Mr Ananda Nanu
President of the British Orthopaedic Association
Hip replacement surgery, technology and materials have improved immeasurably over the years, significantly speeding up hip operations and recuperation time.
Most hip replacements are performed under spinal anaesthetic, so that the patient can stay awake and talk or listen to music during the procedure.
Hip replacement operations hit headlines recently due to the Duke of Edinburgh’s successful hip replacement surgery. It has also brought to light various myths that have developed about how active one could be following a hip replacement operation, says Mr Ananda Nanu, Orthopaedic Surgeon and President of the British Orthopaedic Association.
“For instance,” he says, “when the procedure was in its infancy in the 1960s, patients were traditionally told not to bend their hip more than 90 degrees, or take part in certain activities — such as skiing or breast-stroke when swimming — for fear of dislocation. However, now that technology has moved on and techniques have improved, it’s no longer true today.”
Another myth is that both hip surgery and recuperation take a long time. “With modern advances, most hip replacements are performed under spinal anaesthetic so that the patient can stay awake and talk or listen to music during the procedure,” says Nanu. “From beginning to end the surgery can now take between 45 and 55 minutes — and, post-surgery, the average length of stay in hospital is two days, which really improves the experience for patients.” If a programme of physiotherapy and exercise is diligently followed, full recovery can take around three months, depending on a patient’s age and fitness.
Patients should do their research: surgery must be a mutual decision between them and their surgeon
It is important that patients are fully aware of all the positive and negative aspects of surgery. A hip replacement can provide welcome relief for a patient experiencing pain arising from their hip joint, because all affected bone is removed, helping them to lead a normal, active life again.
“Patients also need to be aware there is always a possibility that things will not go perfectly to plan,” says Nanu. “The biggest risk is infection. There’s also the risk of a clot forming in the leg or that the surgeon’s technique may not be perfect. But we discuss this with the patient. We give them all the information; then they do their own research and come back with a list of questions. The point is that surgery is a joint decision. The old patriarchal system where the doctor tells the patient what to do has gone – a collaborative approach provides better outcomes for the patient.”
How long do modern hip replacements last?
Nowadays the average age of patients undergoing a hip operation is 69 to 70, so a replacement for someone with arthritis is likely to last them the rest of their lives. “However, there isn’t a ‘one size fits all’ hip replacement,” says Nanu. “If someone needs surgery but is young and active, they could be offered a completely different type of joint that doesn’t wear out after 25 years — and which may indeed last 50 years or even their lifetime. However, this type of joint could cost the NHS twice as much.”
Some clinical commissioning groups in the UK are restricting hip and knee replacements for budgetary reasons, says Nanu. “Funds are finite. We need to make sure we are giving good value for money.”
Hip replacement surgery — plus the materials used in it and the technology surrounding it, including robotics and virtual reality — has advanced immeasurably over the years and should continue to do so. “We still don’t have the ability to inject stem cells into the hip so that cartilage can reform itself. I can’t see that happening for decades, but when it does it could transform hip replacement surgery,” says Nanu.