Hip op hooray!

A hip replacement is one of the most common and successful operations carried out on the Island

Each year around 250 patients are admitted to St Mary’s Hospital to undergo the surgery that can bring to an end what have often been years of pain and misery. The operation is fairly straightforward, but when it was MY turn there was inevitably some trepidation. The questions ‘what if…what if?’ went through my mind. But looking back I need not have concerned myself unduly. I could hardly have been treated better by the dedicated NHS team, headed by Salim Nasra, consultant orthopaedic surgeon, with a special interest in hip and knee surgery.

Mr Nasra explained: “Hip and knee replacements are among the most common operations in the UK. It is one of the most successful orthopaedic operations ever invented, and has improved the quality of patients’ life in a huge way.”

The biggest cause of a hip problem is osteoarthritis, with a smaller number due to rheumatoid arthritis. Surgery usually takes between an hour and 90 minutes. There are two procedures; one where the joint is fixed to the bone with cement, and the one I had, which was without cement. With un-cemented, the joint is coated with a special material, and the bone grows into it within six to 10 weeks.

I had some reservations after being told I would remain semi-conscious throughout surgery. Mr Nasra said: “The concept of keeping a patient semi-conscious rather than administering a full anaesthetic has been used for several years. We use spinal anaesthetic instead (the same principle as an epidural), which we feel is good for the patient for several reasons.

“First, there is no intubation, and secondly during the operation the blood pressure remains lower than usual which reduces bleeding, so surgery can be carried out more effectively. More importantly post-operation you don’t have any feeling in the legs, so you don’t need a large amount of painkillers. Around 85 per cent of patients undergoing hip replacement are given this method.”

I can confirm that during surgery, with headphones on listening to music, I heard a certain amount of banging, and recall the sound of staples being used to seal the wound. But it seemed a world away. In fact the anaethetist did speak to me on one occasion, but only to wake me up because I was snoring! Within minutes of the operation being completed I was in the recovery ward, fully conscious and having a cuppa.

In the operating theatre during surgery there was the surgeon, an assistant, the anaesthetist and assistant, the scrub nurse and two or three ‘runners’. So when Mr. Nasra says he needed a certain type of joint the ‘runner’ went to shelves in the store room to get the right prosthetic piece. For a hip replacement there are up to six sizes for the ball joint, and more for the cup.

“We need more than one of each in case we do several replacements in a few days, and do not want to run out,” he said. “The success of hip operations is multi-factorial. It is a combined effort from everyone involved in the patient’s care, which in turn reduces the patient’s stay in hospital after surgery. When I arrived at St Mary’s in 2000 the length of stay was about two weeks. But we have subsequently worked on a fast-track discharge.

“It is a combined effort by surgeon, anaesthetist, doctors and nurses, occupational therapists and physiotherapists. We have pre-admission clinics for everyone to be examined before surgery, and the patients are given leaflets and booklets to explain the procedure, and what they can and cannot do after the operation. It is about preparation and attention to detail.

“Now a patient can be discharged more quickly but without compromising their safety. The length of stay after a hip operation is around five days – a significant reduction to even five years ago.”

I was discharged little more than 48 hours after surgery and told it was because I was quite fit and healthy and still comparatively young for such an operation. A nurse specialist clinic has also been created, with the nurse overseeing all post-operative patients; usually six weeks for knees and three months for hips. But because my hip was un-cemented I was seen again after six weeks.

In all there were a dozen or more NHS staff caring for me, from ward sister to occupational therapist and surgeon to the district nurse, who visited me at home to dress my wound several times after discharge. I would like to thank all of them, and I hope that recounting my experiences will help allay the fears of any reader who is about to face similar hip replacement surgery.

And as real bonus for the first time in more years than I can remember I can now put on my left sock unaided, and tie my left shoe lace again. So for me the operation is already proving a big success!