your hip replacement information for patients

Transcription

1 your hip replacement information for patients

2 Personal Information Your admission date Your operation date Your Consultant s name Your Physiotherapist s name Your Occupational Therapist s name Your notes

3 Contents Introduction... 2 Why do I need a hip replacement?... 2 What is a hip replacement?... 2 What are the benefits of a hip replacement?... 3 What are the disadvantages of a hip replacement?... 3 What are the alternatives to a hip replacement?... 3 Before admission to hospital... 3 Consenting to the operation... 4 What are the risks of having a hip replacement?... 4 Admission to hospital... 6 What should I bring into hospital?... 6 The operation... 6 After the operation... 7 Will I be in pain?... 7 Hip precautions... 8 When will I start walking?... 9 How will I manage everyday tasks?... 9 What exercises should I do? When will I go home? How will I cope at home? When will I be back to normal? Follow-up appointments Are there any problems I should look out for? Useful Information References

4 Introduction This booklet has been written for people who are considering having a hip replacement at Chelsea and Westminster Hospital. It provides you with general information about hip replacement surgery including the risks and benefits of having the surgery. It also explains what will happen during and after your hospital admission. Why do I need a hip replacement? If you have severe pain and stiffness which causes difficulty with walking, sleeping or carrying out your normal activities you may decide that the benefits of having your hip replaced outweigh the risks of having a major operation. The pain and stiffness could also be due to other problems such as avascular necrosis and congential hip conditions. Your hip joint is a ball and socket joint which allows movement between the thigh bone (femur) and the hip bone (pelvis). The pelvis contains the socket which is known as the acetabulum. The head of the femur fits into the acetabulum and allows the hip to move freely through a large range of movement. smooth weightbearing surfaces socket ball The surfaces of the joint are covered in articular cartilage which is hard and smooth to allow your hip to move easily. However, in arthritis and other conditions this gets worn away causing the bones to rub together. This causes pain and stiffness which then makes everyday tasks such as putting on socks difficult. What is a hip replacement? In a hip replacement the worn-out parts of the joint are removed and replaced with an artificial joint known as a prosthesis. The prosthesis may be made out of metal, porcelain (ceramic) and plastic (polyethylene). There are different types of hip replacement and your surgeon will choose the most appropriate option for you. Total hip replacement In a hip replacement the top part of the thigh bone (femur), including the head, is removed and replaced by a metal prosthesis which is securely fixed into the bone. The surface of the acetabulum is roughened up and an artificial socket is put in. smooth cartilage femur Sometimes a prosthesis is cemented into place using special bone cement. However some prostheses have special 2

5 surfaces that encourage bone to grow into them and therefore cement is not required. Hip resurfacing A resurfacing hip replacement is a more conservative procedure as less bone needs to be removed. Instead of the top of the femur being removed, the head of the femur is fitted with a hollow metal cap. What are the disadvantages of a hip replacement? Although a replacement can relieve the pain and stiffness you may be aware that it does not feel the same as a natural hip. Some people will find that one of their legs is longer than the other following a hip replacement. Although a hip replacement usually restores normal leg length it is not always possible for the surgeons to do this. What are the alternatives to a hip replacement? Unfortunately arthritis cannot be cured so, although there are ways to control the symptoms of arthritis, these may only provide temporary relief of your pain. This type of replacement allows more movement than a total hip replacement but is not suitable for all patients. What are the benefits of a hip replacement? The main benefit of a hip replacement is the relief of pain and a reduction in stiffness. 9 out of 10 people are happy with the result of their new hip. The reduction in pain and stiffness will help you move around more easily. Tasks such as shopping, using public transport and climbing stairs should become easier. If you are otherwise fit you should be able to walk easily, drive and do gentle exercise such as swimming. The non-surgical options to reduce pain include: Losing weight this will reduce the load on your hip Exercise stronger muscles will provide better support for your hip Medication this can help reduce pain and inflammation in your hip Your surgeon will also discuss other surgical options if they are appropriate for you. Before admission to hospital If you have decided to go ahead with a hip replacement operation, you will be seen in the pre-admission clinic for a pre-operative assessment. This is carried out by a pre-assessment nurse 3

