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You have been added to the waiting list for a hip replacement on the Rapid Recovery Programme. Providing every patient with kind, effective, quality care and the best possible experience whilst you are in hospital is our priority. This journal is designed to help you increase your understanding of the programme. By you writing and updating this journal it enables you and your family to take an active part in your recovery. Please bring this journal with you to all hospital appointments. As part of the Rapid Recovery Programme the aim is to enable you to be well enough to go home after 1- 2 nights in hospital.
The hip joint is described as a ball and socket joint, this involves the head of the thigh bone (the femur) sitting snugly in the socket of the pelvic cup (the acetabulum). A total hip replacement is a surgical procedure aiming to replace a damaged or diseased hip joint.
Osteoarthritis is a common disease affecting the joints in the body, most commonly the knee and hip. The joint surfaces, which are covered in smooth cartilage, become damaged and gradually thin and roughen – this produces pain. Eventually, there may be no cartilage left in some areas of the joint. There are other diseases which cause joints to be replaced because of pain, such as rheumatoid arthritis.
Total hip replacement is a surgical procedure for replacing the hip joint. This joint is made up of two parts, the hip socket (acetabulum, a cup shaped bone in the pelvis) and the “ball” or head of the thigh bone (femur). During the operation, these two parts are removed and replaced with smooth artificial surfaces. These artificial pieces (the prosthesis) are implanted into healthy portions of the pelvis and thigh bone. The total hip replacement operation is designed to relieve pain, reduce stiffness and improve your ability to walk.
Covering the surface of the bones in the hip joint is a smooth compressible gristle known as articular cartilage. When arthritis occurs, this gristle is worn away and the bone becomes exposed which results in pain.
The pain of arthritis of the hip may be helped by anti-inflammatory medicine and simple pain relief. Physiotherapy may also help to reduce pain and improve movement. Only if these measures are ineffective will the doctor suggest treatment with a hip replacement.
There are more than 60 different artificial hips available for total hip replacement surgery. The types of hip replacements used in this hospital are all tried and tested, are approved by the National Institute for Clinical Excellence (NICE) and have many years of proven experience. Your surgeon will explain the risks and benefits of this with you as an individual.
85% of artificial hip joints last for 10 to 15 years or more, some last longer, others fail more quickly depending on the age and weight of a person.
During the operation, the hip-joint is completely removed. The upper part of the femur is sawn off and the natural space for the head of the femur (the acetabulum) is hollowed out. A new artificial socket, usually of high-density polyethylene, is fitted into the hollow in the pelvis. A short, angled metal shaft, with a smooth ball on its upper end (to fit into the socket) is pushed down into the hollow of the thigh-bone. The new artificial cup and the artificial bone-head may be a press-fit or they may be fixed with acrylic cement.
You will have a spinal anaesthetic for this procedure, along with sedation or a general anaesthetic. This will be discussed at the joint school appointment and also with the anaesthetist on the day of surgery. Refer to pages 24-25 for an more in depth explanation.
Ninety-eight (98%) of patients are satisfied with the outcome of their new replacement hip joint.
Complications are rare but include:
As part of the Rapid Recovery Programme the aim is to enable you to be well enough to go home after 1 – 2 nights in hospital.
You will only be discharged if there are no signs of complication, and you are independently mobile. If required, the district nurse will monitor your progress once discharged and provide assistance depending on your needs.
All patients who are having a hip replacement will be either seen immediately once listed for surgery or booked to attend an appointment at the Treatment Centre. From this assessment we will decide if you are fit for an anaesthetic and your operation. You will receive MRSA screening as part of your pre-assessment, via a nasal swab. The results will be checked and patients will only be informed if the swab results are positive and treatment is required. If you know that you have been a carrier of MRSA please inform the pre assessment nurse.
The pre assessment nurse will inform you of the following:
It is important that you bring the following information to your pre assessment:
After your pre assessment it is important that you contact the clinical surgical unit or your pre assessment nurse if anything changes after your assessment and prior to your surgery, such as:
Depending on the reason, it could be that your blood pressure is too high. The nurse may delay your surgery, or you may be asked to either visit your GP or an Anaesthetic assessment will be organised. We may have to remove you from the waiting list if you are not fit for surgery. Once the problem has been resolved you may then be recalled for another pre-assessment.
Pre assessment will discuss discharge arrangements and may refer you to the Social Work team. The Social Work Team work with the Reablement at Home Team and will triage the referral.
Because skin is not sterile, your skin needs to be as free of germs as possible before your operation. The nurse at Pre assessment will give you a bottle of Octenisan® wash lotion with your name on it.
Octenisan® wash lotion is a special antiseptic wash that helps reduce the number of germs on your skin and the risk of a wound infection.
