Hip Resurfacing vs Hip Surface Replacement
Hip resurfacing involves replacing damaged surfaces in the hip joint with metal surfaces. This procedure can be useful for patients under 65 with advanced hip disease
 
Hip resurfacing surgery is an alternative to standard hip replacements for patients with severe arthritis. In hip resurfacing surgery, the implant is smaller, and less normal bone is removed. Hip resurfacing is gaining interest, especially in younger patients
 
Mr Hugh Blackley was the first to pioneer modern hip resurfacing in New Zealand in 2003. He was trained by the designers and remains a strong advocate for the technique. He has done the most hip resurfacings of any surgeon in New Zealand and currently does 2-3 per week. He remains the most experienced surgeon in New Zealand in the procedure and is on the Australiasian Surgical Advisory Panel for Birmingham Hip Resurfacing.
 
Hip Resurfacing Post Operation Instructions

Immediately after surgery, you will wake up in the recovery room. You may wake up feeling a bit groggy. The staff will monitor you, checking your blood pressure, temperature and pulse and assess your pain. Post-operative x-rays will be performed in recovery. After 45 minutes - 1 hour you will then be transferred back to your room on the ward.

Your pain will be controlled by an epidural pain pump. This is not morphine but local anaesthetic that goes by a fine plastic tube into your back. This will make your legs fell numb and heavy but it is not permanent. You can use a button to control the pain, you can not overdose with this button.

 
Post-Operative Surgery and Rehabilitation

As a general guide to post-operative rehabilitation, the following are offered as guidelines.

 
Medication

Post-operative pain is also controlled with by an oral medication program. This involves a combination of drugs designed to eliminate your pain. It is important to take these when given, even if you have no pain, as they build up in the body to prevent pain, especially when the epidural wears off.

 
Physiotherapy

You will be assisted to stand and walk about 4 hours after surgery with crutches. This may feel unusual as your legs will feel numb from the epidural. You will walk more freely the first day after surgery and can put as much weight as you wish through your operated leg. You will be encouraged to walk. Once mobile your catheters and tubes will be removed.

You will walk up stairs the first or second day. Once mobile and comfortable you may go home, usually at the end of the second day.

 
Wound Care

The incision is closed with absorbable sutures. These do not need to be removed. They take about 4-6 weeks to absorb and when this occurs the wound may become red and warm.

You will be given a new waterproof dressing on the day of discharge this can be removed after 2-3 days by yourself at home and no further dressing should be needed.

You may shower, but suggest you not bathe or swim until 10 days from surgery and only if the wound is clean and dry.

You may apply Vitamin E or some moisturising lotion to the incision after 10 days.

Some swelling and warmth is expected after surgery. It should remain clean and dry, if not contact Mr Blackley.

If you develop increasing redness, oozing from the cut, or fever, please call the office.

 

Exercises

Some exercises are particularly helpful in restoring muscle tone and as an aid to resuming activity.

 

Using your crutches for balance:

  • Swing the affected leg forwards and backwards in a straight line position - 10 - 20 times , 2 or 3 times a day - to an angle of 25 - 30 degrees.

  • Practice straight leg raising while in bed, lifting the leg off the bed to an angle of 15 - 30 degrees.

If you feel pain or discomfort, stop and try again in a day or so.

 
Walking

You will be out of bed and walking within 4 hours after surgery. Upon discharge from hospital you will be walking with crutches. You may discontinue using crutches 1-2 weeks after surgery.

After this time you may use a cane, or if you feel confident you may discontinue using any walking aides.

It is normal to have a limp for 6-12 weeks after surgery as the muscles stretched at surgery recover. Groin and buttock discomfort while the bone heals is normal for a similar amount of time.

Walk using your crutches on a smooth even surface, at a steady even pace. Take even steps and wear comfortable supportive footwear with a low heel.

You will need BOTH CRUTCHES for approximately 3-5 weeks.

 

Your walking distance can be steadily increased. If you feel you have overdone things ( e.g. Some muscular or bone pain or discomfort) rest more for a day or so.