6 and will involve blood and urine tests, MRSA swabs, an electrocardiogram (ECG tracing of your heart) and a chest X-ray. This is done to check if you are generally fit enough for an operation and to rule out any current infections. Approximately 3-5 weeks prior to your surgery you will attend a hip replacement pre-operative information group. Following a presentation about your operation and your recovery, you will be assessed by an occupational therapist, a physiotherapist and an orthopaedic nurse. They will also discuss your admission and discharge arrangements. Please let us know at that time if you think you may need help at home after discharge as we can arrange support for you. You may need to arrange for special equipment such as a high chair or raised toilet seat to be delivered before you come into hospital and you will be advised about this in the pre-operative information group. If you do not make these arrangements your operation may be cancelled. At the pre-operative information group you will have the opportunity to ask the staff questions so please discuss any concerns about your surgery or discharge with them. When you first leave hospital you may not be able to get to the shops on your own so remember to stock up on food and essential items before coming into hospital. You will not be able to bend down easily or lift things so make sure everything you are likely to need is at a suitable level. Consenting to the operation Before you have surgery you will be seen by the surgeon who will discuss the operation with you. It is important that you understand why you are having surgery and all the risks associated with it. You will be asked to sign a form consenting to the surgery. You will also be asked to consent to your personal details being stored on the National Joint Register (NJR). This means that if a problem with a specific prosthesis is found in the future, the NJR will be able to identify the people who have received them. You can find out more about the NJR at What are the risks of having a hip replacement? All operations have risks both from the anaesthetic and from the procedure itself. However, most of these complications are relatively minor and easily treatable but may mean you need to stay in hospital longer. Below are the possible complications that may occur at the time of surgery or shortly after: Thrombosis (blood clots) Approximately 3% of patients will develop a blood clot in their leg, known as a deep vein thrombosis (DVT). You may be given blood thinning drugs to help prevent this. In less than 1% of people, a blood clot may develop in the lungs causing chest pain and/or shortness of breath. This is known as a pulmonary embolism (PE) and it could happen within days or even 4

7 weeks after the surgery. Both a PE and DVT can be treated with blood thinning drugs such as Clexane or warfarin. In extreme circumstances a PE can be fatal. Infection Sometimes a wound can become infected and will require treatment with antibiotics. In about 0.5% of patients a deep infection can develop. If this is suspected you may need to return to the operating theatre for your hip to be washed out. You may also need to be on long-term antibiotics. If the infection cannot be controlled your prosthesis may need to be removed. A new replacement can only be performed once the infection has been cleared. Dislocation In less than 5% of patients the new joint may dislocate (the head of the femur slips out of the acetabulum) which can be very painful. This is most likely to happen in the first few weeks after surgery but it can also happen months later. You may need another small operation to put the joint back together and following this you may also be asked to wear a brace to prevent any further dislocation. To prevent dislocation you will be asked to follow hip precautions which are explained later in this booklet. Fracture In less than 1% of patients the bones around the prosthesis may break during or after the surgery. This can usually be repaired at the time of your operation but occasionally a further operation is required. This may slow down your recovery. Retention of urine About one third of patients have difficulty passing urine after hip surgery. If this happens you may need a small tube (catheter) temporarily inserted into your bladder to drain it. To minimise the risk of infection, you will be given antibiotics at the same time. Leg length difference Following surgery there may be a slight difference in your leg lengths. This is usually at the most 1-2cms and the majority of people will adjust to this quite quickly. Occasionally a shoe raise will be required for the shorter leg. Nerve damage Less than 2% of patients will have some nerve damage which may cause some weakness in the foot. This usually recovers over time without further treatment although occasionally another operation is required to find the cause of the problem. Artery damage Approximately 0.2% of people may suffer some damage to an artery, affecting blood supply to the leg, which will require further surgery. Blockage of the bowel Very occasionally hip surgery can cause the bowel to become temporarily paralysed causing nausea and vomiting. This is usually treated with a tube passing down your throat into your stomach until the bowel recovers. 5

