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July 29, 2017 at 11:31:29 AM Why are knee replacements painful? Written by James Lewis July 2017. Well some are and some are not. This is fascinating. What are the factors that mean some patients have no pain following surgery? The observed pattern is lower weight patients, often men but sometimes women, have no pain. Yes, NO pain after knee replacement. In hip replacement surgery patients frquently tell me that thier pain goes immediately on the day of having the hip replacement. This does happen in knee replacements surgery too but some have pain from the surgery - but some don't. We have been looking in to this. It seems that there are three factors; the bone quality and how careful we are with the bone - interlinked with this is the degree of arthritis as arthritis "hardens" the bone, the soft tissues as in all surgery, and a positive psychology. More

Minimally Invasive Hip Replacement

(Muscle preserving /No muscle-cutting)

with accurate leg-length reproduction

£10150 - August Only Price - all inclusive cost - 10A top rated implants - 0345 912 1000

includes great aftercare including 6 sessions of physiotherapy - can be local to you.

Minimally Invasive Hip Replacement booklet here (PDF)

     

 

What are the features of hip arthritis?

Hip arthritis is miserable. Key signs are groin pain, difficulty in getting down to ones feet, night pain, sometimes newish back pain, often referred pain down the leg- this can be to the front of the knee, to the inside or outside of the calf, difficulty in getting in and out of a car, and simply walking slowly and for shorter distances.  

What are the alternatives to hip replacement?

No one rushes into hip replacement. Options such as cortisone injections, weight loss, activity modification and pain relief can buy time.  An anti-inflammatory diet, tumeric supplements, and rarely an osteotomy (typically in under 40s) can help. Ultimately most will choose hip replacement to regain thier quality of life.

What are the features of hip arthritis?

Hip arthritis is miserable. Key signs are groin pain, difficulty in getting down to ones feet, night pain, sometimes newish back pain, often referred pain down the leg- this can be to the front of the knee, to the inside or outside of the calf, difficulty in getting in and out of a car, and simply walking slowly and for shorter distances.  

What are the alternatives to hip replacement?

No one rushes into hip replacement. Options such as cortisone injections, weight loss, activity modification and pain relief can buy time.  An anti-inflammatory diet, tumeric supplements, and rarely an osteotomy (typically in under 40s) can help. Ultimately most will choose hip replacement to regain thier quality of life.

What are the keys to a quality outcome?

1. Muscle preservation.

The muscles drive the hip and give strength and power for movement and the simple pleasure of walking. Surprisingly many surgeons cut the muscles to get down to the hip - studies show that after this appoach 40% of patients limp. Furthermore this is a difficult suituation to recover from. Mr Lewis's appoach involves parting the muscles like parting the curtains, additionally not disturbing the outer layer of muscles that are used in walking. He does take down one tendon - about the width of a straw that is later stitched back. Overall this means that all the muscles that work the hip are maintained. In short "no muscle cutting" during the hip replacement.

2. Geometric reproduction of the hip.

Sophisctically 3D imaging and software has helped our understanding of the ideal geometry for both socket position and the variables in stem placement. It may sound simple but putting the socket in the right place and in the right angles combined with the stem in the correct place along with what I will term version matching means the new hip is gemoetrically as the old hip was. This may explain the differences in outcome between surgeons. When data is compared and one surgeon has better outcomes, the questio arises- what is it that he is doing that makes the difference? Discussions indicate that it is geometric reproduction with so called anatomic (natural) socket position.

3. Leg length reproduction.

Equal leg length after hip replacement is part of geometric reproduction, but is paramount and deserves special mention. Mr Lewis uses a ruler and won't accept anything outside 2mm of target length reproduction - however long it takes at surgery. A long hip means that the soft tissues are under stretch and will be painful, perhaps a shoe raise is required and back pain can develop. In short a poor outcome to be avoided at all costs. The joy of seeing a patient walk naturally at the 2 week follow up makes the attention to detail at surgery worth the repeated checks and fine tuning.