 

Target distances will vary, but provided you feel strong enough and are not suffering pain or discomfort, total DAILY distances can be:

Weeks after operation:

  • week 1 - up to 0.5 km
  • week 2 - up to 1 km
  • week 3 - up to 3 km
  • week 4 - up to 4 km
  • week 5 - up to 5 km

DO NOT EXTEND OR STRAIN YOURSELF - MORE IS NOT NECESSARILY BETTER.

 

Pain and Discomfort

Both bone and tissue ( muscle, nerves, tendons, ligaments) are undergoing a healing process that will not be complete for several weeks after the operation. ( Healing is generally complete in 10 - 12 weeks).

After you have left hospital there is still commonly felt pain and discomfort. It can take the following forms and unless it persists or is severe is not a cause for concern or anxiety.

Soreness / Pain Around the Scar

  • caused by tissue/scar/repair, and as a result of the exercise.

Sudden sharp, needle-like pain in tissue

  • Caused by tissue repairing and nerves regaining viability

Aching Pain ( feels as if in bone)

  • Caused by excessive exercise or by e.g. sitting or lying in an inappropriate way

STOP ACTIVITY AND REST FOR A WHILE

 
Some Do Nots and Warnings
For the first 2-3 weeks after surgery you will need assistance in putting on and removing underpants, panties, trousers, slacks or similar,socks,stockings and footwear.
 
For the first 4 -5 weeks after surgery you will probably need assistance in putting on socks, stockings, panty hose, tying up shoe laces and taking off shoes.
 

BE VERY CAREFUL when trying to put on socks, stockings, panty hose or shoes for the first 6- 8 weeks after the operation

 

KEEP THE KNEE POINTING OUTWARDS WHEN APPROACHING THE FOOT. You may be able to develop some techniques to do these things, but do not put STRAIN on the joint.

 

Do not try to carry items WHILST USING BOTH CRUTCHES - it can cause you to lose your balance.

 

DO NOT SITE ON LOW CHAIRS OR SOFAS

 

HAVE A CUSHION ON YOUR CAR SEAT

 
If your wound becomes increasingly red or oozes, then contact myself or your GP.
 
Use of Crutches
Use both crutches inside and outside for the first 3 - 4 weeks.
 
After 3 - 4 weeks you may find that around the house or office you can move safely and comfortably with one crutch or a stick, or no crutches.
 
Precautions

There are precautions necessary to undertake after hip surgery. The major precaution is limiting hip bending. With your new hip, your safe maximum hip bend is 90 degrees. The precaution is in place for 1-2 weeks, depending on Mr Blackley’s instructions.

There are four rules of thumb to remember to keep your hip in position:

  • When sitting, keep your knees below your hips, sitting on a small pillow helps.
  • Avoid crossing your legs while lying down or sitting.
  • Avoid bending over at the waist.
  • Sit with your knees 10 - 20 cm apart.
 
Expectations

Each individual has his/her own set of expectations. Our advice is designed to answer the most frequently asked questions of concern and each individual is different. Each patient is treated as an individual with general health, age and attitude considered.

An important thing to remember, you are not sick. You have a problem with your hip that needs to be fixed, so it is important to consider yourself not sick. Therefore getting back on your feet after surgery is the most important goal. ‘Motion is lotion’.

 In the first week you may experience:

1. Swelling: from your thigh down into your foot is common especially at the end of the day.

2. Bruising: marked bruising can be found in some patients. This can be found from your thigh down into your foot.

3. Muscle soreness: your muscles can feel stiff and sore to touch especially around the hip and thigh.

For the first 2 weeks after surgery, your activity level is usually limited, however, you will be able to walk independently, use the bathroom and perform normal activities of daily living.

After 2 weeks you will be able to engage in moderate activities; i.e. driving a car and work.

Within 6 weeks you will have resumed most of your normal activities. Complete surgical healing continues for months. During this time some swelling and discomfort is normal and should be manageable with the prescribed medication.

 The most important thing is to have a positive attitude.

 With the Birmingham hip resurfacing you can look forward to getting back into the swing of things and enjoying life as it was before you were in pain.

 
IF IN DOUBT ASK FOR GUIDANCE
 
Further Information on Hip Resurfacing Surgery :

 

 

 
If you have any queries on Birmingham Hip Resurfacing Surgery please do not hesitate to contact Dr Hugh Blackley's practice rooms during office hours on 09 522 2980