Frequently asked questions: total hip replacement

You will be expected to put care support in place for the individual you care for before coming in for surgery. You could ask family/friends to support or consider contacting the following agencies:

Adult Social Care – 01522 782155

Carers First – 0300 303 1555

It is recommended that you consider seeking support from family and friends after surgery. If you feel you may need assistance with washing/dressing/meals after surgery, this will be something you will need to arrange yourself. Occupational therapy can send you over some numbers and a care booklet to support you in preparing.

It may be useful to prepare meals before coming in and stocking up the freezer or having microwave meals, so that it makes it easier for you post-surgery.

Any concerns will be discussed when the Occupational Therapy team contact you before your surgery.

The additional support can be discussed with the Therapy team, contact the Therapies department at Grantham, Pilgrim and Lincoln hospital.

• Grantham Hospital – 01476 464253
• Pilgrim Hospital, Boston – 01205 446412
• Lincoln County Hospital – 01522573945

You will receive a call from a member of the Occupational Therapy team prior to your surgery who can provide advice in relation to any equipment needs you may have.

More information about visiting our hospitals or gaining support in relation to additional needs can be found on the our website: www.ulh.nhs.uk/patients/outpatients/

Additional support can also be accessed through the following services:

• Sensory Service – 0333 320 2667
• Learning disabilities and autism – 0303 123 4000

Grantham and District Hospital has now been designated as a centre of excellence for orthopaedic care and the vast majority of patients will have their surgery there. As the hospital only deals with elective surgery, your surgery is much less likely to be cancelled as opposed to being listed to have surgery at Lincoln or Boston where emergency surgery takes precedence.

There are a group of patients who will have to have surgery at either Boston or Lincoln due to ongoing health concerns, which may put them at greater risk for surgery and therefore needing more care or a longer stay in the post-surgery recovery phase.

Any concerns about the location of surgery or how this affects your planning around surgery and recovery can be discussed with the orthopaedic consultant or the Pre-assessment team.

We are encouraging patients to wait well for their surgery. This can include maintaining your health by eating well, keeping active, trying to lose weight and stopping smoking if you have been advised to do so. One You Lincolnshire offer guidance and support on each of these topics and you can self-refer to have an assessment by one of their health practitioners who can then guide you with what’s on offer.

As part of your journey in getting a diagnosis and being listed for surgery, you may also have been set exercises by a physiotherapist. You can find the exercise leaflet and demonstration video on our website. You are expected to start them as soon as possible (as pain allows). They will help you maintain mobility and strength around the joint, making the recovery quicker after the surgery.

Versus Arthritis also offer information on their website and free booklets on sleep hygiene, pain relief and activity around the home, plus they have a set of exercise videos for you to do in the comfort of your own home.

For a temporary period, it may put an increased load on your non-operated joints due to offloading your new hip/knee due to pain, but as your pain settles down, this will start to reduce the load on your other joints.

There is enough time to make even the smallest of changes to enhance your recovery.

Ideally not. You should make efforts to stop smoking and certainly do not smoke or vape on the day of your surgery as it increases the risk of any problems or side effects associated with having an anaesthetic. Smoking also affects your circulation and can lead to poorer healing and recovery from your surgery.

Your GP or practice nurse can offer you advice on the various ways to stop smoking. You can also self-refer to One You Lincolnshire for their ‘Be Smoke Free’ programme, which offers weekly 1 to 1 or group sessions, free nicotine replacement therapy and will keep in contact you at the 6 and 12 months of being smoke free.

There can be signs that you are still smoking, such as the ability to smell smoke, the shape and colour of your fingertips and how good your circulation appears to be. However, we have to take your word that you haven’t smoked on the day of your surgery and the risks of continuing to smoke will have been outlined to you along the journey of you awaiting surgery.

You will be in some pain, but you will be given pain relief on the ward and medication to take home with you once you are discharged. Physiotherapy will begin on the day of your surgery to make sure you are able to get up and to start walking. You’ll then be given mobility and strengthening exercises to do once you are home.