4. Complication avoidance.

The list of possible complications is long. The key to have a stable hip, free of infection, no nerve injury and minimal blood loss. Dislocation used to reported as up to 3%. We now have a much greater understanding of the factors involved and how to avoid them. Dislocation (the hip "popping out") in Mr Lewis's hands this is less than 0.5% (Audit data on file).

Putting all this together gives high reproducability and predictability of a quality outcome. We audit all of our hip replacement patient oucomes.

What is enhanced recovery?

Simply put it is a focus on making the recovery easy. It combines elements of positive psychology, patient education and preperation, pain prevention, an anaesthetic that allows the operation to go ahead but after wears off quickly and surgery that is gentle and holistic.

This video explains:

How to chose your surgeon?

Really difficult from the outside. Good honest results matter, ours are here also video outcomes are helpful. Also factors such as approachability, absence of infection, risk minimisation and consistency also contribute. Detailed written information on the hip replacement and anaesthetic are helpful and indicate attention to detail.

Sussex Hip Replacement outcomes 

August 2017, last 9 month completed feedback

    • Would you recommend Mr Lewis?

Yes 100% of patients, no 0%

  • How many marks out of 10 for the new hip replacement?

 9.74/10 all patients

           10/10 76%

            9.9/10 one patient

            9.8/10 one patient

            9.5/10 one patient

            9/10 12%

            8/10 one patient

            7/10 one patient (leg length not equal), no scores below that - hence the real importance of precise leg length reporoduction

  • Leg length equal?

98%

Written Feedback from Patients:

Joan Nicholas commented

Mr. Lewis has given me back my life.  I can now do all the things I want to including travel. Next year a cruise. What a change it has made for me I will never be able to thank him enough.

Barrie Burnley said:

A wonderful job done, no pain, walking a short distance 3 hours after operation back driving and playing golf in 5 weeks from arriving at goring hall I felt completely at ease and comfortable.  All of the staff were so caring and kind I cannot thank everyone from Mr. Lewis down to the porters for their attention and kindness they all gave thank you.

Brian Elliott wrote:

I am back to normal.  I do not have to take any dangerous anti-inflammatory pills. I am delighted.  The whole episode was extremely well orgainised and anxiety free. I felt I was in safe hands and well looked after.

Georgina Williams commented:

I have been able to undertake two holidays after my hip op both walking tours.  I no longer have any back pain and sleep so much better.  My knee pain has also gone.  Mr. Lewis is a hero!

Charmain Stow said:

Despite some pain at night over the first six weeks after each operation, I made a rapid and complete recovery.  Only 3 months after my second hip replacement I was able to embark on a strenuous trip to Australia and New Zealand for nearly 10 weeks.  I have just returned from this trip which involved a lot of travelling and also walking over varied ground and never had a moment of pain or concern.  I am now tackling gardening totally pain free and plan to start (horse) riding again in the next few days.  I am moving better than I have done for ten years and able to enjoy my rather hectic life-style.  My friends and relation have been very impressed with the results of my hip replacements and I believe one or two have already been to see Mr. Lewis.  All in all, a wonderful result which I am very grateful.

Further reviews at end of page

What's this about the Direct Anterior Approach?

Its advantage is that it is muscle preserving, and it respects the superficial muscle layers called the deltoid of the hip. This allows a rapid early recovery. However the downsides and complications mount up. Surgeons who have tried it and I have spoken to, have either reverted to a posterior based approach or are unconvinced that the benefits outweigh the downsides. I have tried it and found it assosciated with too many risks. I use an approach developed over the years that I term an ultraposterior approach. This is muscle preserving, preserves the deltoid of the hip, has a very low blood loss and allows good visualisation of the componet position and preperation.

Which Hip Replacement is best for me?

The UK surgeons as a group favour an uncemented hip rather than a cemented. For most patients I agree that an uncemented hip is preferable and this has been our long standing practice, however if bone qulaity is very poor a cemented hip is used occasionally, perhaps 1-2 % of the time.

What is it made of?

