Total hip replacement

What is a total hip replacement?

A total hip replacement is an operation which replaces both the ball and the socket part of the hip joint. This is done if the hip joint has been damaged and the effects of this are impacting on your child’s daily life. This surgery is also known as a total hip arthroplasty.

The damaged hip joint is replaced with a prosthetic hip joint, which resembles a more typical shape of a hip joint. The stem of the implant is inserted into the top of the thigh bone to replace the ball of the hip joint. Any unhealthy tissue will be removed from the socket and the socket implant will be put in place. The appropriate size implants will be used to make sure the joint is stable.

The implants can be held in place by a bone cement product or a biological product. Both products work by stimulating new bone growth. There are different materials that are used for both implants, these include metal, plastic or ceramic.

What are the benefits of a total hip replacement?

The main aim of this surgery is to reduce symptoms such as pain. Almost all children that have complete, or near complete hip replacement get relief from arthritic hip pain. By reducing your child’s pain, it will allow them to do their daily activities more easily which will increase your child’s quality of life.

What are the risks?

As with any operation, hip replacement surgery has risks as well as benefits.

Most people who have a hip replacement do not have serious complications. All the risks of having a total hip replacement will be discussed with you by your doctor during the consent process.

Pre-operative assessment

Before your child’s surgery, they will have a pre-operative assessment. This will allow you to meet members of the team who will be involved in your child’s care and will be there to help you throughout your journey.

We will also gather important information about your child for tests in preparation of their surgery.

This is also an opportunity for you to ask any questions that you may have about the surgery, post-operative care and rehabilitation.

What should I do before my child’s surgery?

Please inform your child’s school or college about their planned surgery so the school can do a risk assessment in order to accommodate your child’s needs for when they return.

Prepare anything you may need for your hospital stay, such as books, electronics, toothbrush and so on, and appropriate loose clothing such as pjamas.

Familiarise yourself with the hip precautions you should follow for 12 weeks after your child’s surgery. This will depend on the type of planned surgery which your surgeon will explain.

It is important to maintain the range of movement and strength in your child’s lower limbs as much as possible before surgery. They may already have an exercise programme to follow, but there are exercises at the end of this resource if they do not.

How long will they be in hospital for?

Average length of stay for most children will be between 2 to 5 days after surgery.

They will also be given goals chart to help progress after their surgery. Please remember everyone is different and some people recover faster than others.

What will happen on the day of surgery?

Come into the hospital on the morning of your child’s surgery between 7.30am and 7.45am.

Your child will be taken to the theatre admissions unit (TAU) where they will be prepared for their surgery and make sure they do not eat anything.

The surgeon and anaesthetist will come and see you before surgery and can answer any questions you have.

One parent or carer will be allowed to come to the anaesthetic room with your child and can stay until they are asleep. You can go see them again before they wake up after surgery.

How long will the operation last?

The operation should be around 2 hours however this may be longer depending anaesthetic time and time in recovery for your child to wake up.

What happens after the operation?

Your child will be taken to ward 2 to recover after the operation. They can begin to eat and drink when they feel up to it.

They will be seen by different members of the team whilst on the ward including nurses, doctors, physiotherapists, occupational therapists and the specialist pain team.

The nursing staff will be check on them regularly after surgery so if you have any concerns, please do ask a member of staff.

When can we go home?

On the first day after the surgery, your therapy goals will be discussed and agreed by a physiotherapist or an occupational therapist.

For your child to be discharged home safely, your agreed goals will need to be achieved and you will need to be medically fit as decided by the doctors and nursing staff looking after you. All members of the inpatient team will need to be happy with your child’s progress and factors affecting this may include:

• making sure their pain is under control with appropriate pain relief
• able to do exercises consistency as instructed by the physiotherapist
• able to move safely with an appropriate walking aid, such as a walking frame or a pair of elbow crutches
• able to safely go up and down the stairs (if applicable)
• practise any transfers needed for showering or bathing once you get home (if applicable)
• making sure that you are equipped to manage safely at home
• watching for hip precautions as advised by the consultant or therapist

Follow-up appointments

Your consultant will arrange a review appointment at 2 weeks and 6 weeks after your child’s surgery.

They will also need rehabilitation with a physiotherapist in order to progress their range of movement, strength and ability to function day to day.

If you live within Sheffield or would like to have your follow up at Sheffield Children’s hospital, then a series of physiotherapy sessions will be arranged for you with our outpatient team. If you live outside the area, then a referral to your local physiotherapy service will be made.

We encourage that your physiotherapist sees you within the first 3 weeks after surgery.

Wound care

When your child is ready to be discharged, the nurse looking after them will have a look at the dressing (large plaster) covering the wound and decide whether it needs to be changed before going home.

