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[ 30 August 2013 ]

Indian Orthopaedic Association 57th Annual Conference 2012
[ 16 January 2013 ]

International Revision Hip Arthroplasty Symposium November 2012
[ 30 November 2012 ]

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[ 30 August 2013 ]

Tim Board
[ 30 August 2013 ]

Which factors determine the wear rate of large-diameter metal-on-metal hip replacements? Multivariate analysis of two hundred and seventy-six components.
[ 12 July 2013 ]

Medical management of osteonecrosis of the hip: a review
[ 12 July 2013 ]

Frequently Asked Questions

How long should I use crutches for after a hip replacement?
I would usually advise patients to use two crutches initially, one crutch at three weeks and by six weeks patients are often coming off crutches but this does vary.

Will I need physio?
Patients will have physiotherapy in hospital but this is not normally required afterwards because when patients get home we want to give the body time to heal.

When may I drive?
I normally allow patients to drive at six weeks assuming they have progressed as expected.

Can I sleep on my side?
We normally advise patients to sleep on their back for the first 6 weeks after total hip replacement. After knee surgery this is not necessary. After 6 weeks it is okay to sleep on either side as long as a pillow is placed between the legs to prevent the legs crossing. It may be too uncomfortable to lie on the operated side for some months however.

Can I do breast stroke?
Again, after 6 weeks it is perfectly possible for patients to swim. Some surgeons have in the past advised patients not to do the breaststroke due to the perceived risk of dislocation of the hip. However we feel that the leg movements in breaststroke do not place the hip at risk and we are happy for our patients to do breaststroke.
 
What sort of exercises can I do?
The best form of exercise in the first few months after surgery is simple walking. The hip muscles are very active during normal walking and as they are supporting the body weight (and often much more due to the mechanics of the hip) the have to contract very strongly. There is no set amount of walking that patients should so as everyone is different in terms of their pre-surgery fitness and mobility. The most important thing to remember is to build things up gradually over the weeks and months. Some exercises do put the hip at risk and in particular those that involve bending the hip excessively (such as using a rowing machine, yoga, squats) risk dislocating the hip. Running is another exercise that maybe harmful to a hip replacement and if you are keen to get back to running you should discuss this in depth with your surgeon prior to surgery. Some types of hip replacement are more resilient to the impacts of running and it may be possible to tailor implant choices accordingly.

Will I be able to kneel?
After a hip replacement many patients can kneel down. The safe way to do this is to perform a single-legged kneel whereby the patient kneels on the knee of the operated side only. This means that the other hip has to bend whilst the operated hip stays extended. The reverse is true after a knee replacement as it may be too painful to kneel on the operated side whereas a single-leg kneel is possible on the opposite side.

How long should I use high seats and equipment?
High seats, raised toilet seats and other equipment is normally provided by the occupational therapy or physiotherapy departments. It is normally advised to use these for around 6 weeks but occasionally it may be necessary to use them for longer.

Tying shoe laces?
This is not normally a problem after knee replacement. However, after hip replacement some patients still find it very difficult or impossible to either put their own socks on, cut toe nails and tie shoe laces. Generally the stiffer the hip is before surgery, the more difficult it is to achieve flexion afterwards. We do not normally advocate forcing the amount of flexion due to concern about dislocation. One important point to remember is that when trying to reach your toes it is always safer to put your arms down between your knees rather than around the outside of your leg and this rotated the hip into a safer position.

Back to work?
When to return to work is a very common question but it highly variable and depends greatly on the type of work. Someone who works from home using the computer would probably be able to continue with this almost immediately whereas to return to manual labour can take 3-6 months. It is advisable to talk to your surgeon about the expected time frame for return to work but as a guide most patients who are not on their feet al day at work and are not involved with any lifting or carrying return to work at between 6 and 12 weeks.

Bending and lifting?
Before you leave hospital the physiotherapist will instruct you in the precautions you should follow during the first 6 weeks. These are essentially restrictions on the amount of bending at the hip. We try to limit the hip flexion to 90 degrees (a right angle) to reduce the risk of dislocation whilst the tissues around the hip heal. Similarly lifting of heavy objects should be avoided in the post-operative period as this often involves significant flexion of the hip.

Sports

Skiing
Whilst skiing after hip or knee joint replacement is possible it is likely that regular involvement in high activity sports such as this may shorten the life-span of the prosthesis. This may be a risk patients are willing to take but again this should be discussed in depth with your surgeon. The other risk with skiing is of fracture around the joint occurring after a fall. Clearly this risk is proportionate to the skill of the skier.  An expert skier who knows their own limits and can safely stay within them is at much lower risk than a beginner who will certainly fall on multiple occasions.

Running cycling and mountain biking
It is possible to get back to all these sports after hip replacement, however, running in particular maybe harmful to a hip replacement and if you are keen to get back to running you should discuss this in depth with your surgeon prior to surgery. Some types of hip replacement are more resilient to the impacts of running and it may be possible to tailor implant choices accordingly.

Cycling does not really pose any great risk to the hip and is a very good non-impact activity. Positioning of the seat and handlebars is important however. The seat position relative to the handlebars should not be too high so that you have to flex forward excessively to reach the handlebars but equally the seat should not be so low that the hips flex too much when pedalling. It is a good idea to use an exercise bike before going out on the road so that you get your hip used to the movements. Whilst mountain biking tends to have a slightly better riding position, the increased risk of falling off does put the hip at risk of peri-prosthetic fracture (fracture around the hip replacement). This risk is related not only to the skill of the rider and the technicality of the terrain but also to tiredness so it is important to gradually build up your rides and stamina.

Tennis, squash, badminton.
Most keen racquet sport players manage to get back to playing although this may take up to 6 months. Some sports involve higher impact than others and whilst it is possible to play a relatively sedentary game of tennis or badminton, squash does not really lend itself to being played slowly and oftentimes patients will realise that alternative sports are more appropriate.

Horseriding
Recreational horseriding should be perfectly possible after hip replacement. Mounting and dismounting pose the greatest risk (other than falling of course) and it amy be that a high platform is required for this. Once in the saddle the hip position is a relatively safe one but may take some getting used to due to the relatively large amount of abduction (moving the legs apart) required.

Watersports
Sailing can vary from perching in a tiny dinghy to relaxing on a luxury yacht. The main issue is one of hip flexion. If you can sail your boat without extreme flexion of the hip then things should be okay. It is certainly advisable not to go out on your own for the first few times however. Surfing and windsurfing may also be possible after hip replacement however it is advisable to practice the required manoeuvres on dry land first (if possible) to ensure that you can do it. Again the main issue is avoiding flexing the hip too far. Wiping out will obviously put the hip at risk of dislocation and you will probably only want to go out in relatively calm conditions. Waterskiing can involve extreme positions of the hip, particularly when water-starting and in a fall. As with snow skiing it is probably not a sport to take up as a beginner but someone who is already proficient may be able to return to a moderare level. Again we advise discussing things though with your surgeon.

 


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