Hip replacement may be a common operation but it is life changing

Sponsored feature | Chris Gooding, orthopaedic surgeon and hip specialist at Nuffield Health Cambridge Hospital

A hip replacement may be a common operation, but it can be life changing.

Total hip replacement is known to be one of the most successful orthopaedic procedures in the UK with approximately 1,000 performed in Cambridge in 2022 (National Joint Registry 20th Annual Report 2023, Unit level activities and outcome for hip and knee replacements).

Once you have assessed a patient as suitable for a replacement what are your main priorities to ensure that the patient will have the best possible outcome?

Proper patient selection is crucial for the success of a hip replacement, and I will carefully assess the patient’s overall health, activity level, and specific hip condition to determine whether a total hip replacement is an appropriate option for the patient.

It is also important to understand that the success of hip replacements can vary from patient to patient but with advances in surgical techniques and technology we have improved the precision and safety of the surgery and that’s why it is one of the safest and most successful surgeries worldwide. I also take time to understand the patient’s expectations of the surgery including what activities they hope to do afterwards.

How quickly would a patient be up and about following the surgery and how important is it to work closely with your physiotherapist?

Most patients will be walking with the aid of crutches and the help of the in-patient physiotherapy team on the day of the procedure, usually they will be discharged the following day if the clinical team feel that it is safe for them to return home.

Patients will leave hospital with an exercise plan and follow up appointments to see the physiotherapist. It is important that they engage in exercises and activities to regain strength, mobility, and function of their new joint.

The emphasis is on regaining strength, flexibility, and proper movement patterns while minimising the risk of a hip dislocation. It’s a team effort, working together with a multi-disciplinary team to achieve a successful outcome and getting the patient back to doing their day-to-day activities and progressing towards their sports and leisure goals.

We are all aware of lots of activities and movements to avoid following a hip replacement, with all the surgical advances are there still as many post-operative restrictions in place?

These restrictions are known as ‘hip precautions’ and in the UK we have been moving towards a more patient-centred and evidence-based approach. Rather than strictly enforcing a set of rigid restrictions we increasingly emphasise individualised care and focus on helping patients regain their mobility and independence as quickly and safely as possible.

This shift in thinking is based on the understanding that overly strict hip precautions can lead to muscle wasting, stiffness, and decreased functional outcomes, as well as delaying the patient’s recovery. Now we work with patients to create a personalised rehabilitation plan that considers their specific needs, abilities, and the type of hip replacement surgery they underwent.

Ultimately, we are trying to strike a balance between protecting the new hip joint during the initial recovery period and promoting a more active and functional lifestyle for patients in the long term. However, it’s important to note that specific recommendations can vary, and patients should always follow the guidance provided by their healthcare team to ensure a successful and safe recovery.

And finally, how long will the new hip joint last?

In a study published in The Lancet in 2019 (Vol 393, Issue 10172, How long does a hip replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up) which reviewed articles and national data, they estimated that about 75 per cent of hip replacements last 15-20 years with just over 50 per cent of replacements in patients with osteoarthritis lasting for up to 25 years.

A slightly earlier paper, also in The Lancet in 2017 (Vol 389, Issue 10077, The effect of patient age at intervention on risk of implant revision after total replacement of the hip or knee: a population-based cohort study) reviewed more than 63,000 patients who had undergone a total hip replacement. It concluded that the 10-year implant survival rate in this patient group was 95.6 per cent and the 20-year rate was 85 per cent. In addition, the lifetime risk of requiring revision surgery in patients over the age of 70 years was approximately 5 per cent.

Mr Chris Gooding holds clinics at Nuffield Health Cambridge Hospital every Tuesday at 1.35pm-5pm. To make an appointment call 01223 370922 or book online at nuffieldhealth.com/consultants/mr-christopher-rees-gooding#book. Nuffield Health Cambridge Hospital is at 4 Trumpington Road, Cambridge CB2 8AF.