Frequently asked questions

What Is Arthritis?

Arthritis means inflammation of a joint. Inflammation is part of the body's natural response to injury. The signs of inflammation are redness, swelling, heat and pain. It can affect almost any joint; the hip and knee joint are commonly affected by arthritis.

What are the different types of Arthritis?

There are many types of arthritis; the commonest are Osteoarthritis and Rheumatoid Arthritis.

Osteoarthritis is often described as being a form of wear and tear arthritis; it may reflect the normal passage of time and use. But can be due to previous trauma, infection, genetic factors, obesity, sporting injury. In OA the cartilage that covers the ends of the bone becomes thin and breaks down. This exposes the bone, leading to pain, stiffness and deformity. The joints affected are usually the larger weight bearing joints, hips and knees, but the hands, spine, feet and shoulder can also be involved.

Rheumatoid Arthritis is an example of an autoimmune disease. The patients own immune system attacks the lining of the joints, it can also involve many other tissues and organs through the body. The typical patient is a female of childbearing age. The symptoms are those of swollen, hot joints that are stiff and painful. Fortunately the classic picture of severely deforming rheumatoid disease is becoming increasingly rare due to the improving early diagnosis and more aggressive treatment of rheumatoid disease, with newer more targeted disease modifying drugs.

What are the causes?

Depending on the type of arthritis there are many causes, some of which may be preventable. Age, family history, genetics, gender, ethnicity, are all unalterable, but other factors such as injury, sporting activity, occupation, obesity, sedentary lifestyle are factors which we can control. Some forms of arthritis arise from child hood hip problems, growth disorders, previous infections, inflammatory conditions, endocrine disorders, and metabolic diseases.

What can you do?

Discuss with you family doctor to determine the type of arthritis you have. Treatment depends on a correct diagnosis. Take medication as advised by your doctor. Appropriate rest and or exercise may be sensible, as advised by your doctor or health professional. Pain relief such as heat or cold therapy, weight control to prevent extra stress on weight bearing joints, are all reasonable precautions. As always maintain your general health and well-being, and don’t smoke.

What are the treatment options?

Treatment for osteoarthritis begins with conservative non-operative interventions. A balance of rest and exercise, avoiding vigorous weight bearing activities, education in arthritis management, support, and joint protection such as walking aids or braces. Drug treatments include pain relieving and anti-inflammatory medication, complementary medication, possibly injections into the joint of cortisone.

Treatment of osteoarthritis focuses on reducing pain and improving movement, it can include:

Education, Exercises, Support, Joint protection, Weight control, Physiotherapy, Surgery

Does dieting, supplements and exercise help?

If you are over weight this will place a great deal more stress on joints, so weight loss will be very beneficial.

The use of medication, anti-inflammatory gels/rubs, anti-inflammatory drugs such, as Ibuprofen, and simple analgesics such as paracetamol, will help. Complementary and alternative medications such as glucosamine with or without chondroitin, whilst very popular have a variable response helping some but not all that try them.

Exercise is very important because it increases lubrication of the joints and strengthens the surrounding muscles, putting less stress on joints. Exercise in heated swimming pools, hydrotherapy, can bring enormous relief from pain and stiffness. Also studies have shown that exercise helps people with arthritis by reducing joint pain and stiffness and increasing flexibility, muscle strength and energy. It also helps with weight reduction and offers an improved sense of well-being.

What is a hip replacement?

Total hip replacement replaces the worn out hip joint with an artificial joint, and was advanced in the UK by Sir John Charnley. Over 70,000 total hip replacements are performed in the UK each year; it is one of the most dramatic life changing surgical procedures performed in medicine today.

Are all hip replacements the same?

There are many types of hip replacement available, each with a different design, method of fixation, bearing surface and size of femoral head.

The most commonly used consist of a metal ball articulating with a plastic socket. Some hip replacements are designed to be used with acrylic bone cement, which secures the implants into the bone (cemented); others have a special coatings and surfaces to encourage bone growth onto the prosthesis to give biological in growth and long term stability (uncemented).

Do hip replacements wear out?

Yes, all surfaces that move relative to another will eventually fail, regardless of what they are made from. We hope that the wear process is sufficiently slow such that the implant will out live the patient. In younger patients this may be an issue with the patient wearing out the replaced joint in their lifetime.