8 A heart attack, stroke or chest infection Any big operation puts a strain on your heart, lungs and brain but less than 1% of patients will have serious problems with these soon after their operation. These are more likely in patients who already have heart or chest diseases. Dying from surgery The risk of death, usually due to heart attack, stroke or PE, is approximately 0.5%. The risk is higher in patients who are obese or who smoke and lower in younger, fitter people. Other complications may occur months or even years after your replacement such as: Infection Late infection can occur at any point after a replacement as it can be carried in the blood from another part of your body. Fractures In some people with weak (osteoporotic) bones a simple fall can result in the bone around the prosthesis breaking. This may require surgery or revision of the hip replacement. Loosening or wear of the prosthesis Studies have shown that in 7 out of 10 people, a total hip replacement will last for more than 10 years. However, over time some hips can show signs of wear or can become loose. This can cause it to become painful or to dislocate. If this happens the hip joint may need replacing again. Admission to hospital Most people will be asked to come into hospital early on the day of their operation. You must remember not to eat or drink that morning. Occasionally some people will be asked to come in the day before their surgery. Sometimes, particularly if you have a long way to travel, you will spend the night before your surgery in the patient s hotel instead of on a hospital ward. The hotel is based within the hospital and you will not be charged for this. What should I bring into hospital? Do not bring too much with you when you come into hospital as storage space is limited. You should not bring large amounts of cash or valuable items. You should bring the following items: Any medicines you take regularly Any walking aids you use Comfortable, loose clothes Nightdress/pyjamas Flat supportive shoes/slippers not backless and big enough to allow for your foot to swell a little Washbag toothpaste, deodorant, soap, etc The operation The operation may be performed under a general or spinal anaesthetic. The anaesthetist will discuss these options with you. You may also be given a nerve block which numbs pain in your leg for several hours after your surgery. A hip replacement takes approximately 1-2 hours although this can vary according to the complexity of your 6

9 surgery. Your incision will be along your hip and thigh and will be about 6-10 inches in length. After the prosthesis has been fitted into your hip the surgeon checks that it is stable and moves freely. The wound will be closed with stitches and covered in a dressing. Occasionally a tube may be inserted into the area to drain off any blood collecting around your hip. In order to reduce the risk of infection you will be given intravenous antibiotic injections before and after the surgery. Some people will also be given blood thinning drugs to reduce the risk of blood clots forming. Most but not all people will be asked to wear TED (elasticised) stockings and special compression pumps around their legs which can also reduce the risk of blood clots. After the operation When you return to the ward you will be lying on your back and are likely to have several drips attached. You will also be wearing an oxygen mask. Your leg will be in a foam trough to prevent it moving into the wrong position. The nurses will check on you regularly noting things like your blood pressure, pulse and respiratory rate to ensure that you are recovering well from the operation. If necessary you will be given a blood transfusion which may use the blood collected in your wound drain (known as an auto-transfusion). You can try to move your leg if you wish by bending your knee up and down a little but you may find that your leg is still numb from the nerve block. If you are able to move it, take care not to make your heel sore by dragging it on the bed. Will I be in pain? Although you will experience some pain from the operation this should be controllable. Immediately after surgery it is likely that you will have a PCA (Patient Controlled Analgesia). This is a device that you can press to administer painkillers through a drip into your arm. This means that you can give yourself painkillers when you feel you need to but it will not let you take too much. You should aim to use as much of the PCA as you need to make you comfortable enough to move about in bed, and do your exercises with the physiotherapists this will help you to get better faster. You will also have bruising and swelling in your leg which can make it feel stiff and uncomfortable. This often feels worse after you have been sitting or lying still for long periods so try to avoid this. If you are in pain it is important that you let the nurses know as they can arrange for your drugs to be altered. Remember to take any painkillers regularly as this makes them most effective. Keeping your hip pain-free will make it easier to move. Sometimes painkillers can cause constipation so speak to your nurse if you are in any discomfort from this. They can arrange for laxatives to be prescribed to relieve this. 7

10 Hip precautions Following a hip replacement it is important to follow these hip precautions to minimise the risk of your new hip dislocating. These precautions must be followed for at least 3 months after your operation. 1. Do not bend your hip more than 90 degrees (a right angle) When you sit down, your knees should never be higher than your hips. This means that you must avoid sitting on low beds, chairs or toilets. You must take care when standing up and sitting down to ensure that you do not bend forward too far. your operated leg to fall into the wrong position. 3. Do not twist your operated hip When you are standing do not twist your leg fully inwards or outwards. If you need to turn around, step around slowly rather than swivel on your operated leg. You should also be careful not to twist your upper body around when you are standing or lying as this also causes too much rotation at your hip. 4. Do not pick anything up from the floor If you drop something try to ask someone else to pick it up or use your helping hand grabbing device. 2. Do not move your operated leg across your midline Imagine a line from your nose to your tummy button to between your feet. Your operated leg must not cross that line. When getting in and out of bed you should be particularly careful about this. You must not cross your legs, either at your knees or ankles. When sleeping, lie on your back or on your operated hip. You should not lie on the other side as this can cause In an emergency, and if your balance is good, follow the instructions given in the How will I manage everyday tasks section on the following page. In order to comply with these precautions, and at the same time maintain your independence, the occupational therapist will work with you to identify different ways of performing everyday tasks, for example getting washed and dressed. They may recommend that you use special equipment to help you adhere to the precautions. You will be advised about what equipment you need at the pre-admissions assessment and you will need to 8

