Do I need to stop any medication before my operation? It is important to clarify which medication should be stopped or continued. Most medication should be continued after discussion with your surgeon. Medication to thin your blood (Warfarin, Coumarin,Aspirin) is usually stopped prior to any operation, UNLESS there is a specific risk with stopping it. Diabetic medication is usually not taken on the morning of the operation to prevent low blood sugar occurring. If you have any concerns you should contact your surgeon/hospital for advice. Will I need a blood transfusion? All patients loose a certain amount of blood after a joint replacement. Some patients are more symptomatic from the post-operative anaemia compared to others. Occasionally patients feel dizziness, palpitations or faint when they try to stand up post-operatively. If this occurs you may require a blood transfusion to relieve the symptoms and speed up your rehabilitation. The body would replace the lost blood volume itself in time without transfusion, but you would continue to feel symptomatic. Can I fully weight bear after joint replacement? This depends on the type of joint replacement you have. If a joint replacement is fully cemented then you are encouraged to fully weight bear and perform your exercises to strengthen the muscles of BOTH hips. You do not require crutches once you are comfortable and stable walking. If you have an un-cemented joint replacement it is preferable to use 2 crutches and only allow half your weight through the operated side. After 4 weeks you can progress onto 1 crutch held with the un-operated side. Importantly you should fully weight-bear to perform your exercises with BOTH hips three times a day. Un-cemented implants are usually stable to weight bear on post-operatively, but it is probably beneficial in the long term to avoid too much stress/ motion at the implant/bone surface initially. If you have a hip resurfacing, the ball is cemented and the socket is un-cemented. Patient’s who have a hip resurfacing need to partial weight bear on the operated side for 4 weeks before progressing onto full weight bearing. As above, all exercises should be performed 3 times a day with BOTH hips fully weight bearing. The rest of the time the patient should be partially weight bearing. What activities am I able to participate in post-operatively? Gardening 2 months Golf 4-6 months Skiing 1 year for hip resurfacing Do I need to take antibiotics for dental treatment following hip surgery? We feel that antibiotic cover before any dental procedure is advisable for the first 3 months after joint replacement. Any dental procedures after this point do not require antibiotic cover unless there is evidence of infection. What happens if a get an infection? The risk of infection is low, but may be increased if you have certain risk factors. Eg. steroids, immunocompromised patients, diabetes or infections elsewhere on your body. The risk of a superficial wound infection is 2-3 per 100 cases. It is important to contact your Doctor quickly if you have ANY concerns about infection. This can be treated easily with a course of appropriate oral antibiotics and usually settles. Deep infection has far more significant implications. It occurs in approximately 1 per 150 cases. If an infection develops around the implant it is difficult for the body to combat it. The body fights infection with it’s white blood cells. Since, an implant has no blood supply it is difficult for the white blood cells to fight the infection. This means that implants that become infected need to be removed to fully treat the infection. This involves an operation to remove the implant and debride the tissue, a temporary spacer in inserted with antibiotics and long term antibiotics for 6 weeks are given. The infection is monitored and the patient has a period without antibiotics to ensure the infection is cleared. Then a new replacement is implanted. What nerve damage can occur after hip replacement? With hip replacement/resurfacing Mr Higgins favours the posterior approach. With this approach there is a small risk of injury to the sciatic nerve. It is incredibly rare to cut the nerve, but stretching the nerve or constricting it can cause bruising. This nerve runs down the back of the thigh behind the hip joint. It has been reported that the patient can develop a sciatic nerve palsy (ie. bruising which causes numbness and difficulty lifting the foot up towards the knee). The published incidence is 0.7%-3.0%. There have been no cases under Mr Higgins care to date. What are the risks for blood clots (Deep Venous Thrombosis/ Pulmonary Embolism)? How do you reduce these risks? The risks are reduced by: injections or tablets to thin the blood foot pumps to keep the blood circulating early rehabilitation/movement to prevent stasis of the blood stop smoking graduated compression stockings for 6 weeks.

Do I need to stop any medication before my operation?

