nikhil pradhan's
 Cheshire Hip and Knee Clinic

Specialist: Knee Surgery, Hip Surgery, Sports injury & general orthopaedics
Birmingham Hip Resurface
What is a Hip Resurface?

The worn surfaces of the hip joint are made smooth. The smoothed surfaces are covered with the metal parts of the Hip Resurface.

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Why do I need it?
You may have a number of the following:
  1. Osteoarthritis of the hip joint.
  2. Severe pain in the hip joint.
  3. Reduced movement of the hip joint.
  4. Difficulty walking.
  5. Unable to participate in sport
Benefits ?
  1. The majority of the original hip joint is preserved.
  2. Recovery is quicker than a conventional hip joint replacement.
  3. No restrictions of hip movement need to be adhered to as for a conventional hip joint replacement.
  4. Aids for daily living are not required as for a conventional hip joint replacement.
  5. Reduced neuromuscular damage.
  6. Excellent post-operative function.
  7. Return to sports after 12 weeks post-op.
Risks associated with the operation
  1. Blood clots in the legs or lungs.
  2. Infection.
  3. Fracture occurring just below the new joint.
  4. There can be problems with the general anaesthetic
Checklist of items to bring into Hospital.
  1. Nightwear.
  2. Toiletries.
  3. Underwear.
  4. Day clothes – remember it is very warm in hospital so bring short-sleeved blouses/shirts, shorts or loose skirts.
  5. Towels.
    Reading material
Before the operation
  1. You will receive a letter with the details of your admission, usually with 3 weeks notice.  You are usually admitted on the morning of your surgery.
  2. For 72 hours prior to your admission, avoid alcoholic drinks and drink 3-4 litres of non-alcoholic drinks.
  3. If you smoke, try to stop smoking prior to admission to  hospital.  There is no smoking in the hospital buildings and grounds.
  4. Follow the advice given by the pre-operative nurse about your medications, including herbal remedies.
  5. You will not be able to eat or drink (including water and sweets) for a minimum of 6 hours before your  surgery.
  6. You will be seen by your anaesthetist on the ward. They will discuss the anaesthetic with you and pain management for after your operation.
  7. If you did not see a doctor at the pre-operative  assessment clinic, the doctor will see you on the ward.He will explain the operation, you will sign the consent  form, and go for an X-ray if necessary.  He will mark your affected leg with a black pen to indicate the leg to be operated on.
  8. You will be asked to shower/bathe and put on your operation gown and white stockings (TEDS).
  9. You will then be taken to theatre in a wheelchair by your nurse.
After the operation
  1. You will wake in the recovery area of the theatre suite – you will be on your bed and will be taken  care of here until you are fully awake.
  2. Once awake you may find the following:
    • Nasal spectacles or a mask giving you oxygen – this assists you in the waking-up process and will be in place for 24 hours.
    • An intravenous infusion (drip), this will be in your hand or arm – it will be administering either a clear fluid (saline solution) or blood – this replaces the fluid lost during your operation and stays in place until you are drinking adequately.
    • You may have up to 2 drains from your wound, which helps to drain away blood and swelling.  This helps your wound to heal and prevents some of the bruising, which may occur.
    • A catheter in your bladder may be in place.
    • A dressing over your wound.
  3. Your pain may be controlled by:
    • A PCA (patient controlled analgesia).  This consists of a button which you can press to give you pain relief when you need it.
    • Intrathecal Diamorphine, which is an injection into your spine that is administered in theatre.
    • Epidural, which is commenced in theatre.
  4. The nurses will check you regularly that evening.
    • As soon as you are awake enough you must perform deep breathing and circulatory exercises every houras outlined in the rehabilitation section.
    • You may have visitors but try to keep this to a minimum for your comfort.
    • You must assist the nursing staff to move you in bed by using the overhead bar and your unoperated leg (you will be instructed on how to do this).
    • You will be assisted with daily hygiene as necessary by the nursing staff.
  5. Movement of your operated leg and mobilisation will be instructed by the physiotherapist – she will visit you  the day after your operation. You will commence mobilising with a zimmer frame and progress to elbow crutches.
    • Approximately 1 day following your operation the drains will be removed and your wound checked.
    • A waterproof dressing will be applied to allow you to have a shower when you are confident at   mobilising
    • Try not to interfere with your wound dressing – this      can introduce infection – your nurse will redress your wound as necessary.
  6. Your wound may have dissolvable stitches.
    • It is important that you take painkilling tablets to keep you comfortable.  However, painkilling tablets together        with your reduced mobility can cause constipation – if you have any problems, which last more than 3 days please inform your nurse.
    • Try to eat a healthy diet – this will help the wound to heal.  If possible try to take at least 2 litres (4 pints) of liquid a day.
  7. Your urinary catheter will be removed when you are mobile, approximately 48 hours after surgery.
    • A check X-ray of your hip will be requested by your doctor on day 3 onwards.
    • Prior to discharge you will be walking confidently with elbow crutches and will have been taught to walk up   and down the stairs by the physiotherapist.
    • Remember you will be in hospital for ehabilitation and therefore you will be very busy.  Please encourage visitors to keep to the visiting time (3pm until 4.30pm and 6.30pm until 8pm) to allow time for your rehabilitation.
Rehabilitation
Rehabilitation is very important if you are to achieve a good result from your operation.
The physiotherapist on the ward will teach you the exercises.  It is up to you to continue these at home until you attend for your outpatient hysiotherapy appointment.  This is approximately one week after discharge from hospital.
Exercises
1) Deep breathing exercises.