At the beginning of your recovery, you do need to balance the pain and what you can tolerate with being able to move and complete your exercises. The harder you work at the beginning the better your recovery will be in the long term.

After your surgery, you will go from the theatre to recovery and then back to the ward. You may have a drip in your arm, which helps with rehydration after surgery until the point when you can eat and drink freely again. You will be given stockings to wear and may come back from the theatre with the Flowtron on. This is a device which gently squeezes your calf to help your circulation and prevent a blood clot. Everyone gets blood-thinning medication, which is given as  tablets that need to take for 35 days.

If you have a general anaesthetic, you may still be quite sleepy when arriving back on the ward. Once the anaesthetic has worn off, you will be able to get out of bed and start to move around.

If you have a spinal anaesthetic, you will be able to sit up and eat and drink straight away.  With a spinal anaesthetic, the sensation and feeling to your lower body and legs can take a while to return so you may not be aware that you need to go to the toilet. This is normal, so please do not be alarmed.

If you have any further questions about your surgery or initial recovery on the ward, please discuss with the pre-assessment team when you come to the clinic.

Everyone will have a different preference, so you need to learn what works best for you – whether it’s hot, cold or medication.

Exercise can be good to keep the joint mobile and maintain the strength around the joint, but it can sometimes increase the pain. As with any exercise, it is about pacing yourself and only completing what you feel able to do.

There are many different forms of pain relief available. What you may need will depend on the levels of pain you are experiencing, any other health conditions or medications you may be taking and what has suited you best previously. The need for medication can be discussed with your GP, any prescribers within your GP practice, pharmacists, physiotherapists, your consultant or advanced clinical practitioners working in the clinic.

As part of the enhanced recovery programme, there is a set of medications that you will be given after your surgery, which includes pain relief, anti-sickness medication and a laxative, as we know opioid-based medications can lead to constipation.

Currently, there are no restrictions to visiting; however, it is best to check with the ward on the day of your admission as to the visiting hours. We would advise anyone who is feeling unwell in any way not to visit you. If you are having your operation at Grantham, usually patients go home on the day of surgery or the day after.  Our visiting times are listed on our website.

• Don’t twist on your operated leg
• Do not sit with your legs crossed
• Do not sleep with a pillow under your knee (you do not need to sleep in a special position after the operation)
• Do not stand for long periods of time, as this could cause swelling in your ankles
• Avoid twisting your foot inwards
• Avoid bending down or bringing your knee above waist height
• Do not do household tasks that involve lifting or moving anything heavy for the first 3 months

The surgeons will do their very best to ensure the leg length on the operated side matches your other leg. We do find that occasionally there is a short-term leg length discrepancy due to swelling, tightness in the soft tissues and altered walking pattern due to pain. Once you start to heal and recover, and your walking pattern improves, any leg length discrepancy should reduce.

Yes, however, it is not recommended in the first 6 weeks. We recommend that you move regularly used items to an appropriate height and get support from your family and friends.

It is recommended to lie on your back for the first 6 weeks; however, it is possible to lie on your non-operated side, but you will need a pillow in-between your legs to prevent crossing your legs.

The following is a list of potential problems where you should seek help from a health care professional:

Wound breakdown – if you have uncontrolled bleeding of your wound and dressings seem to be getting soaked with blood easily, then please ring the ward or contact the practice nurse at your GP. The dressings that are in place when you leave the hospital should last for 10 days to two weeks before being changed.

Clips opening up – wounds are now clipped together rather than stitched; sometimes these can become dislodged, or the wound appears to be opening between the clips. If this happens, then please follow the advice as per the wound breakdown.

Any wound discharge – if the wound starts to produce green/yellow discharge or if the area becomes red and swollen, you may have a post-operative infection. During normal working hours, please contact your GP as you may need antibiotics. If it is outside normal working hours, please go to A&E or your nearest urgent care centre.

