Mrs. EF, a 47 year-old Pilates instructor.
Ms EF is 47. She is a Pilates instructor who owns her own business. She was a keen runner in her 20s, and enjoys horse riding, cycling and skiing. She has had pain in the left groin and thigh for a couple of years which became worse after she had a fall whilst skiing last year. The pain makes her limp, and she struggles at times to finish her Pilates classes. She is in good health and wants to be able to continue her active lifestyle. Her mother and grandmother both had hip problems and developed osteoporosis in middle age, and EF has noticed that her other joints have become a bit more stiff and painful since she started to have symptoms of going through the menopause.
The Problem:
Mrs. EF was still relatively young for surgery. Radiographs of her hip joints showed that she has slightly shallow sockets (dysplasia) and has signs of osteoarthritis in the left hip. We discussed the options for treatment including:
- reducing her activities and taking painkillers and anti-inflammatories
- having an injection of steroid into the left hip
- going ahead with a hip replacement
The Solution:
Mrs EF was absolutely sure that she wanted a definitive answer to her hip pain, and that all things considered, she wanted to have a hip replacement Given her active life and the slightly unusual anatomy of her hips, I recommended that she have the Exeter hip replacement with a ceramic on polyethylene bearing, using the Mako system. This uses a pre-operative CT scan and robotic assisted surgery in order to improve precision and accuracy.
Mrs. CT, a 79 year-old retired nurse.
Mrs CT is 79. She is a retired nurse who was recently widowed. She looked after her husband for several years before he died. She now lives alone in a large house with a garden that she has nurtured for over 30 years. Her adult children live in London and Sydney, and she has several grandchildren. She enjoys seeing her friends, doing aquarobics and is involved with the local church where she arranges the flowers. She flies to Australia every November to see her daughter and grandchildren. Her right hip has been painful for several years, but she was unable to do anything about it whilst she was looking after her husband.
The Problem:
She’d very much like to continue to live in the family home for as long as she is able. She was very concerned about the risks of becoming increasingly frail, losing her balance and having a fall. She certainly had a stiff painful hip, and the X-rays confirmed the diagnosis.
The Solution:
Mrs CT decided that she would like to have her hip replaced as soon as possible I advised her that an Exeter hip replacement using a dual-mobility bearing would be best, as it is associated with an excellent chance of a successful long term outcome with a very low risk of dislocation.
Mr. RJ, the 53 year-old lawyer.
Mr RJ is 53. He’s a successful City lawyer who commutes to London every day. He like to walk to work from Waterloo Station and has noticed recently that his right hip has been painful, particularly towards the end of the day. He’s started to use the Underground because of this. He’s not been sleeping well because the hip pain wakes him up at night, and because of this he’s feeling quite tired and irritable. Since Christmas, he’s put on quite a bit of weight, and he’s recently been diagnosed with high blood pressure. He played a lot of sport when he was younger – rugby, tennis and hockey. Nowadays he likes to play golf, ski and do country sports. The last time he went shooting, he was really struggling to walk on rough ground, and his friends noticed that he was limping.
The Problem:
His right hip was very stiff and painful to move when I examined him. X-rays showed severe osteoarthritis of the hips and degenerative disease in the lower part of his back. I advised him to think very carefully about surgery. We talked about the different options including a hip replacement with a ceramic on polyethylene bearing using the Optimized Positioning System (OPS), the Mako robot or Hip Resurfacing. I explained to him that because of his age and expectations, Hip Resurfacing would be an excellent option. It would allow him to continue to do the activities that he enjoyed so much.
The Solution:
However, I stressed to him that he should wait until he had made some changes to his lifestyle, particularly to try and lose some weight, get his blood pressure under control and manage his workload so that it wouldn’t interfere with his postoperative recovery. He thought he’d be fine to go back to work within a few weeks, but I explained to him that surgery can often make you feel very tired for a couple of months, and it is often difficult to make complex decisions and concentrate fully during this time.
Mr. PL, the 68 year-old businessman.
Mr PL is 68. He’s the owner of a marine engineering company, which he has been running for 30 years. His son is the managing director. PL has had problems with his hips since he fell from his motorboat onto a concrete pontoon last summer. He is otherwise in good health, but has type 2 diabetes, and had prostate cancer a couple of years ago. He’s been told that there is no sign of it now, having had successful surgery. He’s a keen golfer and enjoys being on his boat and fishing in The Solent. He lives in a house with his wife. They have a house in France to which they go several times a year.
The Problem:
His The last time they went to France he had a miserable time because his hips were so painful, especially after several hours spent on the ferry and in the car. He’s had to stop playing golf. The X-rays showed arthritis of the hips and we talked about what could be done.
The Solution:
In his case I thought it best that replace the most painful hip first, using an Exeter hip replacement with a ceramic on polyethylene bearing. If the other side was still causing trouble once he’d recovered from surgery, we would consider replacing it after 3-6 months. Sometimes we do both hips under the same anaesthetic, but in his case I thought it best not to, because diabetes can increase the risk of complications such as a heart attack, stroke and infection.
Mrs OB, the 62 year-old with a problematic hip replacement
Mrs OB had a hip replacement done 5 years ago in London. She’s now 62 and continues to work as an interior designer, running her own business. She said that her new hip had 'never felt quite right'. She’d had a dislocation a few weeks after the operation, and this had dented her confidence significantly. Her surgeon had seen her several times since the hip replacement, but he’d told her that there was nothing wrong with it. The hip was painful, particularly when she stood up after sitting for a while. X-rays of the hip showed an uncemented hip replacement but didn't look quite as I would have expected.
The Problem:
There were some subtle signs of loosening of the cup of the hip replacement. I was able to compare the old X-rays and saw that the signs had progressed during the last two years. I explained to Mrs OB that it was my feeling that the hip replacement was loose and that we would need to consider doing revision surgery. Hip replacements that never felt ‘right’ are often infected. This causes loosening between the bone and the implants.
The Solution:
We talked about what could be done to help her. I arranged for her to have some blood tests to see if there were any signs of infection. I ordered a nuclear medicine bone scan to see if there was a reaction that might confirm the diagnosis and then brought her in to hospital to have an aspiration of the joint. This procedure involves inserting a needle into the hip joint and removing any fluid that is there. I usually do this with the patient in the operating theatre, under a quick general anaesthetic. The fluid is sent to the path lab for analysis. The tests showed no signs of infection, but the bone scan showed that the cup was loose. Mrs OB had surgery to explore the hip. I removed the old cup and put in a new one made from 3D printed titanium. This has a very rough porous surface which is ideal in this situation.