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Tim Board
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Which factors determine the wear rate of large-diameter metal-on-metal hip replacements? Multivariate analysis of two hundred and seventy-six components.
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Medical management of osteonecrosis of the hip: a review
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Preparation for surgery

Referral

By this stage you have seen your General Practitioner who has discussed the potential for surgery.  You have been referred to a Consultant or specialist where a detailed history and examination has been carried out and potentially investigations such as x-rays and an operation has been discussed with you.  The consent process has been explained and you are going to proceed with an operation.

Before surgery

The operation may be within a couple of weeks, alternatively it may be three or four months off depending on the precise circumstances.  Patients often ask what should they do at this stage.  The broad advice is to stay as healthy as you can.  If you are a smoker you should avoid smoking as smoking significantly interferes with respiratory function following surgery. Avoid excessive alcohol intake. Eat sensibly.  It is probably not wise to go on a crash diet as this has a potentially adverse metabolic effect but equally avoid over-eating.  Sensible exercise, obviously pain may prevent you from exercising in some circumstances but continue muscle action such as walking.  Don't become a couch potato!  Try and ensure you have not got an areas of active infection.  It may be worth visiting a dentist to have your teeth checked out to make sure there are no areas of dental sepsis.  Keep an eye on your skin for any infections and any urinary tract infections, if you are prone to urinary tract infections.

Time off work

There will be several arrangements to make either with your partner, family and work.  Quite commonly patients are off work for up to three months following a hip or knee replacement but with less active forms of work patients may get back to work within six weeks, possibly less. It does vary and you need to consider your own exact circumstance.  You should already be considering what happens after the operation to make any other preparations. 

Flying after your operation

The other thing that comes up not infrequently is holidays and timing of holidays and flying. If you can avoid travelling, air travel in particular in the first six weeks that is sensible.  If you do travel you may need to take extra agents to reduce blood clot risk such as aspirin but you should consult your GP about this.

Pre-Operative assessment clinic

Before the operation you may be called to a Pre-Operative Assessment Clinic for an assessment.  More frequently nowadays this may happen on the same day as being seen.  In other cases it will happen nearer to the time of surgery.  This may be carried out by a specialist nurse or an anaesthetist and this is an opportunity to check your blood pressure, carry out a heart tracing, chest x-ray as necessary and perform blood tests and to do a blood grouping and typing.  If you do need blood then that has already been taken care of.  This is to reduce any potential for late cancellation to make sure that all your physiological parameters are considered.  You may or may not see the anaesthetist.  If there are particular risks then you may require further investigation such as for example an echocardiogram if there is concern about your heart and there may be a necessity to take further blood readings if you are hypertensive.  The anaesthetic nurse may consult with the anaesthetist.

Type of anaesthetic

Patients quite often ask about the anaesthetic, will they have a general anaesthetic, a spinal, or an epidural?

A general anaesthetic is when you have an injection and basically you go to sleep.  With a spinal anaesthetic or an epidural a needle is placed into the back and your legs are made numb.  The spinal tends to be a one-off injection of anaesthetic which is good for shorter procedures whilst in an epidural a tube(catheter) is left in and drugs can continue to be administered after surgery for prolonged pain relief. These types of anaesthetic  are very effective for several reasons.  They do control blood pressure very effectively which often reduces intra-operative bleeding.  It is quite good at providing good haemodynamics which potentially reduces blood clot risk and probably even more importantly, it does provide very good post operative pain relief. 

However, there are different trends and recommendations and some surgeons are using infiltrations of local anaesthetics combined with a general anaesthetic, so practice does vary and it is important to discuss this with your surgeon or anaesthetist to understand what you are having.  Sometimes a pain relief is administered by pain pump locally into the wound post operatively or by pushing a button to administer safe doses of painkillers - called patient controlled analgesia (PCA).

Some patients have a fear of not waking up and therefore wish to be awake and it is possible to have a spinal and stay very alert and even potentially talk to the anaesthetist and surgeon doing the operation but equally it is possible to be sedated with a spinal, so don't think you have to stay awake if you have a spinal anaesthetic.


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