The Stem and Socket is mace of titanium and often coated with bone minerals to enhance bone ingrowth. These bone minerals are called Hydroxyapatite.

What type of hip replacement does Mr Lewis use?

Mr Lewis uses a Corail Stem and a Pinnacle socket. These have excellent long term results and carry the English OPED rating 10A- the highest available. More detail on the specifications and data of the products on the brilliant www.corailpinnacle.net website

For patients with unusual hip geometry Mr Lewis will recomend a custom hip replacement from Symbios see the follow up video of the footballer, below! 

How much does a Hip Replacement Cost?

£12, 032. This includes everything one would reasonably think of, specifically surgeons fees, anaesthetic fees, cost of the prosthesis, physio, medicines, any gadgets, follow up appointments, 6 sessions of specialist physio including hydrotherapy after leaving hospital - this can be local to you. It also includes an element of insurance such that if there where any problems relating to the surgery or anaesthetic then any care resulting and preapproved will be covered.

Videos of patient outcomes

Lovely Hip Replacement story and video, from Real Life tested. Quality of life restored, back walking along the beach in Worthing, Sussex after Hip Replacement. 

Video  Hip replacement patient showing free walking on the second day following Minimally Invasive  Hip Replacement, Sussex, Goring Hall.

Custom Hip Replacement- again muscle preserving technique: the following video was filmed by the patient himself:

    

Hip Replacement Results from regular Feedback Audit, uploaded July 2017 all from the last 9 months of reviews

Patient Feedback (consent given for publication)

Paul Battams says

Main difference is being able to walk further, faster and for a longer period.  Do get muscle ache. Recommended swimming to tone muscles not just after op but as a new fitness regime to keep weight down

Tracey Maitland said

I am very happy with my hip especially having the minimal invasive.  I had my left hip replacement elsewhere in 2004 and would be happy to go back to James Lewis when the time comes.

John Saunders wrote

I feel that I can now walk long distances without pain whereas before my lifestyle was restricted. I can return to Pilates and go back to bowls and gardening and DIY

Maureen Warden records

Walking is much more comfortable as legs are now equal length.  I do not have pain spasms getting up from the dining room table I can walk quite long distances without discomfort and I really appreciate the difference this hip implant has made.  One other great benefit is that the scar is small and in general people are amazed at my fast recovery.

Alan Tapp reviewed

I am very pleased with my new hip.  I have always enjoyed being active and the new hip has enabled me to continue with my badminton and walking.  I don’t drive a car so walking both for leisure and everyday activity is vital.

Pauline Hurt said

We have been on holiday to Tenerife now I am going to Dubai on my own.  I am looking forward to it.  Thanks to you Mr. Lewis.

Maureen Warden records

Walking is much more comfortable as legs are now equal length.  I do not have pain spasms getting up from the dining room table I can walk quite long distances without discomfort and I really appreciate the difference this hip implant has made.  One other great benefit is that the scar is small and in general people are amazed at my fast recovery.

Margaret Halliwell said

Prior to the operation I was struggling with everyday tasks.  I couldn’t walk more than 100 yards before a painful spasm made it difficult to put my foot on the ground.  The care I received at the hospital was outstanding and the physio following the operation was excellent.  3 months after the operation was walking 2+ miles without difficulty.  I have also been able to resume my hobbies of ballroom dancing, table tennis and 10 pin bowling.  I can’t thank Mr. Lewis and his team and the physios at Goring Hall enough for giving me my life back

Margaret Vine wrote

I can now move easily and without pain, I find standing for long periods trying this is possibly because I now have 2 new hips and 2 new knees which were done in 2015.  I have travelled abroad alone 2 months ago.  Requested wheelchair attendance because of distance in airports also because of queuing.

Mrs. SD

My hip is now less painful and allows me to sleep without waking.  Rehab took a little longer than I thought it would but I got there in the end. As a frequent flyer airport security is a lot more fun than it used to be but I’m now getting to enjoy it!  I am much more happy with my hip and it has made a great improvement to my life.