We advise that once your child is are discharged, you make an appointment 7 to 10 days after the day of discharge with your GP or practice nurse, to do a ‘wound check’. This means removing the dressing and assessing the wound to see if a new dressing needs to be put on.

We will provide you with a resource before you go home which will detail exactly what operation your child had, and the type of stitches used to close to wound, which you can take to your GP appointment.

In between discharge from the ward and your appointment at the GP, try and keep the dressing as dry as possible. The dressing is ‘splash proof’ although should not be submerged in water, we will send you home with some spare dressings just in case.

What will I need to do at home?

When you get home, it is important that your child continues with their exercise programme. Thy should also gradually increase their level of activity while also getting enough.

Have a routine in place so your child can do their exercise programme provided by the physiotherapist 3 to 4 times per day. Continue to follow the advice given regarding hip precautions and make sure that daily activities are adjusted as detailed below.

Hip precautions

Please make sure that your child:

• avoids taking their hip beyond 90 degrees. Be mindful of certain positions for example a very low chair would place their hip in more than 90 degrees
• avoids twisting on their operated leg
• does not apply additional pressure to their operated side for example lying on their operated side
• does not cross their legs. When sleeping, place a pillow between their legs to avoid this movement
• does not do any strenuous activity
• does not bend forward to put shoes or socks on as this bends the hip more than allowed

You may notice that after surgery the hip replacement should assist your child in returning to normal everyday tasks. We recommend that your child listens to their body, and if they are in too much pain, stop the activity immediately and do not overexert themselves particularly for the first 12 weeks.

Everyday activity

Sleeping

Ideally your child should try to lay on their back for sleeping. However if they like to sleep on their side, they need lie on their un-operated side and place a pillow or large cushion between their legs to avoid crossing over.

Make sure their bed height is not too high or low, to let them get on and off the bed comfortably. They need to avoid twisting their legs so you will need to help hold one of their legs when they get in and out of bed.

Sitting

It is important that they do not sit on low, deep chairs. Try and sit on chairs which are higher and if possible, with arms. This will help to avoid bending their hip too far and make it easier to stand up from.

Washing

The dressing which covers the wound are waterproof, but should not be completely submerged in water. You will be given spare waterproof dressings in case it does get wet and the nursing staff will show you to how to apply it.

Your child must bathe by sitting a bath tub until 3 months after the surgery, but they will be able to shower carefully. Depending on your home environment you may need additional equipment. This will be discussed at your pre-operative assessment and provided before being discharged.

Car transfers

Where possible, your child should get into the car at a reasonable level from a driveway or the road, rather than up on a kerb. The seat should be as far back as possible and slightly reclined to allow more space for their leg. Make sure the car seat is not too low avoid their hip bending too far.

Exercises

To help strengthen the muscles and progress it is very important that your child to does these exercises after surgery. The physiotherapist will show you how to safely do these exercises, but you can practise to familiarise yourself with them before surgery if you want.

Ankle flexing

Start by lying on your back.

Point your foot and toes down to the floor or bed then slowly pull your foot and toes up towards your knee. Keep your leg straight throughout.

Repeat 10 times.

Knee and hip bends

Start by lying on your back or in sitting.

Begin with your leg straight, and then bend your knee by bringing your heel towards your bottom. Do not pass bend your knee beyond waist level.

Repeat 10 times

Hip abduction (scissor exercise)

Start by lying on your back with your legs together.

Keeping your leg straight, bring your leg out to the side and then return back to the starting position. Make sure that you keep your knee and foot in line and your toes pointing upwards throughout.

Repeat 10 times.

Static quads (knee squashes)

Start by lying on your back.

Push your knee down firmly against the bed. Keep your leg straight with your foot and toes pointing upwards.

Hold for 5 seconds.

Repeat 10 times.

Static glutes (bum squeezes)

Start by lying on your back.

Squeeze your bottom firmly together. Hold for 5 seconds then relax.

Repeat 10 times.

Seated knee extension

Start by sitting in a chair.

Point your toes upwards and straighten your knee. Hold for 5 seconds before slowly returning to the starting position.

Repeat 10 times.

Calf raises

Start by standing up and hold onto a study surface, with your feet hip-width apart.

Push up on to your tip toes before slowly lowering back down.

Repeat 10 times.

Standing hip abduction

Start by standing up and hold onto a study surface, with your feet hip-width apart.

Raise the leg that was operated on sideways before slowly returning back to the middle. Avoid leaning to the opposite side. You upper body should be upright throughout.

Repeat 10 times.

Standing extension

Start by standing up and hold onto a study surface, with your feet hip-width apart.

Bring the leg that was operated on backwards by tightening your bottom before returning to the starting position.

Repeat 10 times.

Mini squats

Start by standing up and hold onto a study surface, with your feet hip-width apart.

Slowly bend your hips and knees, then slow return back into standing squeezing your bottom muscles at the top.

Repeat 10 times.