Intra-operatively

When you have been anaesthatised, you will be taken into the operating theatre. The surgeon will help to position you on your side and, using purpose made supports, will ensure that your pelvis is correctly orientated. Care will be taken to pad any pressure points to avoid any bruising or post-operative discomfort.

The surgeon will then scrub his forearms and hands with a sterilizing soap and put on a surgical gown and gloves. Your leg and hip are then cleaned with an iodine containing preparation to sterilize the skin and surgical drapes are positioned around your hip.

It is now possible for the majority of patients to have the surgery through an incision as short as 10cm.  Your surgeon will discuss this with you before the surgery.  The initial skin incision is over the outer side of the thigh and hip. Important nerves and muscles are identified and protected and then the hip joint itself is exposed.   The ball part of the top of the thigh bone (the femoral head) is then removed.  The surgeon now has access to the hip socket and it can be prepared to accept the new socket of the hip replacement.

The worn out cartilage and bone are cleared away with specially designed instruments.  If your surgeon has decided to use an un-cemented socket, it is now possible to tap this into place.  Further work is required if a cemented socket is planned

• Multiple drill holes are made to key the cement to the bone.
• A thorough wash is performed to clean away any debris
• The bone cement is mixed and pressurized into the bone
• The new plastic socket is positioned carefully in the cement.

The thigh bone (femur) is then prepared for the Exeter hip replacement stem.  Inside the bone, the marrow is cleared and a space shaped to fit the hip replacement stem.  A plug is inserted lower down inside the bone and the cavity in the bone is washed. The space above the plug is filled with bone cement and the hip replacement stem is inserted.

When the cement has set, the surgeon puts the stem with its new head into the socket and checks the stability of the new hip to ensure that it will not dislocate.  The length of the leg is checked to try to balance it with your other leg. Once everyone is happy, the surgeon will close the tissues with stitches that eventually dissolve and a dressing will be applied.

Post-operatively
You will probably wake up in the recovery ward and you will have an oxygen mask on. If you have had a spinal anaesthetic then your legs may feel heavy. Some times it is necessary to have a tube placed in your bladder - a urinary catheter. Once you are awake you will be returned to the ward.

The next day you will be sat out of bed, perhaps in the afternoon.  If you are able the physiotherapists will assist you in taking your first steps on your new hip.  From the second post-operative day the rehabilitation starts in earnest.