Mrs. CS

Difficult to do this as I have had knee replacement since then.  Overall I am delighted with my hip

Mrs. DT

Since both my hips were done this year my life has turned around and I feel 20 years younger.  I can garden, play with the grandchildren take long haul flights and walk wherever I wish only one fault I set off all the security alarms at airports.  A very small price to pay for a pain free and active life style.  I’ve recommended Mr. Lewis to all my friends whether they need a new hip or not.

Mrs. PD

My new hip fitted 11th may 16 has been good no real problems.  Please note I also had new knees on 28th June and 11 October and these have had a big effect on how I have progressed

Mrs. AJ

Having had nearly 15 years of pain words cannot describe the effect my new hip has had on my life.  I was walking 3 months ago 6-7 miles and have returned to life that I had in my 30s I am walking cycling

Mrs. DE

Pain free in right hip since replacement.  The operation was very straight forward and the aftercare virtually pain free.  Am now able to go walking on my own without the need for walking sticks

Mrs. SS

After my THR surgery I have been able to walk long distances without pain, cycle without pain and return to my exercise pattern very quickly.  I was very surprised how soon after the surgery I was able to swim also without pain and I would definitely recommend Mr. Lewis and his team for this procedure it has enable me to return to a full and active quality of life improving my fitness weekly hydrotherapy has also helpful encouraging speedy healing

Mrs. MF

It’s great to be free from pain and walk normally.  Using vacuum cleaner is a slight problem.  Walking is fine. But not yet confident to walk on my own (I think I am frightened of falling) Must stop being a wimp!

Mrs. RL

My new hip has changed my life. The first week it was a little painful sleeping was difficult but after 2 weeks I was walking without a stick pain has disappeared no problems at all can enjoy walking and standing in the choir money well spent.

Mrs. AS

This hip has been very successful I can resume Pilates - cycle - go for long walks do the stairs with ease so it has changed the quality of my life (much better than the left hip which has caused tendon pain)

MRS IK

My new hip has allowed me to do unlimited walking up hill and uneven surfaces, stand upright, travel on all kinds of transport without difficulty, resume gardening activities, in summary having a total hip replacement has enabled me to return to all me activities of twenty years ago it’s hard to believe now just how poor my quality of life had become.

Mr. CH

It has allowed me to fully resume all aspects of running our business and pain free walking and exercising I really am not conscious of having a new hip. It never crosses my mind

Mrs. SG

Excellent operation I need more time to heal yet! I exercised well after operation No problem.  I have pain now after exercise and advised by physio to slow down! Not Happy.

Mrs. JP

No more pain getting on and off buses and trains and in and out of cars.  I marvel at where the pain is no more and why I never had the hip replaced a long time ago

Mrs. SB

It is wonderful to be pain free! Gardening swimming walking all great again venturing back to the gym soon all because of my new hip

Mrs. MV

I have had 2 knees and 2 hips in 2 years all are most successful.  I am most grateful that my life has been restored many thanks to Mr. Lewis

Mr. BA

I am back to a full and active life.  I played 18 holes of golf at 4 weeks and have now done all the following in my first 6 weeks none of which I could easily have done before - mountain biking, road cycling white water canoeing. I am planning to ski next month and complete a charity 100km walk this summer and am entirely confident in my new hip

Some patients preferred anonyminity but wished to pass on the difference that it had made to them

I can now walk without pain

I am very pleased with results am free of pain and should have had it done 3/4 years ago. 

Can now do gardening, relatively easily and life is hip wise pain free thank you James Lewis

Have been able to walk the dog again which was not possible before the hip replacement. 

It has given me a new lease of life.

I have been able to visit museums and galleries without needing to sit down every 5 minutes

Relief from pain - wonderful

My left hip is now comfortable moves freely and has gained in strength

Older, but still important reviews here:

  • Able to drive again without cramp pelasure walking bird watching and visiting historical houses and gardens plus future holidays continue with exercise - very important.