Deep Vein Thrombosis (DVT) risk – We hope that the use of stockings and anti-coagulant medication will reduce your risk of DVT. However, if your calf becomes red, hard, painful and swollen, please go to A&E immediately for further assessment of your symptoms.

When you are discharged from the ward, you will be given a discharge summary and further guidance about your follow-up care. You will need to take this paperwork to your GP surgery and arrange a practice nurse appointment for your clips to be taken out 2 weeks after your surgery.

You will get a call from the orthopaedic team 2-3 days after your surgery to check how you are doing, so please raise any concerns with the team.

Following total hip replacement, you will leave the ward with a set of advancing exercises and guidance on building up your walking ability. It is no longer standard practice to have physiotherapy as an outpatient following a hip replacement. However, if at your 6-week check, the orthopaedic team believe it would be beneficial for you to have further physiotherapy, they will refer you for an appointment at that point.

You will be seen in clinic 6 weeks after your surgery by the consultant or a member of their team.

A return to work can be variable depending on the nature of your job. It is certainly recommended that you plan for a minimum of 6 weeks off work, and this can be discussed when you attend the clinic for your 6-week post-surgery check.

A return to sport will depend on what you are aiming for. We advise avoiding impact activities such as running or jumping for 14 weeks. Your physiotherapist can guide you on a gradual return to sport and ensure you have a programme of strengthening in place to build back to previous levels of activity.

Following a hip replacement, you should avoid sexual activity for 4 months, at which point there are no restrictions and you can do what feels comfortable for you.

You will be advised against driving for the first 6 weeks after your surgery. At the 6-week point, you need to ensure you can get in and out of the car comfortably and complete an emergency stop, should you need to. It is advisable to contact your car insurance company and discuss with them the surgery you have had so they can guide you further.

Read this information about how to get in and out of the car safely following your hip replacement procedure.

Accordion content

X-rays can be requested through radiology, and they can be shown to you in the clinic. Due to the protection of information and governance policies, we are not able to let you take a screenshot of your images.

Other options to consider, other than surgery, are:

• Being active or following an exercise programme: maintaining joint mobility and strength alongside being a healthy weight can help you maintain the longevity of your joints. Your physiotherapist can advise on an exercise programme for you to follow. One You Lincolnshire and Versus Arthritis have advice on maintaining a healthy lifestyle and activity. Going to physiotherapy will not delay your surgery in any way.
• Pain relief: there are different options for pain relief based upon your needs, medical history and current medications. Pain relief can be discussed with a pharmacist and your GP.
• Corticosteroid injections are used to reduce inflammation and pain within the joint. You can have up to three injections per year, but not within the 6 months prior to any planned surgery.

In order to help people make decisions about their care options, the NHS has developed shared decision-making tools. These tools outline the treatment options available to you and can be used to aid discussions about what you would like with health care professionals. The tools can be found electronically using the links below. You can ask your health care professional for a paper copy.

Hip arthritis: www.england.nhs.uk/publication/decision-support-tool-making-a-decision-about-hip-osteoarthritis/

Versus arthritis:  www.versusarthritis.org/about-arthritis/healthcare-professionals/musculoskeletal-decision-support-tools/

Risks and benefits of the surgery

The benefits of surgery include reducing your pain, increasing your movement and mobility, and enjoying a better quality of life, allowing you to do the things you enjoy.

Risks of surgery include: post-surgical infections, nerve and blood vessel damage, ongoing pain or stiffness following knee replacement, requirement for further surgery, metal work failure – leading to further surgery and blood clots.

All the risks and benefits will be discussed in detail with you when you have your orthopaedic consultation and when the decision to list you for surgery takes place.

When you are listed for surgery, we are hoping to offer everyone surgery within a 3-month window. Some people may get their surgery sooner than this, while others may wait slightly longer.

This is dependent on who is completing your surgery and what priority your surgery has been identified as.

Yes, there is. Things like pain levels and ability to manage day-to-day tasks are taken into consideration. There is a grading process in which the surgeons make the final decision about the need and urgency of surgery.

