HIP REPLACEMENT UPDATE Mr Simon Mellor BSc(HONS, MB ChB, M Phil, FRCS (Tr and Orth) Highgate Private Hospital Total Orthopaedics London Royal Free Hospital NHS Trust E: pamellor@totalorthopaedicslondon

HIP REPLACEMENT UPDATE Hip replacement is one of the most successful medical interventions available – improved quality of life with long term social and functional return to normality or near normality National Joint Registry – early warning of implant failure leading to real improvement in clinical care - eg ASR hip resurfacing leading to near complete cessation of metal-on-metal implants High incidence of asymptomatic hip replacements soon after surgery – the so-called Silent Hip Replacement

PRIMARY CARE TRIAGE Clinical history Daily SIGNIFICANT pain, despite painkillers Especially REST PAIN / NIGHT PAIN LIMP USE OF A STICK CANT COPE WITH DAY TO DAY ACTIVITIES. TRIED PHYSIO CLINICAL SIGNS Chair examination Active and passive hip flexion. Passive rotation in flexion.

Primary care Common pitfalls Trochanteric Bursitis Referred pain Psoas Tendonitis Inguinal hernia

Young adult hip pain Labral tears Femoral-Acetabular impingement Hip Arthroscopy - required MRI Arthrogram. Repair or resection of cartilage Resection of femoral neck ‘bump’ Use of Biologics

Hip Replacement

Hip Replacement

HIP REPLACEMENT UPDATE Average length of stay reduction Pre-operative patient education (Joint School) Enhanced Recovery AVERAGE 3 DAYS Use of Spinal and sedation vs GA Early physiotherapy input Avoid Opioids and use of surgical drains

HOW? HIP REPLACEMENT UPDATE Question – How can we improve on this? Answer – LESS INVASIVE SURGERY MUSCLE-SPARING TECHNIQUE AVOID POSTOPERATIVE PAIN AVOID POSTOPERATIVE DISLOCATION HOW?

HIP REPLACEMENT UPDATE

HIP REPLACEMENT UPDATE ANTERIOR APPROACH MUSCLE-SPARING THR NO MUSCLES CUT OR DETACHED OR DIVIDED LESS SOFT TISSUE TRAUMA LESS POST-OPERATIVE PAIN – EARLY MOBILISATION LESS POST-OPERATIVE DISLOCATION – MUSCLE ‘ENVELOPE’ FALLS BACK INTO PLACE PROTECTING THE HIP HAPPY PATIENTS!!

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II HIGHGATE PRIVATE HOSPITAL www.highgatehospital.co.uk

ANTERIOR HIP REPLACEMENT AVERAGE SCAR LENGTH 8cm only. INITIALLY ONLY SLIM PATIENTS WITH LONG FEMORAL NECK. NOW WIDER INCLUSION CRITERIAE - all but the obese. SPINAL WITH LOCAL ANAESTHETIC INFILTRATION. ONLY REQUIRE MINIMAL POSTOPERATIVE ANALGESIA. EARLIEST MOBILISATION JUST 5 HOURS AFTER SURGERY.

HIP REPLACEMENT UPDATE PERSONAL EXPERIENCE STARTED IN 2012 – SELF-EDUCATION, VISITING INTERNATIONAL EXPERTS, CADAVERIC LAB WORK AND ANTERIOR HIP REPLACEMENT CONFERENCES FIRST SURGERIES UNDER DIRECT SUPERVISION USE OF INTRA-OPERATIVE X-RAY NOW OVER 40 PATIENTS SINCE 2015 – SELECTION CRITERIA!

HIP REPLACE MENT UPDATE

HIP REPLACEMENT UPDATE OUTCOMES EXCELLENT CLINICAL SCORES LOW POST-OPERATIVE PAIN LEVELS ONE COMPLICATION - WOUND HAEMATOMA AT 2 WEEKS REQUIRED WOUND WASHOUT NO FRACTURES. NO NERVE INJURIES. NO DISLOCATIONS.

HIP REP LACEMENT UPDATE

HIP REPLACEMENT UPDATE NOW SELECTED AS A ‘REFERENCE CENTRE’ FOR EDUCATING OTHER SURGEONS AVAILABLE AT HIGHGATE HOSPITAL FOR BOTH INSURED AND SELF- FUNDED PATIENTS AVERAGE LENGTH OF STAY NOW JUST OVER 1 DAY. THE FUTURE - DAYCASE HIP REPLACEMENT??

QUESTIONS?