A total hip replacement is a major operation. If like me you come to this without ever having experienced a surgical operation of any kind, then the whole prospect can seem quite frightening. However, what I experienced was nothing like as bad as I had feared and in this article I am going to try to convey to you exactly what it was like for me.
Whilst some details may turn out differently for you, the overall experience should be fairly similar unless you are unfortunate enough to run into a complication. In that case I cannot help you because for me, as I believe for most people, everything went according to plan.
If you are reading this article then you are probably a bit like me in that you are trying to learn as much as possible about the operation beforehand, at least in theory anyway. However, theory and practice are not necessarily always the same and the contribution I am trying to make here is to give you a taste of the realities from a patient's point of view.
There will have been an initial consultation with your consultant orthopaedic surgeon and a period of waiting before the operation, which will probably vary depending on whether you are having the operation done through the NHS or privately, on which hospital you go to, on what part of the country you live in, etc..
Once a date for my operation had been fixed, I was first asked to go to the hospital as an outpatient for preliminary tests about a fortnight before the date of the operation. They took readings of my pulse, weight and blood pressure. They took some blood and urine for tests and some more blood to store for use during the operation (although they said this might not be needed). They also monitored my heart, which meant sticking pads all over me and watching the waveform of my heart beat on a display screen.
They said that if I did not hear anything within a few days, then all tests were positive and the operation could go ahead. There was one proviso though, that I should not pick up any infection prior to the operation or it would have to be postponed.
Whilst there I also saw a physiotherapist who asked me to practice walking with crutches which I would have to do for up to six weeks following the operation. She also showed me an artifical hip joint and explained why I would have to avoid certain movements of my hip during the recovery period.
I was asked to arrive at the hospital at 7 o'clock in the morning on the day of the operation, a Saturday, having not eaten or drunk anything since midnight as instructed. I was to expect that the operation might be as early as two hours after I arrived, although in the event it took place at 1.30 pm.
As I had an hour's journey to get to the hospital and I did not want to be late, I allowed plenty of time and actually arrived just after half past six. I was shown to a waiting area and at about seven o'clock I was taken to my room. Straightaway you will see that I was having the operation privately, and I assume that with the NHS you would be shown to your bed in a ward with several other people.
I sat in a chair and waited. I had the option of watching television but I was not in any mood for that so I just sat. It was not until about nine o'clock that first the surgeon and later the anaesthetist came in for a preliminary chat. Both of them were very kind and understood my anxieties. Later the surgeon's assistant came and drew an arrow on my right leg pointing upwards towards my hip, so that there would not be any doubt in the operating theatre as to what was to be done. An identity label was placed round each of my wrists giving my name, date of birth and hospital number, and this was checked frequently and meticulously by everyone who dealt with me. Another label, this time red, was placed round my right wrist stating 'no caffeine' as for me this is a migraine trigger and it was important that I should not be given any drugs containing caffeine (not to mention drinks of tea or coffee, but of course I could refuse these).
In due course a nurse told me when the operation was now expected to happen and asked me to change into a theatre gown, but I did not need to get into bed until the last minute.
The nurse came back just before half-past-one and confirmed that I would shortly be taken down to the theatre and that I should now get into the bed. I said that this was the moment I had not been looking forward to as I did not know how I would feel when I woke up from the anaesthetic. He (for it happened to be a male nurse at this point) said that I would be fine, that there would be plenty of pain killing drugs available including a means of self-administration under observation, and that in any case I would be a little vague for some time because of the anaesthetic and would not be fully aware of what was going on.
Shortly another nurse arrived with a porter and they pushed me in the bed through the corridors towards the theatre. Just before we reached the theatre my consultant stepped out from a doorway, smiling and said "Well done!" (I suppose he meant well done for not chickening out at this point!) and I was able momentarily to touch his arm. This was a nice gesture from him which I appreciated and he clearly understood that what for him was a daily routine was for me an anxious step into the unknown.
Next thing we turned into a doorway and we were in a small room which was little more than a corridor with a work surface on each side. The anaesthetist was there and he proceeded to give me an injection which was the pre-medication to put me to sleep. Within a couple of seconds I felt myself beginning to 'go', and I said "I am going!" ... and I was gone!
When you wake up after a night's sleep you have some sense that time has passed. The operation would have taken an hour-and-a-half, but it seemed to be almost immediately that I heard a nurse saying "Hello! It's all over! How are you feeling?", or something like that. I tried to respond but only came out with something like "Nnnn!". I was not aware of any pain at all. After a bit I was giving one- or two-word answers to questions, but in a low-pitched drawl. My sense of time for the rest of that day and the beginning of the following day was not very clear. After a bit I became aware of a dull heavy-ish ache in my right thigh, but I felt nothing from the foot long incision that had been made and stapled back together around the outside of my right buttock.