                            Consent given, Hip Replacement July 2014, review January 2015. Score: 9/10

  • I now walk with a normail gait; i can happily walk my dog and can tackle stiles uneven surfaces etc.  It is with great joy that I can play with my small grandchildren as getting up and down is so much easier.  It has removed the frustration that i used to feel at the restrictions that my painful hipplaced one my life.  I realise now that one of the main difficulties was the reduced mobility in the joint.  The new hip is remarkable and relaly does move smoothly and with ease.  I cannot praise Mr lewis and his team strongly enough.  Nothing was too much trouble and I was always treated with care, compassion and courtesy.

                            Mrs JJ, Hip Replacement July 2014, review January 2015. Score: 10/10

  • I have got my independence back I no longer have to rely on my daughters help.

                            Consent given, Hip Replacement July 2014, review January 2015. Score: 10/10

  • To be without pain relief is to be given back quality of life I had forgotten.  I feel I have come alive. I am completely unware of my new hip.  Post-operative discomfort was very short lived and is a distant memory.  Even my tiny scar has almost disappeared.  If there is anyone out there who is dithering about having a hip operation I can only say 'get on with it'. Get a life. I cannot thank Mr lewis and his team at Goring Hall enough for what they have been able to do for me. I would recommend them to anyone and everyone.

                           Consent given, Hip Replacement July 2014, review January 2015. Score: 10++/10

  • Pain in legs now gone but pain in lower back remains but improving gradually.  

                           Terence Parkes, Hip Replacement June 2014, review December 2014. Score: 10/10

  • I have no pain in my hip at all and if wasn't for my back pain caused by a stupid friend when I was was 10 who pushed be off my bike it would be perfect.

                            Priscilla Fullerton, Hip Replacement June 2014, review December 2014. Score: 10/10

  • I didn't realise how restricted my life had become until me new hip "set me free"

                             Mr  JC, Hip Replacement June 2014, review December 2014. Score: 10/10

  • My hip opeation has given me back the level of pain free movement that I used to take for granted.  From the operation to recovery has been marvellous.  I could not be more pleased.  Thank you dosen't seem enough.

                             J Edwards , Hip Replacement June 2014, review December 2014. Score: 10/10

  • Sometimes I have to remind myself how liberated I feel - no more pain or inhibiting walking.  I am amazed at how normal everything has become and how much better my persistent back pain is.  

                           Rosalie Murphy Hip Replacement April 2014, review October 2014. Score: 10++/10

  • My right hip is wonderful (replaced)- my left hip (arthritic) I have difficulty walking up stairs i have to hold on.  

                           Anonymous, Hip Replacement April 2014, review October 2014. Score /10: not stated.

  • Without a doubt it has made a huge differnece to every day living.  I can now enjoy going for walks and playing golf as before. 

                           Jean Roberts Hip Replacement April 2014, review October 2014. Score: 10/10

  • I didn't realise how much my hip stopped me doing things I wanted to do and how much it stopped me sleeping.  Im now back riding my horse, walking dogs. 

                            Anonymous, Hip Replacement March 2014, review September 2014. Score: 10/10

  • I can now work out three times a week without any pain.  I am planning a walking holiday in india.  My new hip gave me back my life thank you.

                            Mrs JB Hip Replacement March 2014, review September 2014. Score: 10/10

  • I can now walk around giolf courses and last week was able to walk 7 miles in a day without discomfort.  I have got my life bacl! Should have had the operation years ago.

                            Mr RC, Hip Replacement March 2014, review September 2014. Score: 10/9

  • I can go for long country walks with no discomfort and i have started to play tennis again.

                            Mrs JC, Hip Replacement March 2014, review September 2014. Score /10: 10

  • Before the op I was wheelchair bound.  Now I can walk normally 4 miles around a golf course 3/4 times a week inc pushing a trolley.  I exercise on the bike for 25 mins 4 days a week and swim 10/12 lengths of a 25 meter pool 4 days per week.  I also do other things its best not to tell you about. 