11 arrange delivery of it before you come into hospital. This equipment is not provided by the hospital. If you require equipment you may have to purchase or hire this at your own expense. Social Services will only supply equipment if you meet their eligibility criteria. If you do not make these arrangements before your admission your operation may be cancelled. When will I start walking? You will see a physiotherapist on the first day after your surgery. They will check that you are able to use your thigh muscles and move your hip before helping you to get up. Initially you will use a walking frame for support but this will quickly be progressed to walking with crutches and possibly sticks before you go home. How quickly your walking improves varies from person to person. Most people will be allowed to put as much weight on their leg as feels comfortable to them. However, sometimes people will be told not to put all their weight on the operated leg (partial weight-bearing) and your physiotherapist will instruct you on how to do this. If you are told that you should only partially weight-bear, you should continue doing this until you are seen at your first clinic appointment after discharge. You will then be told if you may start fully weight bearing. The physiotherapist will also teach you how to climb stairs safely. Going up stairs Hold the rail in one hand and your stick in the other. Go upstairs with your good leg then bring PhysioTools Ltd your bad leg and stick up to the same step. Repeat this on every step. Going down stairs Hold the rail in one hand and your stick in the other. Put the stick down onto the next step then move your bad leg down. Then bring your good leg down to the same step. Repeat this for every step. PhysioTools Ltd Practising this technique before you come into hospital will make it easier after you go home. How will I manage everyday tasks? Following these instructions will make everyday tasks easier. Remember that it is important that you do not sit on low surfaces for 3 months while you are following the hip precautions. The staff on the ward will ensure that you have a bed and chair of suitable height during your hospital stay. There will be raised toilet seats on the ward for your use. The occupational therapist will advise you what height your chair, bed and toilet should be after discharge and will work with you to source any equipment you may need. 9

12 Getting on/off a chair, bed or toilet When standing up move to the edge of the seat and put your operated leg out in front of you. Put your crutches or sticks in one hand and use the other hand to push up from the chair. Most of your weight should be on your good leg. When sitting down move back to the chair until you can feel it touching your legs. Put your operated leg out in front of you and your sticks or crutches in one hand. Feel for the chair with your other hand and lower yourself down with most of your weight on your good leg. When using the toilet remember not to twist around to use the toilet paper. Do not pull yourself up on a towel rail or anything else that is not designed to take your weight. Getting in/out of bed If possible you should get in and out of bed on the same side as the operated leg. When getting out of bed, move your operated leg out of bed first. Lower it down to the floor as you slide your body and other leg around. When getting into bed slide diagonally backwards towards the pillow. Lift your good leg into bed first then slide your operated leg onto the bed. If it is not possible for you to get in and out of bed on the same side as your operated leg, discuss this with your physiotherapist and occupational therapist. They will show you an alternative way of doing it but you will have to take extra care not to let your leg cross over your midline. Picking things up Place your operated leg behind you and use a firm surface or walking aid to lean on for support. Put most of your weight on your good leg. Lean forwards from your waist and bend your good leg until you are able to reach the object you need. You will be provided with a piece of equipment called a helping hand to help you pick up small objects from low surfaces to stop you bending over or crouching down. You can also use the helping hand when dressing your lower body (eg when putting trousers over your feet). Washing and dressing Your occupational therapist will work with you to help you maximise your independence with your personal care. As you must not bend down to your legs and feet you will require some long handled equipment or someone to help you wash and dress. When dressing, sit on the side of the bed or on a high chair. Always dress your operated leg first and undress it last. 10

