The hip joint is a ball and socket joint. It can undergo wear and tear changes which can cause pain and stiffness in the joints. This is called osteoarthritis of the joint. The typical symptoms you will experience will be pain across the top of the thigh on the outside and pain in the groin. You will struggle to climb stairs and getting in and out of car, putting shoes and socks on and simple day to day to tasks like cutting toenails. The arthritis in hip can affect your walking and you may experience some shortening of the leg, limping whilst you walk and you may need to use a walking aid to help you walk better. The walking becomes slow and the walking distance becomes shorter. Please use the walking stick in the hand opposite to the affected hip.
You will need pain killers to get on top of your pain and regular exercises to keep the muscles around the hip healthy. If the pain gets increasingly worse and starts interfering with day to day activities, and all conservative treatments options have been exhausted, a hip replacement would be a sensible option to consider.
It is one of the very common operations undertaken in the UK. I am a specialist hip, knee surgeon and I undertake high volume of this work. The hip replacement will involve removing arthritic cartilage of the joint which includes reaming the socket (acetabulum)and giving you a new socket, taking away the arthritic bit of femoral head and giving you an artificial femoral head on top of the femoral stem.
The principal is the worn out bit of the joint is replaced by a smooth articulating surfaces which in return relieves pain. It is a highly successful operation with high patient satisfaction rate. I undertake hip replacement through a posterior approach with spares the main abductor muscles of your hip. Hip abductor muscles are the most important muscles you need to mobilise your hip well. This helps a quick recovery from the operation and reduces the risks of limping and bursitis. I also undertake an enhanced recovery programme which combination of specialist pain medications and infiltrating the operation area with high volume of local anaesthetic. This allows you to get up and about earlier after the operation helping you to recover quickly and get back to your normal self as soon as possible after the operation.
There are some precautions to follow after a hip replacement since it is an artificial ball and socket joint until the scar tissue heals up around the hip which is around 6 weeks' time. I do like my patients to follow certain precautions which include not crossing their legs, not to sit on a low seating chair and not to sleep on the side. However after 6 weeks when the scar tissue around the hip has healed well, you will be getting back to your normal life. After about 6 weeks after the operation, I am happy for patients to start driving, getting back to work and getting back to sexual life.
There are small risks associated with the operation which we will keep you informed to you if you are listed for a total hip replacement. The main risks include infection, however the operation is performed in clean air theatre and antibiotics are given to your before the operation to reduce the risk. There is a risk of affecting nerves or vessels around the hip, but I am very familiar with the anatomy and I take every precaution to avoid this. There is a risk of thromboembolic event (blood clots) for which you will be given a blood thinner injection and tablets for about 5 weeks of the operation. The physiotherapist will work through hip muscles strengthening exercises and to avoid risk of dislocation. You may need crutches or sticks for first few weeks to help with mobilisation.
The overall aim will be to get you home in your familiar environment (and home cooked food!) as soon as it is safe to do so. The wound will be reviewed by the practice nurse at about 2 weeks. You will see me in clinic at about 6 weeks from the operation for a routine check.
Total hip replacement is a highly successful operation and will help you to get back to an active life without pain.
Knee arthritis is very common amongst the UK population. The amount of knee replacement undertaken in UK is rising every year. Knee arthritis causes pain and stiffness around the knee. The most common type of arthritis is varus arthritis ('bow legged' arthritis) but in very small number of cases, patients can have lateral compartment or valgus arthritis ('knocked knees' arthritis). The pain around the knee joint can get worse after walking long distances, stairs can be difficult to climb, activities involving squatting and kneeling down are usually found to be difficult.
The first line of management for knee arthritis is to make sure your body weight is within the healthy limits for your height (healthy BMI). You will need regular painkiller to be on top of your pain and undertake regular knee exercises to keep the muscles around your knee toned up. If the pain continues to increase, one could consider local anaesthetic and steroid injection in to the joint. This is to break the pain barrier to allow you to exercise. The effects of a steroid injection are variable with some patients getting a few weeks to a few months of relief.
If the pain gets significantly worse, then one could consider a knee replacement. The principal is the worn out bit of the joint is replaced by a smooth articulating surfaces which in return relieves pain.
This involves replacing the ends of the knee joint which is the end of the thigh bone and the top of the shin bone, and replacing the irregular articular surfaces to smooth articular surfaces. In some cases, the patella (knee cap) may be resurfaced as well.
It is a common operation and there are some risks with the operation. The main one is infection the operation is done in a clean air theatre with antibiotics given before the operation to reduce the risk. You will receive two weeks of blood thinners tablets, Aspirin to reduce the risk of thromboembolic event (blood clots). The knee can be stiff and you will need to work hard with the physiotherapist to regain the range of movement in the knee. The skin in front of the knee, especially, on the outside can feel a bit numb. This is entirely normal. This tends to improve with time.
I undertake an enhanced recovery programme which combination of specialist pain medications and infiltrating the operation area with high volume of local anaesthetic. This allows you to get up and about earlier after the operation helping you to recover quickly and get back to your normal self as soon as possible after the operation.
You may need crutches or sticks for first few weeks to help with mobilisation. The overall aim will be to get you home in your familiar environment (and home cooked food!) as soon as it is safe to do so. The wound will be reviewed by the practice nurse at about 2 weeks. You will see me in clinic at about 6 weeks from the operation for a routine check. Most of the patients are able to get back to working life, normal walking and driving at about 6 weeks from the operation.
Knee replacement is successful in patients for treating knee arthritis. You will need to work hard on the exercises after the knee replacement for the first few weeks as the knee replacement can be challenging and this is the most crucial period to get your exercises going with the help of pain killers to get long term good result.