                            David Carter, Hip Replacement Febuary 2014, review August 2014. Score /10: 10

  • Every day has been transformed so that walking to the shops or for pleasure has become possible again.  My working life as a dance teacher is now pain free and has become enjoyable again.  I am still not yet at full dance fitness but my strength is improving week by week and my firends and colleagues are amazed at the progress I have made. Thank you. 

                              Mrs JT, Hip Replacement Febuary 2014, review August 2014. Score /10: 10

  • Fantastic results! Previously in constant pain now I have free movement in my hip which allows me to undetake many activities not possible before.  SO many thanks Mr lewis brilliant result!

                              Anonymously, Hip Replacement Febuary 2014, review August 2014. Score /10: 10 

 

  • Last week i returned to dance after a 3 year gap.  Unsurprisingly it was a bit scarey at first but I managed the Fox-trott and the Samba.  Please to say I did it even better than it used too!

                               Mrs SH, Hip Replacement Febuary 2014, review August 2014. Score /10: 10

  

  • My new hip has given me a new lease of life.  I have gone from dreading all social occasions to appreciating how wonderful; it is to be completely pain free.  I am now enjoying everything including holidays abrad, going to the gym and going for long walks.  Life is really worth living again.  Thank you Mr Lewis.

                               Alan Hillman, Hip Replacement Febuary 2014, review August 2014. Score /10: 10

 

  • Completely changed my life! No pain at all.  Can now walk, drive and fly to Australia to visit family.  Life was really miserable before the operaiton even work which i love was becoming something I dreaded mainly due to disturbed nights and lack of sleep.  I am grateful to Mr Lewis and his team.

                               Patricia Raggett, Hip Replacement Febuary 2014, review August 2014. Score /10: 10

 

  • Unfortunately after about 4 weeks I started getting pain in my other (right hip and knee).  This finally resuteld in limping and physio/chiropractic couldnt help.

                                Mrs LW, Hip Replacement Febuary 2014, review August 2014. Score /10: 10

 

  • Now very happy to be able to enjoy gardenning and to play golf without the pain.  Thank you.

                               Mrs GD, Hip Replacement January 2014, review July 2014. Score /10: 10  

 

  • I am amazed and delighted with my new hip which feels perfectly normal.  I now walk without a limp and am able to walk, swim, play short mat bowls and garden with ease.

                                Jane Everett, Hip Replacement January 2014, review July 2014. Score /10: 10 

  • The main difference is that I can now climb stairs or steps using the leg with the new hip first.  Of course the abscence of pain from this hip is a great boon.

                               Mr EF, Hip Replacement January 2014, review July 2014. Score: 10/10 

  • I can now walk and play golf as much as I like without pain and discomfort.  Putting on socks remains a chore but a relativly small inconmvenience.

                               Anonymously, Hip Replacement January 2014, review July 2014. Score: 9/10

  • Am now fully fit for sailing.  Just one problem - my new hip is so good that it makes me aware of other jonts which might need further attention.

                               Stuart Sanderson, Hip Replacement January 2014, review July 2014. Score 9/10

 

 

Would you like a muscle preserving (no muscle cutting) Hip replacement with obsession of leg length reproduction?

A track record of good outcomes?

Being looked after by a good and lovely, real people, team?

500m from the fresh air of the sea

Please ring 0345 912 1000 and speak to Deborah for an appointment, or use the contact form here

Looking forward to meeting you and doing my part to explain your options and if hip replacement is your chosen route then to personally carry it out to the highest possible standards. There are no stand-ins!

James, 

July 2017 

No Muscle-cutting Hip Replacement

Video feedback of patients walking naturally at 1 week after hip replacement and recovery at day 1 (different patient).

      

Teamwork

We work with a consistent team pre-operatively, in theatres and on the wards. 

Our practice is based at a specialist planned surgery only Hospital which doesn't have any emergency admissions and so it can protect itself from MRSA which often will enter a hospital through elderly admissions from residential and nursing homes. Goring Hall is by the sea with its fresh sea breeze, it enjoys extensive gardens and a beautiful courtyard garden from its prior life as a stately home. Goring Hall, Sussex now has 4 theatres and an impressive team of anaesthetists, with continually highly ranked patient theatre and recovery experience.