Place your hands on your lower ribs. 
Take a large breath in through your nose and sigh the air out through your mouth.
Repeat 6 times.

2) Circulatory exercises.
3) Static quadriceps exercises.

Bend your ankles and push your knees down firmly against the bed.
Hold 5 seconds – relax
Repeat 10 times.

4) Inner range quadriceps exercises.

Place a rolled towel under your knee. 
Bend your ankle, straighten the knee and push it down against the towel. Repeat 10 times
Repeat 40 times by day 4 post-operation.

5. Hip flexion.

Lying on your back with a sliding board under your leg. Bend and straighten your hip and knee by sliding your foot up and down the board.
Repeat 10 times

6) Hip abduction.

Lying on your back with a sliding board under your leg.
Bring your leg to the side and then back to mid position.
Repeat 10 times.

7) Diaphragmatic breathing.

Lie on your back.
Put your fingers in the fleshy part of your abdomen just below your breastbone.
Gently breathe in allowing your fingers to rise; your upper chest should remain still. As you breathe out your fingers should lower.

8) Pelvic floor exercises.

Lie on your back.
  Tighten up the muscles around the back passage as if you are trying to stop passing wind.
Whilst performing the above squeeze, pull up the front passages as if you are trying to stop passing urine. Try to hold this contraction for 10 seconds. Repeat 10 times.

9) Transversus Abdominus

Lie on your back with your unaffected knee bent. 
Breathe in and out. 
Tighten the pelvic floor and draw in the lower abdominal muscles to form a hollow below the umbilicus.
Hold for 10 seconds and recommence diaphragmatic breathing.

Leaving The Hospital
  1. Most patients are discharged 3 to 7 days post surgery.
  2. Remember you have had a major operation so you will feel tired for several weeks after discharge.
  3. If you are to have any medication on discharge it will be given and explained to you before you leave.
  4. It is normal for your knee and thigh to remain somewhat swollen for 8-12 weeks following your surgery.  A major increase in swelling should be reported.
  5. At 2 weeks following surgery you can walk up to half a mile out of doors with 2 sticks and can start to walk around the house with 1 stick.
  6. At 4 weeks following surgery you can:
    • Start to walk around the house with no sticks, but should still walk out of doors with 1 stick.
    • Start to drive.
  7. By 5 weeks following surgery you can walk approximately 1 mile without any walking aids.
    • You should still be taking things fairly easy until 6 weeks post-operatively.
    • You will receive an outpatient appointment to see your consultant, either before you leave the hospital or by post once you are at home.
    • You will be given an outpatient physiotherapy appointment.
    • If you have any problems or are worried at all once you are discharged home – do not hesitate to contact the        hospital for advice.
Contact:
Spire Cheshire Hospital
Fir Tree Close,Stretton Warrington,
Cheshire WA4 4LU
Tel: 01925710401
Fax: 01925710401
email: drnpradhan@gmail.com
Consultant in Trauma and
Orthopaedic Surgery

Warrington Hospital NHS Trust
Lovely Lane Warrington
Cheshire WA5 1QG
Tel. 01925662758
Fax. 01925 662211