THE RIGHT HIP REPLACEMENT
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TOTAL HIP REPLACEMENT - CHOOSING THE RIGHT CONSULTANT AND THE MOST SUITABLE HIP REPLACEMENT OPERATION
1. Choose the right consultant:
If you have the operation done privately, you have complete freedom of choice over choosing your surgeon. On the NHS you still have the right to be able to see a consultant Orthopaedic Surgeon of your choice - as long as they deliver NHS operations. It might be difficult to persuade your GP to allow you to do this, as often they will have bulk purchased operations with a particular hospital. Bearing in mind this advice is primarily for active outdoor and sports persons, you may well want to research the background to surgeons and choose one who has a specific interest in sports related problems, and in any case, one who has performed hundreds of successful operations. Be comfortable with your choice of consultant. To avoid the delay in waiting for an appointment, arrange to see the consultant privately (about £180 and usually within a few days) and check that he will then place you on his NHS list - this could save months. Talk extensively to the consultant and make sure he/she understands exactly what you want to achieve post-op as this influences the choice of materials used and type of operation. Ask them to explain how their suggested type of replacement will benefit you and be comfortable with their explanations. If you're not happy - see someone else. After all, you would probably get a second opinion or quote on many everyday jobs, so why not this?
2. Choosing the right Operation
When you have a hip replacement there are 2 main options - a total hip replacement or hip resurfacing. My GP suggested Hip Resurfacing, which involves the surgeon putting a cap on the head of the femur and a new socket into your pelvis to receive it. The femur is not sawn off and the operation is said to have a shorter recovery time. I was then advised against this by the consultant, as I was a potential heavy user of the joint, and was told that some active patients were starting to come back with problems after 2/3 years, requiring a further operation to perform the total hip replacement option. I was advised, correctly I believe, that for anyone wanting to pursue an active lifestyle, the total hip replacement is a better long term solution. Don't take my word for this - discuss it with your consultant.
If you choose a total hip replacement, it then comes down to two main issues - the materials out of which the new joint will be made, and the size of the femoral head (ball joint). The current best advice for active people wanting to maintain an active lifestyle, is to go for a ceramic on ceramic joint, with a bigger than normal femoral head and socket to match.
Ceramics are said to be the longest lasting material currently available. Ceramics are inert and do not pose a threat of metallic particles getting into your bloodstream as recent problems highlghted in the press with metallic surfaces have revealed. I believe there are also different makes of ceramic joint, some of which have increased strength advantages.
The size of the femoral head is important if you are an active person. A larger femoral head means a larger surface area for lubrication, which is supposed to help with free movement, and it is also a more stable joint, with less dislocation problems. Some surgeons eg Sussex Hip Clinic, make a real seling point of this "Big Ball Hip Replacement'
So, as far as all the advice I received and all the research I have done, the bigger femoral head, with a ceramic on ceramic bearing seems to be the best option for those people wanting to maintain an active lifestyle. Certain large bearing metal on metal hip replcements have recived much adverse publicity recently, you should check out the latest advice from your consultant.
The evidence? As I write this, I was driving 3 weeks post op, walking short routes on gentle, but rough mountain terrain after 5 weeks, skiing easier/mid grade ski runs after 8 weeks and snowmobiled 120km to the Russian border also after 8 weeks - all without problem. You'll find more details on the other pages.
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