We have a particulary good team of enthusiastic and attentive ward nurses and dedicated physiotherapists. The anesthetists and our team take pride in risk minimisation. Athough it is a relatively small hospital it thrives on its teamwork, it is a top 10% hospital in terms of joint replacement volumes in England and Wales carrying out 200 joint replacements in the first quarter.  Our focus is is to achieve an excellent, consistent outcome every single time to help restore your quality of life. 

      

Minimally invasive hip replacement

A minimally invasive hip replacement is a full modern hip replacement carried out through a scar of less than 10cm, respecting the soft tissues and preserving the major muscle attachments.  We have moved on from minimally invasive hip replacement to a focus on precise geomtric reproduction of the hip with muscle preservation. The scar is still short but a little longer than it used to be.

I use a minimally invasive ultra posterior approach preserving piriformis, leading hip replacement implants as shown in national joint registries and an award winning enhanced recovery program. All xrays and transfusion requirements are peer reviewed monthly as part of our quality control. All patients have pre-op and 6  month oxford hip scores to allow benchmarking. I am pleased to have a 0% transfusion rate for the last 12 months. 

We hope you enjoy the videos and the two PDFs below (enhanced recovery and no muscle cutting hip replacement).

  • Key Benefits:
  • A smaller scar
  • Less surgical trauma
  • Therefore less scarring and stiffness.
  • Quicker recovery (audited)
  • No damage to the main “walking” muscle
  • Less pain
  • Less blood loss
  • Lower risk of transfusion (and consequently lower infection and thrombosis risk), now 0% over last 7 months. 
  • Shorter time in Hospital, can be day case.

Click Here Award Winning Enhanced Recovery Program (opens pdf)

Click Here to download the minimally invasive hip brochure (opens pdf)

Click Here Corail Hip replacement stem (opens PDF)

Click Here for Pinnacle Socket details (opens PDF)   

Although there has been emphasis on the smaller scar length (3” in a slim person, 3 ½” to 4” in a medium build person, longer in heavy person), the real focus is the avoidance of surgical trauma to the muscles on the inside. Muscles are separated rather than cut and it is this, that leads to the rapid recovery. However it does require special equipment, training, and different expertise when compared to a traditional hip replacement.

Ceramic Hip Ball; Engineering details.   

 

ITV News feature 2005 on minimally invasive hip replacement, Southlands Hospital, West Sussex.

There have been refinements in the anaesthetic and medicines used over time.

2 days length of stay was impressive then but is now the norm, with  1 night stay and daycase surgery being provided by some units, including the Sussex Hip Clinic.

 

http://www.sussexhipreplacement.co.uk/

 

   

   

Rapid Recovery after hip replacement - as seen on TV! 

ITV News feature 2005 on minimally invasive hip replacement, Southlands Hospital, West Sussex.

There have been refinements in the anaesthetic, surgery and medicines since then.

2 days length of stay was impressive then but is now the norm, with 1 night stay and daycase surgery being provided by some units, including us at the Sussex Hip Clinic.

  

 

_________________________________________________________________________________________________________________

  • Highlights from The National Joint Registry released 2013 (10th edition)
  • 86,488 hip procedures last year (76,448 first time, 10,040 re-dos)
  • 7.5% up from previous year
  • Average age for hip replacement of 68.7 years, peak age however is 70-79 years for both men and women, (the young skew brings down the average age
  • Wide patient age range from just 7 years old to 105 years.
  • Female patients predominate (60%).
  • Only 21% were of normal weight (or below), or re-worded 79% of people having hip replacements were overweight (BMI >25).

Surgical Approach to the hip

Posterior approach gains ground to 61% from 59% the prior year.