13 Consider using your long handled equipment, eg a helping hand to grip garments, a long handled shoe horn and a sock/ stocking gutter, to stop you bending. While sitting, use PhysioTools Ltd your equipment to pull pants and trousers to knee level to put them on. When you stand up to pull up your pants and trousers, ensure that you are well balanced. Do not have all your weight on one leg. When you are sitting on the edge of the bed, remember not to twist around to pick up items from behind you. You are advised not to bath for the first 3 months after your operation. You should have someone with you in the house when you do start to bath again until you are confident about getting in and out of it unaided. What exercises should I do? After your operation, you will need to do exercises so that you are able to move your hip easily and to regain muscle strength. It is worth familiarising yourself with these exercises before you come into hospital as that will make them easier after surgery. However only do them if you are able to do so without exacerbating your pain. Other exercises can also help prevent breathing and circulatory problems. Deep breathing exercises Every hour take 3-4 deep breaths and cough strongly. This will help prevent a chest infection. Circulatory exercises When lying or sitting, keep wiggling your toes and vigorously pump your feet up and down. This helps the blood to flow in your calves. Heel slides (hip flexion) exercise Lying with your leg out straight, rest your leg on a slippery board or tray. Slide your heel up towards your bottom as far as you can. Hold for 5 seconds then lower PhysioTools Ltd it gently. Make sure that your heel does not become sore rest it on something soft. Static gluteal exercises Lie as flat as you can on your bed with your legs out straight. Tense the muscles in your buttocks (gluteal muscles) and hold for 10 seconds. It is important to lie as flat as you can while doing this as it stretches the muscles at the front of your hips. Hip abduction exercises Lying with your leg out straight, rest your leg on a slippery board or tray. Slide your heel out to the side and then back to the middle. Be careful not to move your leg across your midline. PhysioTools Ltd 11

14 Do not worry if you cannot move your leg very far just trying to make it move will make your muscles work! Static quadriceps exercises Lie or sit with your leg out straight. Tighten the muscles at the front of the thigh (the quadriceps) and hold for 10 seconds. This should help push your knee down but don t dig your heel into the bed too. If you find your knee won t go fully straight, do this exercise with a small rolled towel under your heel. Sitting quadriceps exercise Sit on a high chair or bed. Keeping your thigh on the chair, lift your leg up until your knee is straight. PhysioTools Ltd Hold for 10 seconds then lower your leg slowly. Standing hip exercises Once you are able to stand relatively easily, hold on to a firm table or chair for support for the following exercises. Toe standing Keeping your knees straight, lift up on to the tips of your toes and hold for five seconds. This will help to strengthen your calf muscles. PhysioTools Ltd Hip flexion Keeping the top part of your body (trunk) still, stand on your good leg and lift your other knee up in front of you, taking care not to bend your hip more than 90 degrees. Hold for 10 seconds. PhysioTools Ltd Hip abduction Keeping your trunk still, lift your operated leg out to the side then slowly bring it back. Hip extension Keeping your trunk still, move your operated leg backwards then slowly bring it forward to its starting position. Your physiotherapist will advise you on how many exercises to do after your surgery. PhysioTools Ltd When will I go home? Most people go home about 4 days after their operation. Before you go, your wound must be healing well. You will not need to have the stitches or clips removed before you go. The nurses will make arrangements for this to be done after your discharge. You can go home as soon as you are able to walk safely, carry out everyday tasks such as getting in/out of bed, toileting and going up and down stairs. If possible you should arrange for family or friends to pick you up from hospital. You can travel in most ordinary cars but you must take care getting in and out. 12

15 Getting in and out of a car (as a passenger) When getting in and out of the car, it should be parked away from the kerb so you can get in from the road level rather than the pavement. Push the front seat back as far as possible and recline the seat back slightly. Ask someone to hold the door open and wind the window down so you can use this to hold onto. Hold onto the seat back and door frame to lower yourself down onto the seat in the same way as you would sit on a normal chair. Slide well back onto the seat (sitting on a plastic bag can make sliding easier but this must be removed before you are driven off). Lift your legs in one at a time, taking care not to bend your hip more than 90 degrees. When getting out do the same in reverse, making sure you have both legs out of the car before attempting to stand up. If you think you will need transport home, please discuss this with your nurse as soon as possible. How will I cope at home? Many people, particularly if they live alone, are anxious about leaving hospital. Some assistance can be provided at home for a short period after your discharge. Organising your kitchen and workspace before you come into hospital will help you avoid over reaching or bending down too much. Stocking up on quick and easy food items will also help. You may need some help with heavy housework such as cleaning, shopping and laundry. You can use a helping hand to retrieve items from the washer/dryer. Friends or family may be able to help you with this. However, if you feel you will need some assistance, please discuss this with your nurse or occupational therapist as you may need to be referred to social services. When will I be back to normal? Recovering from a major operation can take some time and you may feel quite tired for several weeks. You should avoid any major commitments for about 6 weeks and avoid long haul air travel. The following tips may help you return to normal: Do not stop using your sticks or crutches until you can walk without limping and you feel confident without them. You should continue with your painkillers at first to allow you to continue your exercises. Gradually increase your activities each day as the pain and swelling allows. It is common for swelling and bruising to extend down to your foot after a hip replacement. If you overdo it the pain 13

