are things which you can do as a patient to help reduce your own risk.
Personal hygiene – wound infections are most commonly caused by bacteria from the surface of your skin getting into the wound during or soon after surgery. It is very important to reduce this risk as far as possible. In the week before surgery, you should be showering twice per day using antiseptic wash. Any moist skin creases should be kept perfectly dry and washed with antiseptic. Use an exfoliating scrub or cloth to remove all dead and dry skin scales but don’t rub so hard as to cause redness to the skin.
Don’t shave your upper legs the day before surgery as this may cause tiny abrasions or cuts which can be contaminated by skin bacteria.
Don’t apply creams or oils to your legs on the day of surgery. This will reduce the effectiveness of the surgical antiseptic working on your skin surface.
Avoid getting any cuts or abrasions in the 2 weeks leading up to surgery, and if you do have any, please let my team know before your admission and be sure to show me any skin abrasions or redness when I check you in and mark your leg.
Make sure that you shower with antiseptic on the day of surgery (and wash your hair), and dress in clean clothing for your admission.
It’s probably a bit late to get your weight under control this late in your hip problem, but it is important that you understand that being overweight or underweight significantly increases your risk of infection. If there is any way that you can move your BMI closer to an ideal weight, this will reduce your risk.
This graph shows that the lowest risk for infection (and in fact all complications) is between BMI 22 and 30, and that your risk is higher if you are underweight or overweight. At BMI of 40, you run double the risk of infection compared to someone who has a BMI of 25. The same applies if you are severely underweight with a BMI of 18.
Mouth infections have commonly been the cause of hip joint infections. Ensure that your dental hygiene is as good as possible. Visit a dental hygienist if you aren’t sure, but make sure that any dental cleaning or procedures are at least 2 weeks before your surgery.
If you are aware that you have any sort of infection before your surgery (urinary, dental, skin or any other), please contact my team prior to admission.
I will try my best to be as minimally invasive as possible during your operation. This not only involves trying to keep your wound length as short as possible, but more importantly, involves trying to avoid cutting muscles, ligaments and tendons in the hip unless it is absolutely essential to get your hip implants in the optimum position.
The cut will be made lengthways along the side of your hip and will be anything from 10cm up to 30cm depending on how deep the tissues are on the side of your hip and the technical difficulty of your operation. Deeper fat and muscle and technically difficult operations will end up with the longest incision.
After surgery, your wound will be sutured with dissolving stitches which don’t need to be removed. It will be glued closed with a layer of reinforcement mesh and there will also be a wound dressing applied over the mesh. As long as the dressing is perfectly sealed, you may shower as soon as you like after surgery.
The top dressing can be removed 2 weeks after surgery) but it doesn’t have to be if it is well adhered). It can simply be taken off any time after 2 weeks when it starts to come loose naturally. If it comes loose before 2 weeks, a new dressing should be put back on to seal the wound as soon as possible. The glue mesh under the dressing will fall off like a scab when the wound beneath is healed. As it comes loose, just cut off the loose bits. The entire mesh can be peeled away at 4 weeks by yourself or your family.
If there is any fluid leakage from the top dressing (or other wound concerns), please contact Duchy immediately for a wound check. Please do not contact your GP or attend ED. If you have travelled to Cornwall for your surgery please contact my secretary during normal office hours or the Duchy at any time who can advise after seeing photos of your wound).
High sugar levels in your blood stream dramatically increase your risk of an infection in your hip. You should moderate your sugar intake for at least 6 weeks before and after surgery. Carbohydrates are turned to sugar in your stomach, so you should also avoid a diet high in carbohydrates. A diet high in protein and iron is what I recommend before and after surgery. The iron will help your blood levels return to normal more quickly after surgery. Sweets, chocolates, sweet fruits, cakes, pastries, energy drinks etc are not good for your infection risk. If you are diabetic, your sugar levels need to be extremely well controlled to reduce your infection risk.
If we took no precautions to prevent blood clots at all, 1 in every 5 people would develop a clot in their calf veins after a hip replacement. If that clot travels up the leg veins to the lung, it can cause an embolism which can be fatal.
We take blood clot prevention very seriously and routinely will prescribe blood thinning treatment for you. This will usually be 10 days of injections followed by 25 days of tablets. Please adhere to your prescription.
Blood thinning medication unfortunately can cause bleeding and swelling. Deep tissue bleeding is therefore common and expected. This results in swelling and bruising around the hip and down the leg. This can be worse if you take high dose blood thinners regularly for a heart condition.