Two days before your operation date, you should start showering daily (washing your hair at the same time if possible) using the Octenisan® wash lotion and following the instructions below. This should be repeated daily and for the first two days after your operation. A shower is recommended, however if you are unable to use a shower, please use the product instead of your usual soap when washing in the bath or at a sink.
You can use the table below to tick off when you have completed the body wash.
2 days before my operation
1 day before my operation
|At home on the morning of Operation Day||
1 day after my operation
2 days after my operation
Octenisan® is hypo-allergenic and should be suitable for all skin types, even skin that is sensitive to soap or susceptible to allergies. If you do experience any skin reaction such as severe burning, itching, redness, blistering, peeling, swelling, rash or any other severe irritation discontinue use of the Octenisan® and tell your doctor.
Please remember to bring your Octenisan® wash into the hospital with you as you will use this to wash with the day after your oper If you are coming into the hospital from home, please shower using the Octenisan® wash (including hair wash) before you leave.
Do not apply lotions, powder, or deodorant to your body.
Please use the Octenisan® body wash for at least 2 days after your operation, or until the bottle is finished. After this you can revert to your usual products.
You will be asked if you want to complete a PROMS (Patient Reported Outcome Measures) questionnaire. Please click here for more information.
The Joint School gives you the opportunity to learn about your surgery. The Joint School is held on alternate Tuesday afternoons between 2pm and 3.30pm. You need to ensure you attend the Joint School for Hips.
To book (or to reschedule your appointment): 01908 997 006
It is important to plan your discharge before surgery to prevent any delays in getting home.
Things to consider are:
The way you carry out some activities of daily living may need to be altered temporarily.
It is also important that you bring with you the following items if you normally use them at home:
Please do not bring with you:
The Trust cannot be held responsible for your valuables.
Please arrive at the stated time on your letter. It is important that you follow the instructions carefully or your operation will be cancelled.
Please call the relevant Clinical Surgical Unit if you have any questions: 01908 997 006 – Trauma and Orthopaedic
If you no longer wish to proceed with your operation, please let the hospital know as soon as possible.
You will be asked to attend the Same Day Admission Unit which is located in the Treatment Centre. After surgery you will go to ward 24.
The Same Day Admission Unit admits patients who are staying in hospital for longer than a day. There are trolleys and chairs, along with a change and wait area.
Visitors can accompany you to the Reception Area until you are taken to your waiting area. Due to limited space/privacy visitors will then be asked to leave.
Please keep your property to a minimum for example a small bag (similar to a onboard flight bag).
If you have any questions about your surgery please ensure you ask at this time.
Whilst you are in theatre your property will be taken to the war Once you have had your operation you will go to the ward.
Ward 24 is a 20 bedded surgical ward, it is nurse led and we care for both male and female patients. Visiting times are 2pm – 8pm. We ask that relatives do not visit outside the visiting times, so that patients can rest following their surgery. Please respect the patient’s protected meal times: Lunch 30pm – 1pm, Supper 5.30pm – 6pm.
We do not encourage very young children and babies to visit the wards due to the risk of possible infection to them. Please do not allow your visitors to eat food as many patients are not allowed to eat before their operation. We do not encourage visitors to sit on the hospital beds. It would be helpful to ask one person from family/friends to ring the ward to find out news of your progress. This person can then pass this information onto other members of your family and friends.
Please remember that staff are limited on the information they can give and will not disclose information about your procedure. If you have a concern during your stay in hospital then please raise it with the nursing staff at the time or ask to speak to the Senior Sister or Matron covering the area.
You may be booked onto an all day theatre list, which means you will arrive in the morning and may not go to theatre until the afternoon. Your anaesthetist will inform the nursing team if you are able to have a drink on the ward, due to the timing of your operation and a drink will be provided. It is essential that you are fully informed so if you have any questions please feel free to ask the nursing or medical teams.
The nursing staff will settle you into the ward environment and inform you of the ward routine.
The Surgeon, Anaesthetist and Physiotherapist will visit you before your operation. This is a good time to ask questions and tell the Anaesthetist about any worries that you have. Your leg will be marked.
You will have:
During your stay in hospital you will be encouraged to be as independent as possible. This means that you will be expected to do as much for yourself as you can e.g. washing, dressing and walking to the toilet.
You will be expected to sit out of bed when you are well enough rather than staying in bed.
You will be encouraged to get into your day clothes rather than spending all day in your nightwear. This usually makes you feel better in yourself and helps you stay independent.
You will be able to go home 1-2 nights after your operation. Your plans for discharge should be in place before you come into hospital for your surgery so that there will be no delays.