It is important to clarify which medication should be stopped or continued. Most medication should be continued after discussion with your surgeon. Medication to thin your blood (Warfarin, Coumarin,Aspirin) is usually stopped prior to any operation, UNLESS there is a specific risk with stopping it. Diabetic medication is usually not taken on the morning of the operation to prevent low blood sugar occurring. If you have any concerns you should contact your surgeon/hospital for advice.

Will I need a blood transfusion?

All patients loose a certain amount of blood after a joint replacement. Some patients are more symptomatic from the post-operative anaemia compared to others. Occasionally patients feel dizziness, palpitations or faint when they try to stand up post-operatively. If this occurs you may require a blood transfusion to relieve the symptoms and speed up your rehabilitation. The body would replace the lost blood volume itself in time without transfusion, but you would continue to feel symptomatic.

Can I fully weight bear after joint replacement?

This depends on the type of joint replacement you have. If a joint replacement is fully cemented then you are encouraged to fully weight bear and perform your exercises to strengthen the muscles of BOTH hips. You do not require crutches once you are comfortable and stable walking.

If you have an un-cemented joint replacement it is preferable to use 2 crutches and only allow half your weight through the operated side. After 4 weeks you can progress onto 1 crutch held with the un-operated side. Importantly you should fully weight-bear to perform your exercises with BOTH hips three times a day. Un-cemented implants are usually stable to weight bear on post-operatively, but it is probably beneficial in the long term to avoid too much stress/ motion at the implant/bone surface initially.

If you have a hip resurfacing, the ball is cemented and the socket is un-cemented. Patient’s who have a hip resurfacing need to partial weight bear on the operated side for 4 weeks before progressing onto full weight bearing. As above, all exercises should be performed 3 times a day with BOTH hips fully weight bearing. The rest of the time the patient should be partially weight bearing.

What activities am I able to participate in post-operatively?

Gardening 2 months

Golf 4-6 months

Skiing 1 year for hip resurfacing

Do I need to take antibiotics for dental treatment following hip surgery?

We feel that antibiotic cover before any dental procedure is advisable for the first 3 months after joint replacement. Any dental procedures after this point do not require antibiotic cover unless there is evidence of infection.

What happens if a get an infection?

The risk of infection is low, but may be increased if you have certain risk factors. Eg. steroids, immunocompromised patients, diabetes or infections elsewhere on your body.

The risk of a superficial wound infection is 2-3 per 100 cases. It is important to contact your Doctor quickly if you have ANY concerns about infection. This can be treated easily with a course of appropriate oral antibiotics and usually settles.

Deep infection has far more significant implications. It occurs in approximately 1 per 150 cases. If an infection develops around the implant it is difficult for the body to combat it. The body fights infection with it’s white blood cells. Since, an implant has no blood supply it is difficult for the white blood cells to fight the infection. This means that implants that become infected need to be removed to fully treat the infection. This involves an operation to remove the implant and debride the tissue, a temporary spacer in inserted with antibiotics and long term antibiotics for 6 weeks are given. The infection is monitored and the patient has a period without antibiotics to ensure the infection is cleared. Then a new replacement is implanted.

What nerve damage can occur after hip replacement?

With hip replacement/resurfacing Mr Higgins favours the posterior approach. With this approach there is a small risk of injury to the sciatic nerve. It is incredibly rare to cut the nerve, but stretching the nerve or constricting it can cause bruising. This nerve runs down the back of the thigh behind the hip joint. It has been reported that the patient can develop a sciatic nerve palsy (ie. bruising which causes numbness and difficulty lifting the foot up towards the knee). The published incidence is 0.7%-3.0%. There have been no cases under Mr Higgins care to date.

What are the risks for blood clots (Deep Venous Thrombosis/ Pulmonary Embolism)?

How do you reduce these risks?

The risks are reduced by:

1.injections or tablets to thin the blood
2.foot pumps to keep the blood circulating
3.early rehabilitation/movement to prevent stasis of the blood
4.stop smoking
5.graduated compression stockings for 6 weeks.