Minimally-invasive surgery (MIS) was recorded as being used in 5%

Uncemented Hip Stems

  • Uncemented hips predominate at 43% to against Cemented 33% (down from 36% last year).
  • In 2009 uncemented hips overtook cemented hips by percentage surgeon choice, uncemented hips continue to grow in popularity.
  • Corail stem has maintained its position as the most commonly used stem as chosen by surgeon at 46% of uncemented stems. Indeed the 8-year results are good across the three common bearing couples.

Hip Resurfacing- data shows it still has a place.

  • Equivalent 7-year survivorship in young males (age 55) compared to ceramic on ceramic despite the report narrative.
  • Hip resurfacing is now only 1% of all hip surgeries.
  • The Birmingham hip resurfacing is the most popular implant used.
  • Revision rate at 7 years for a 55-year-old male with a 52mm ball (all resurfacing products) 3.77%, if using the leading Birmingham 2.87% (estimated mid point between 50mm and 54mm ball 3.27% and 3.47% respectively).
  • Revision rate at 7 years for a 55-year-old male with a 36mm ceramic on ceramic 2.91%.

Ball size

The preference to use large diameter heads to improve stability continues:

30% of femoral heads (balls) being 36 millimeters

30% being 32 millimeters

40% being 28 millimeters.

Head sizes over 36 millimeters and the small 22.25 millimeters are rarely used.

Best Ball size for ceramic on poly as judged by absence of revision 32mm

Best Ball size for cobalt chrome on poly as judged by absence of revision 32mm with an uncemented cup, but 26mm with a cemented cup.

Survivorship (absence of revision) at 8 years

Corail / Pinnacle  98.2%, 97.3% and 97.0% for Ceramic on poly, ceramic on ceramic and Metal on poly – however these are old and new ceramic mixed in the calculations, however the data as stated suggests ceramic on poly as the optimum at 8 years.

Furlong / CSF    98.0%, 95.6%, and 96.5% as above, again with this uncemented pairing ceramic on poly has the lowest redo risk at 8 years.

This data confirms the excellent survivorship of the Corail and Furlong (JRI) at 8 years, particularly with a ceramic on poly bearing combination. It would be helpful to have sight of the Delta ceramics (pink) and the Forte ceramics (brown) seperately, as it may be that the delta ceramics are better than the ceramic on poly combination.

 

Bearing Combination

60% are metal- on-polyethylene, followed by a ceramic-on- ceramic articulation, with a slight increase in the use of ceramic-on-polyethylene

At 9 years for all uncemented hips the re-do rates according to bearing surface were:

Ceramic on Polyethylene  3.03% (medium cost)

Ceramic on Ceramic         4.08% (highest cost)

Metal on Polyethylene      4.30%  (lowest cost)

Metal on metal                 17.7% (medium cost – clearly terrible long-term outcomes for metal on metal hip replacement (not to be confused with metal on metal resurfacing – there is a key difference in the failure mechanism).

However the old ceramics (Forte) are mixed in with the new ceramics (Delta). The old ceramics had a notable fracture rate, which is rare with the new pink Delta (personal communication Ceramtec). Therefore it is possible, that the delta ceramic on ceramic failure rate is lower than the ceramic on polyethylene. It would be really helpful to have clarification of this. It is fair to say that that the new polyethylenes are a vast improvement on their predecessors, furthermore ceramic on polyethylene abolishes the squeak issue, which is an occasional occurrence (approximately 5% in extremes of position for example gardening) with the ceramic on ceramics.

Bearing type usage England and Wales:

Ceramic on ceramic 19%

Ceramic on polyethylene 7% (this later choice is expected to grow given the favourable outcome data, and perhaps also the lower cost)

Outcomes Oxford Hip Score

Patients fill in a score prior to hip surgery to gain a score out of 48. The same score is then applied at 6 months. The gain over the 6 months from the surgery can be calculated. Furthermore the final score out of 48 can be measured

Score at 6 months out of 48 (best possible)

Cemented 40

Uncemented 42 

Hip resurfacing 44

Please note hip resurfacing operations are often younger more active patients, so the higher score may be due to confounding factors, rather than it giving an inherently better outcome score, interesting nether the less.

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