PREPARATION FOR THE OPERATION

Operability

Your family doctor, or any other doctor of your choice, will be asked to make a report on your current state of health and your history, to be passed on to our anesthesia department. This will allow the anesthesiologists to assess the operative risk, and to make an informed choice of the most appropriate technique for your personal case.


Medications

In order to reduce bleeding during the operation, certain medications, in particular anti-inflammatories, must be stopped some time before the intervention: Aspirin, Voltaren, Ponstan, Olfen, Brufen, Tilur, must be stopped 10 days before the intervention , Xefo and Celebrex can be taken up to 48 hours before.

Physiotherapy

A few physiotherapy sessions may be prescribed just before the operation, in order to better prepare your muscles and familiarize you with the use of canes and the correct movements. This contact with the same physiotherapists who will follow you during your stay in the clinic will facilitate postoperative rehabilitation.

Entry into the clinic and preparation

You will enter the clinic the day before the operation, generally in the afternoon, or the same day, depending on your state of health, and the order in which you are scheduled for the operation. The anesthesiologist will visit you and together you will decide on the appropriate anesthetic technique. You may be given a light sedative the day before, or just before the procedure, but only if necessary and with your agreement.

Anesthesia

The procedure can be performed under general or loco-regional anesthesia (epidural, spinal, etc.). The advantages and disadvantages of the various techniques will be discussed with the anesthetist during the preoperative visit.

 

DURING THE OPERATION

The intervention takes place in a position lying on the side, or lying on the back, depending on the operators and the surgical techniques. The incision is made on the side of the hip, lengthwise, or curved slightly back towards the buttock. The procedure itself takes approximately 2 hours.

 

AFTER THE OPERATION

You will spend a few hours, possibly overnight, in the recovery room or intensive care unit for postoperative monitoring. The operated hip will be covered with a bandage from which will come out drains, small flexible pipes allowing to evacuate the surplus of bleeding and thus to avoid the formation of a hematoma. These drains will be removed in the room after two to three days. In some cases, a urinary catheter is needed for some time. The first getting up will take place, depending on the circumstances, the very afternoon of the operation, or the next day, after which walking rehabilitation will begin.

Post-operative pain is mainly located on the outer side of the thigh; they are usually quite tolerable. In addition, powerful drugs are administered on demand. The pain that was due to osteoarthritis of the hip disappears very quickly.

Precautions against dislocation

Certain movements and positions are to be avoided during the first months, as they can cause the prosthesis to "dislocate", or dislocation. The physiotherapist will show you how to perform certain movements. Particular care should be taken when sitting, getting up and lying down, and when picking up something from the floor.

In bed: do not cross your legs.

To get out of bed: turn around “en bloc” keeping your legs together.

To sleep: after a week, you can sleep on the healthy side, placing a pillow between your legs.

During the first months, it is necessary to sit in a “high” position (knee lower than the hip).

To pick up something on the ground, lean forward while moving the operated leg back.

To get in and out of the car, turn “en bloc”.

At home , you need to use a toilet seat lifter. Bathing is only permitted after 3 months; before this time, you must take showers only.

In order to reduce the risk of postoperative thrombosis (blood clot obstructing a vein in the leg), you will receive anticoagulant treatment (which keeps the blood in a thinner state than usual) in the form of tablets or injections for several weeks. after the operation. White bands (TED), going up to below the knee, are put on every getting up until the end of the stay in the clinic; they also serve to reduce the risk of thrombosis.

 

POSTOPERATIVE FOLLOW-UP

With some exceptions, I close all the scars with intradermal stitches, that is to say which do not appear on the skin: there are therefore no "small holes" on either side of the incision. There are also no wires or staples to remove. The skin is closed with small tapes called steristrips, which you can remove yourself 2 weeks after the operation.

The evolution of the operated hip is monitored by regular check-ups at the consultation, accompanied by X-rays, generally according to the following scheme: 6 weeks, 3 months, 1 year, 5 years and 10 years after the operation. The canes can be gradually abandoned between 3 and 6 weeks after the operation.

In the longer term, care must be taken to prevent secondary infection of the prosthesis. This can happen any time bacteria are released into the bloodstream, such as during a dental procedure, examination, or surgery on the bladder or bowel. Always tell any doctor treating you that you have a hip prosthesis.

In airports, passing through certain metal detectors can trigger the alarm. A certificate in French and English will be given to you, attesting that you have a prosthesis.

After 3 to 6 months, the patient can resume an almost normal life. Some sports such as cycling, swimming,  walking or skiing can be practiced.

© Dr. P. Zangger, Lausanne. Thanks to Mr. D. Bettens, Lausanne.