16 and/or swelling may increase. If this happens lie down as having your leg elevated will reduce the swelling. Do not sit with your feet up on a stool as that might cause your hip to bend more than 90 degrees. Reduce your activities until it settles then gradually increase them again. Remember to follow the hip precautions for the full three months even if you feel you have fully recovered. Most of the improvement is made in the first few months after your surgery but your hip can continue to improve for over a year as the muscles get stronger and the tissues heal. Returning to work If you are intending to return to work discuss this with the surgeon at your clinic appointment following your operation. Generally you can return to an office type job at around 6-8 weeks. If your job involves standing for long periods you are likely to need 3 months off work. Driving If you normally drive, you can start driving again after 6 weeks. You should not start driving until you feel you can safely move your hip easily and quickly enough to perform an emergency stop. Sexual intercourse You can resume sexual intercourse about 6-8 weeks following surgery provided you are not in pain. You should be aware of the position into which you put your hip as your hip precautions will still apply. The most recommended position is for you to lie on your back with your partner on top. Use positions that do not make you raise your knees higher than your hips. Ask your occupational therapist or doctor if you need further advice. Follow-up appointments You will usually have your first follow-up hospital appointment about 6 weeks after surgery. The frequency of further appointments will depend on your progress. Are there any problems I should look out for? It is important that you look after your hip and if possible identify any problems early so that they can be treated quickly. Blood clots In the first few weeks after your surgery, look-out for any increased heat, redness or swelling in your legs, as this may be the sign of a blood clot and you should contact your GP. If at any time you experience chest pain and/or shortness of breath seek immediate medical advice from your GP or nearest hospital, explaining that you have had a recent hip replacement. This may be a sign of a blood clot in your lungs, which requires immediate treatment, usually with blood thinning drugs. 14

17 Infection Early infection can occur if there are problems with wound healing or excessive bleeding into the joint, so look-out for increased redness and swelling around the wound or for any excess oozing from the wound. If you notice any of these symptoms within the first 6 weeks after your operation please telephone David Evans Ward for advice (numbers overleaf). Infection in the hip can also be caused by it spreading from other areas of the leg, so seek advice form your GP if you develop any ulcers on your shin or infected cuts. You should also be treated with antibiotics if you have any urinary tract infections. Always tell your dentist that you have had a hip replacement as you may require antibiotics before some dental procedures. Long term problems Over time your hip replacement can wear out and become loose. Reducing the stress on your hip by avoiding weight gain, keeping strong muscles and avoiding high impact activities can help prolong the life of your replacement. If your prosthesis does need replacing, revision hip replacement can be carried out. 15

18 Useful Information The Arthritis Research Campaign (ARC) PO Box 177 Chesterfield Derbyshire S41 7TQ T: W: NHS Direct T: W: David Evans Ward T: or Sister in Trauma & Orthopaedic Outpatients T: Clinical Specialist Physiotherapist T: Bleep 4693 Senior Occupational Therapist T: Bleep 0419 M-PALS If you require information, support or advice about our services, you can contact our Membership and Patient Advice & Liaison Service (M-PALS). The M-PALS team can be contacted by visiting the M-PALS on the ground floor of the hospital just behind the main reception. T: E: No Smoking Policy Chelsea and Westminster is a no smoking hospital smoking is strictly prohibited anywhere in the hospital building and its grounds. Hospital Address Chelsea and Westminster Hospital NHS Foundation Trust 369 Fulham Road London SW10 9NH T: W: References A New Hip Joint Arthritis Research Campaign. Updated Dec Total Hip Arthroplasty (Hip Replacement) Consent information patient copy Queensland Health: Orth_44 v4 May 2004; Published Jul Hip replacement. An operation to replace your hip with an artificial one BMJ Publishing Group Ltd,

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20 Cover photo: Total hip replacement patient Jonathan Bolton-Dignam leaves a follow-up appointment 369 Fulham Road London SW10 9NH Main Switchboard +44 (0) Website September 2010