1. 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:

2. 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

3. 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.

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

5. 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

6. Hip Replacement

7. Hip Replacement

8. 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

9. 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?

10. HIP REPLACEMENT UPDATE

11. 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!!

12. II ll·opsoas Rectus fe•mori s Tensor fascia,1e la·ta e AMIS Approach
Sartorius
HIGHGATE
PRI V A TE H O S PI T A L
ll·opsoas Rectus fe•mori s Tensor fascia,1e la·ta e
G ·luteus minimus
G lute us medius
Gluteus maximus

13. II
HIGHGATE
PRIVATE HOSPITAL

14. 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.

15. 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!

16. HIP REPLACE
MENT UPDATE

17. 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.

18. HIP REP
LACEMENT UPDATE

19. 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??

20. QUESTIONS?