In the metal on polyethylene bearing surface, it is the polyethylene that wears out. The rate at which this occurs is related to the load, activity level and type of activity being undertaken. Advances in technology and greater understanding of joint movements has led to the development newer bearing surfaces which can tolerate higher levels of activity and will hopefully wear more slowly. Patients who are young and physically active may be candidates for these new bearing surfaces.

What is hip resurfacing?

This operation is a form of hip replacement, it differs in many ways from a total hip replacement. The component parts are larger and are entirely metallic, the device is felt to offer a number of advantages over conventional total hip replacement. Initial results have suggested good short to medium term results, however over the long term there are concerns as to whether this encouraging early success will be continued. The operation should be used with caution if at all in female patients, those with known metal allergies, patients with renal impairment, or patients with abnormally shaped joints, or those with smaller ball and socket joints.

What are the risks of joint replacement surgery?

There are many potential risks with all forms of surgery. The risks arise from both the anaesthetic and the surgery. Thankfully the likelihood of any is small, but prior to consent you will be fully informed of all serious risks.

How do you reduce the risk of DVT/PE?

Joint replacement surgery is a risk factor for deep vein thrombosis, a clot in the deep veins of the legs and pelvis and the presence of these clots can lead to a pulmonary embolus, where the larger blood vessels in the lungs are blocked by these clots. This can be fatal. All patients are risk assessed for the likelihood of a post-operative deep vein thrombosis. To identify those patients at increased risk and to ensure that patients are treated appropriately. We commence mobilization of all patients within hours of surgery, and all are given compression stockings to wear. With regard to drugs used to reduce the risk further we follow the latest guidance from the National Institute of Clinical Excellence, Royal College of Surgeons and other Professional Organizations.

How long will I be in hospital?

Depends, hips on average 4 days and knee around 3.5 days.

Will I need to have physiotherapy?

Our highly trained physiotherapy professionals see all patient whilst in hospital. They post-operatively guide the mainstay of recovery and rehabilitation. If any additional therapy is required after discharge then they will arrange for this, also all patients are given an exercise regimen to continue with whilst at home to aid their recovery.

How soon can I drive after surgery?

By six to eight weeks most patients are well enough and safe to drive. If you are in any doubt about your safety you should check with your insurance company.

Can I sleep on my side?

Ideally patients’ sleep on their back for the first 6 weeks after total hip replacement, this can be difficult for some patients and their partners. After 6 weeks it is fine to sleep on either side as long as a pillow is placed between the legs to prevent the legs crossing. For some it may be uncomfortable to lie on the operated side for some months, whilst the scar is healing and maturing.

Can I exercise?

In the first few months after surgery simple walking is the best form of exercise, the muscles around the hip joint are very active during normal walking. There is no required amount of walking that patients should do, as everyone is different in terms of their pre-surgery fitness and mobility. It is important to remember to build things up gradually over the weeks and months, after your surgery. Some exercises do put the hip at risk and in particular those that involve bending the hip a great deal (such as using a rowing machine, yoga, squats) risk dislocating the hip.

Running is another exercise that might be harmful to a hip replacement and if you are keen to get back to running you should discuss this in more detail 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.

Can I horse ride after my surgery?

Recreational horse riding should be possible after hip replacement. The greatest concern will be stability of the hip due the risk of dislocation. Mounting and dismounting pose the greatest risk and it may be that a high platform is required for this. Once in the saddle the hip is in a relatively safe position, though it may take some getting used to due to the large amount of abduction (moving the legs apart) required.

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?

The occupational therapy or physiotherapy departments normally provide high seats, raised toilet seats and other equipment. It is normally advised to use these for around 6 weeks but it may be necessary to use them for longer.

When Can I go back to work?

When to return to work depends greatly on the type of work. People in relatively sedentary jobs may be fit to return to work within six weeks or so after a joint replacement. If your job involves a reasonable amount of physical activity I usually advise around 8-12 weeks off work.

Bending and lifting?

Before you leave hospital you will receive instructions from the physiotherapist of the precautions you should follow during the first 6 weeks. These are essentially restrictions on the amount of bending at the hip, to limit the hip flexion to 90 degrees (a right angle), to reduce the risk of dislocation whilst the tissues around the hip heal.

Can I Ski after a hip replacement?

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 risks of skiing are fracture around the joint and dislocation, 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 is more likely to fall on multiple occasions.

Is Running, Cycling or Mountain Biking possible after a hip replacement?

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 pedaling. 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.