You can reduce this swelling by ensuring that you walk full weight bearing through your operated leg for 15 minutes 5 times per day as soon as possible. This helps to pump excess fluid from your foot and calf muscles.
Sports compression trousers or shorts can also help, as can full length compression leg pumps (as used by sportsmen and available on Amazon from about £250 or to rent online – search for leg compression pumps.
We are unable to provide these pumps, but advise that you try to borrow, rent or buy a set to use as soon as possible after your surgery and use them for 40 mins 5 times per day after each of your walking and physio exercise sessions.
A cheaper alternative is a hip ice pack wrap which is about £20 on Amazon, but much less effective at reducing swelling.
If your leg does swell and bruise, this will usually get worse until about 3 weeks after your surgery and then start to come back down. This is normal and not a complication.
If however, you develop swelling mainly in your calf and your calf muscle is very tender to press on, you should get it checked by your GP for a possible blood clot.
During your surgery, important muscle tendons (piriformis, obturator internus, both gemelli and quadratus femoris) and ligaments (posterior hip capsule) at the back of the hip joint are cut to allow me to get to your hip joint to do your surgery.
I try very hard to repair these tissues back to precisely where they were cut from at the end of the operation. These tissues are stitched with a very strong suture material but it is possible for you to pull these stitches out which would leave you with a long term weakness and a higher risk of your hip dislocating in the future.
If you bend your hip past a right angle with your body, or you turn your knee in across your body towards your opposite knee, you will strain these stitches and you may pull them out. If they do pull out, your ability to twist your leg outwards will be permanently weaker and you will also lose the muscle restraints which stop your hip coming out of joint when you deep bend in the future.
It is therefore safest to sleep on your back with a large pillow between your legs if you can manage this. If you find this is too difficult, you may sleep on your side but only with a large pillow supporting your operated hip. Once your hip is comfortable enough to lie on, you may sleep on your operated side without a pillow.
Avoid sitting down in low chairs which cause your hip to bend too far.
DO NOT bend over to reach your feet or the floor when standing or sitting until 6 weeks after your surgery.
DO NOT try bath or swim until 6 weeks after your surgery. Getting in and out of the bath is likely to be very risky for bending your hip too far.
Even though you may start to feel very comfortable and safe from around 3 weeks after your surgery, these very important deep tissues at the back of your hip take a full 6 weeks to heal, so it is very important not to put any strain on them during that time.
You should not take a flight longer than 4 hours for 6 weeks before and 12 weeks after your surgery. This is due to the increased risk that long haul travel causes for blood clots.
If you do have any travel plans, please advise my secretary as soon as possible.
Travel by car, rail or boat is fine as soon after your surgery as you feel safe to do so, but should involve regular stops to ensure that your legs are kept moving.
You should not drive for 6 weeks after your surgery but may start at the 6 week date. If you have an automatic car and have had your left hip operated on, you may contact your insurer who may cover you from as early as 3 weeks
It is very important to walk as soon as possible and very regularly. Your new hip will be solidly implanted into the bone during surgery. You should put all of your body weight through your new hip as soon as possible.
I encourage you to walk for 15 minutes at least 5 times daily followed immediately after by your prescribed physio exercises.
This will help your bone to heal to the new implants quicker and your leg muscles to recover their function. Your crutches are to help your balance, not to offload weight from your leg. As soon as you are able to manage full weight bearing, you may reduce down to a single crutch in the opposite hand to your operated hip. This will help with being able to carry things around indoors and will encourage your hip muscles to function quicker.
Use both crutches outdoors until you feel completely stable and have no limp. You should only walk completely without your crutches or sticks if you have no limp left over.
Please DO NOT attempt to return to exercise for your legs apart from walking before 6 weeks from surgery. Only do your physio prescribed exercises and walking (as far as you feel like).
Absolutely no attempt at jogging or cycling before 6 weeks, and no leg weights. Remember that your hip should not be bending past a right angle with your body until those muscles are fully healed.
We now look forward to welcoming you for your surgery. It is completely normal to be highly apprehensive before your operation, but we will endeavour to make your stay with us as comfortable as possible. Most patients report that they suffer with much less pain following hip surgery than they expected but our nursing team will ensure that you are kept comfortable and safe during your stay. We usually expect you to stay with us for one or two nights in total before going back home.
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