Data has shown us that joint replacements last an estimated 20 years; therefore, if you are having surgery in your 40s and 50s, there is a chance that you will need to have revision surgery in later life. If you want to read more about joint replacements and see the UK data, it can be found on the National Joint Registry website: www.njrcentre.org.uk

There is no upper age limit on having a joint replacement. Those who are younger will be advised about the life span of a joint replacement and what this would mean for further surgery at a later date.

If you have been seen in a private clinic but would like your surgery on the NHS, you will need to speak with your consultant to be transferred onto their NHS list, if they hold one, or be transferred to another consultant.

This will be a mutual discussion between you and the consultant. It may be that an element of your health may increase the risks of surgery, so the consultant will discuss options with you to help you make an informed decision about your surgery.

Once you have agreed to surgery, you will be added to the waiting list. Once a date for surgery is offered to you, the pre-assessment team will be in touch with you to arrange an appointment to complete your pre-operative tests. This appointment and tests can take up to 6 weeks before your surgery date.

If you want to defer your surgery, please let us know as soon as you can, before the day of your operation. We can then discuss with you the reasons behind the decision and plan from there.

If you have changed your mind and choose not to have the surgery at all, you would be removed from the waiting list. If at a later date you decide you’d like the surgery, your GP would need to refer you again to orthopaedics to restart the process.

There is some flexibility in dates. Please let the orthopaedic or waiting list teams know of any dates when you wouldn’t be able to have surgery, and we will do our best to offer you dates around that.

If you feel well enough despite a cough/cold, you can come to the ward and be assessed as to how fit you are to undergo surgery.  If you feel too ill, then please let the ward know as soon as possible, and we can rearrange your surgery.

You will be admitted to the ward and be seen by the consultant and the anaesthetist to assess you again to make sure you are ready and happy to go down to the theatre. You will then be asked to change into a theatre gown. From here, it is a case of waiting for your theatre time slot. We aren’t able to give information on exactly what time you will go to the theatre, but we will often be able to tell you whether you will be on a morning or afternoon list.

With newer metals used in joint replacements, you shouldn’t beep when going through airport security. Some people will beep, so just ensure you tell security before you pass through the check area.

You will need to check with your chosen insurer in line with their policies

The Citizens Advice Bureau can offer advice on any benefits or financial support you may be entitled to. In addition, many banks have independent financial advisors who can assist with your overall finances or mortgage queries.

Lincolnshire County Council have set up a cost of living support line that can guide you towards agencies that can help with your individual requirements https://lincolnshire.connecttosupport.org/information-and-advice/cost-of-living-support/

There are also a number of charities that may be able to offer further guidance and support: Age UK, Royal British Legion, British Red Cross. A list of Lincolnshire-based charities and their contact details can be found in the following link: www.locallife.co.uk/lincolnshire/charities-voluntary-groups.asp#google_vignette

Physiotherapy helps to restore movement and function when someone is affected by injury, illness or disability. It can also help to reduce your risk of injury or illness in the future. It takes a holistic approach that involves the patient directly in their own care. Treatment may include education and advice about your conditions, tailored exercise programmes and activity advice, plus hands-on treatments to mobilise the joint or soft tissues.

You will be seen by physiotherapists whilst still on the ward following your surgery. They will assist you to get out of bed and walking again, plus set you an exercise programme to do at home after you are discharged. You will come back to physiotherapy as an outpatient around 2 weeks after your surgery to continue your care and work towards your recovery goals.

Occupational therapists work with people of all ages and can look at all aspects of daily life in your home or workplace. They look at activities you find difficult and see if there is another way you can do them. You will be contacted by them before surgery to discuss your equipment needs and ensure you have organised everything for your surgery.

First contact practitioners (FCP) at some GP practices are known as musculoskeletal practitioners. These clinicians are all physiotherapists who are working in primary care to assess, offer advice and guide you to the relevant service. If they feel ongoing physiotherapy care may be beneficial for your condition, they can refer you to the various services across the county for further assessment and treatment.