As my awareness continued to return I noticed that I had a drip attached to my left wrist and an extensive dressing over my wound and that three small tubes, known as drains, were emerging from my right thigh and draining into some receptacles on the floor, which I could not see because I was not allowed to move. Also there was a wedge-shaped 'thing' placed between my lower legs to keep them slightly apart. Despite all of this I was passably comfortable. In addition, I was provided with a button to press to call a nurse at any time.
When I said that the ache in my thigh was getting a bit uncomfortable, they triggered a shot of morphine through my drip to deaden the pain. Unfortunately, and this is most unlikely to happen to you, I reacted to the morphine almost immediately by retching from my empty stomach. They tried this two or three times with the same result and then said "You are unusually sensitive to the morphine, so we'll have to try something else". My memories are still a bit vague at this stage but I remember having an injection two or three times near the top of my left thigh which was probably an alternative pain killer, but I am really not sure if it was for that reason or for something else.
This is how they refer to the day following the operation (day one of your recovery I suppose). I was gradually coming back to normal but it takes a long time for the after effects of the anaesthetic to wear off.
At some point during the day my drains were removed. This was a very uncomfortable two seconds. You know that if you have a cut on your finger, say, and you knock it against something, it hurts. Well that seemed to happen about six times during these two seconds plus other unpleasant sensations as the tubes were dragged out of me.
Later that day they got me out of the bed and walked me across the room to the toilet (I had an ensuite shower room with toilet, but you may not be so fortunate if you are with the NHS). I say walked. It was with a zimmer frame taking most of my weight with my hands when putting the right foot to the ground. This aggravated the ache in the hip area. The hip joint itself, of course, being artificial and not part of 'me' could generate no pain, but the soft tissues around the joint would have been severely bruised as a result of the operation.
I did not get out of bed again that day and used a bottle when needing to urinate, but having not eaten since the Friday night I had no need to use my bowels. In fact, urinating was difficult for a couple of days and I had to force small amounts even though my system was saying I needed to go. This gradually eased and began to flow normally after a couple of days. My bowels took longer but were back to normal by the Wednesday (day four).
I did not feel anxious to eat immediately following the operation, but today I was advised to try some dry toast at lunch time and then I had a small supper later the same day. The following day I felt hungry and I have eaten normally ever since.
I got out of bed a few times on day two, still using the zimmer frame, but on day three they changed me over to crutches. The ache in the hip was gradually becoming less bad, and they started me on pain killing tablets: specifically Co-Proxamol. A few days later they tried to change me to Brufen (also called Ibuprofen): I had never taken this before which was just as well, because it knocked me out completely for two-and-a-half hours and I felt very peculiar for the following couple of hours, as if I were not entirely on this planet. So they crossed that off my list and put me back on the Co-Proxamol. My reactions to the morphine and the Brufen were seen as unusual, so it is unlikely that you will react in the same way.
On day one I had been helped to have a superficial wash whilst still in bed, but on days two and three I was able to shower sitting in a shower chair, needing help only with my lower legs. After that I was able to shower standing up, although still not able to reach my lower legs.
Because of the risk of dislocating the artifical hip joint while the soft tissues are recovering, I had to sleep on my back. I do not normally have any trouble sleeping, usually dropping off within minutes of going to bed and waking up almost exactly six hours later duly refreshed. But I sleep on my side. My system regards lying on my back as 'lazy lying awake mode' and it was fully two weeks after the operation before I managed six hours' sleep at night for the very first time, albeit with short waking periods every two hours. I had to continue with this for six weeks, still with a pillow between my legs to keep them slightly apart.
Other restrictions were that I could not drive, I could not take a bath and I was not to bend my hips by more than 90° or apply any twisting force to the operated leg or allow the leg to move across the body past the 'mid-line', and I was required to wear surgical stockings day and night for six weeks to guard against 'deep vein thrombosis' (DVT) in the legs. It was because of the 90° restriction that I could not reach my legs and I needed help every day with changing the stockings and washing my legs. Also, partly to exercise the soft tissues around the joint and partly to assist in warding off the DVT, I was told that it was important to keep active and walk a little further each day. At first this meant a few trips up and down the corridor outside my room, and later wider excursions around the hospital corridors and out into the two gardens that were available for patients and visitors.
Things were getting a little easier each day now, and I could probably have returned home after five days as some other patients did, but I had arranged to be collected after seven days as I had originally been advised and the surgeon agreed to this. I did develop a dry cough on day five which I was told was probably a side effect of the anaesthetic: a simple linctus would be enough to clear it up they said, but in fact it persisted for another ten days.
A friend came to collect me at about 10 o'clock on the Saturday morning seven days after the operation. It was a bit of a tight squeeze as she came in an old Jeep! The key thing as always was to avoid bending the hips more than 90°. The advice from the hospital was to raise the seat a little with a firm cushion and to wrap this in a plastic dustbin bag to make it slippery, whilst also sliding the seat back as far as it would go and tilting the back slightly. I first moved to stand with my back to the vehicle's passenger door and then lent backwards against the seat holding the door frame and slid across both front seats with my body still almost straight until my head almost reached the driver's window. My friend then took the weight of my operated leg as it cleared the door frame and I swivelled gently around and up into the sitting position. Foot room was a little restricted in this vehicle, but I managed to adopt a position with my legs slightly parted.
I wondered if the jolting of the vehicle might result in pain in the wound, but there was no problem at all and we arrived back without incident. By reversing the above process I was able to alight from the vehicle. My friend made sure that I was established at home and then had to leave for another appointment.
I live on my own and I had been prepared by the occupational therapist for coping with day to day matters, except that I could not change my own DVT stockings as explained above. Whilst most people, I imagine, would have someone else at home or a close relative or partner near at hand, circumstances are such that I have no-one within easy reach on whom I could impose the burden of coming in every day to spend half an hour changing my stockings and washing my legs, back and hair.
Apart from that, however, I had arranged in advance chairs of a suitable height with a means of levering myself out of them, and I had also arranged with my local supermarket to be able to shop by telephone. In addition the hospital had loaned me a plastic seat to raise the height of the toilet and a 'helping hand' (for picking things up off the floor without bending) as well as the crutches of course.
But to cope with the stockings, I had to pay for someone to come in each day. And this person was also able to collect my shopping from the supermarket, post letters and do other simple things which were temporarily beyond me. I had arranged for this to begin the day after I returned, but on the first day I found I needed some help, as I had my trainers on for returning from the hospital and I could not reach down to take them off and I did not want to sleep in them! I called a friend and she kindly came over and did that for me and also moved some things between upstairs and downstairs as it is very difficult to carry things up and down stairs whilst on crutches.
I was given some pain killers to take for the first few days at home and also some junior Aspirin as an anti-coagulant (to assist with preventing the DVT). On day twelve, the local District Nurse came and removed the seventeen staples that had held my incision together while it healed: there was nothing that you would call pain associated with this and in fact I barely felt anything at all.
Things then set into a similar pattern until six weeks after the operation, with the discomfort in the hip subsiding very slowly. I had been given exercises to do when lying down, exercises to do whilst sitting and exercises to do whilst standing with the good leg on a pile of telephone directories, and I also continued walking a little further each day.
After six weeks I had an appointment back at the hospital to see how things were going. After this I no longer needed to wear the stockings and I could reach my feet with care, and I could also begin taking baths and driving my car again and (thank goodness!) sleeping on my side.
Also I no longer needed to use the crutches, but it was suggested that I used a stick instead for a while to avoid putting my whole weight on the operated side for a little bit longer. Recovery was not deemed to be complete until twelve weeks after the operation, when I returned to the hospital for another check up.
I have failed to mention the most important thing. All the pains in my thighs, legs and back that had been associated with the osteo-arthritis in the hip joint had, of course, now gone. They were temporarily replaced with the discomfort resulting from the operation, but once that had gone ... total relief!
So, whilst there was a good deal of inconvenience to cope with, there was no excruciating and unremitting pain at any time. For the first couple of nights I did have a persistent ache in the front of my right thigh which was tiresome, but I could have avoided even this if I had not, in an attempt to avoid taking too many drugs, refused some of the pain killers I was being offered.
Whilst there is always the possibility that one or more complications may arise, it is much more likely that you will have no worse an experience than I did, and if there should be any complications the hospital staff will be well equipped to cope with them anyway. It is easy to say "don't worry!", but I am saying that overall there should not be any reason to worry if you are prepared to cope with the inconvenience in order to reap the benefits.
My grateful thanks are due to Mr Richard Villar, the consultant orthopaedic surgeon, Dr S Ghosh, the anaesthetist, and Moira Burgham, the senior nurse, together with all her teams of nurses and carers, not to mention the catering and cleaning staff at the hospital, all of whom were kind, caring and helpful to the point that I was in danger of actually enjoying the experience!
David - September 2000
The second operation seven months later went even more smoothly than the first. I was up and about sooner this time and came home after only five days. Three months later I began going to the gym regularly which I am still doing three times a week, and I also take part in a weekly aquarobics class. In addition, I have been learning to play golf and now play twice a week, and I have even started to play badminton again at a social level (being careful to step about the court and not run or jump). So, whilst I have had to make some changes to my lifestyle, I have been able to find alternatives that are equally challenging and fulfilling.
David - July 2002
I have been returning every two or three years for check-ups consisting
of X-rays of the hips and thighs and a discussion of these and of my condition
with a consultant. The last check-up was in October 2008 when everything
was found to be in perfect condition, and indeed it was suggested that if this
was the case 7 or 8 years after the operations then I may never need to have
them done again (second and subsequent operations are known as revisions).
David - December 2008
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