Explaining fracture management

Question 1

How would you explain a THR to a patient?

Answer 1

• Hip is made up of a ball and socket joint (demonstrate with hands)
• In a total hip replacement we replace both the ball and the socket with a prosthetic
• Replacement can be made from metal, plastic, and ceramic
• Replacement is either fixed in place with cement or left unfixed for the bone to grow over it (usually in young people)

Question 2

What is the most common method of total hip replacement?

Answer 2

Usually cemented THR: 90-95% of cases

Question 3

How would you explain hemiarthroplasty to a patient?

Answer 3

• The ‘ball’ part of the joint in replaced and the ‘socket’ is left as is
• Sometimes the socket is replaced and the ball remains as it

Question 4

How long does a hip replacement last?

Answer 4

• In 60% of people the hip replacement lasts at least 25 years
• 1 in 8 people require revisions to the replacement within 10 years, this is usually due to wear and tear
• How long your hip replacement lasts will depend on how hard it has to work - keeping your weight down and doing exercises to keep the muscles around your hip strong are really important

Question 5

What are the possible immediate complications following hip replacement?

Answer 5

1. Bleeding - a blood transfusion may be required during the procedure
2. Pain
3. Blood clot inside vein (VTE)
   - given medication to thin the blood and compression socks to help pump the blood from your legs back to your heart
4. Dislocation of the hip
   - most likely to happen in the early days and weeks after replacement
   - this is why it is very important to do the strengthening exercises recommended by the physio
5. Other complications:
   - UTI
   - Constipation
   - Chest infection, especially in COPD patients
   - Infection
   - Breakage of the prosthesis
   - Fracture

Question 6

What are the possible later complications following hip replacement?

Answer 6

1. Failure - hip replacement becomes loose and breaks (will require further operations)
2. Infection

Question 7

What post-operative follow up is there for hip replacements?

Answer 7

• Within about 8 weeks of the operation, the patient will be followed up by the hospital where the surgery
  was done
• Reviewed again at least after 7 years and then every 3 years
• Appointments may involve a x-ray of the hip

Question 8

What are the possible reasons for needing a knee replacement?

Answer 8

• OA
• RA
• Haemophilia
• Seronegative arthritis
• Avascular necrosis
• Gout

Question 9

How would you explain a knee replacement to a patient?

Answer 9

• Operation usually takes between 1 and 2 hours
• surgeon makes a cut down the front of your knee and cuts away any damaged bone (thighbone and shinbone)
• once the damaged bits of bone have been removed, they are replaced with a specially shaped artificial surface
• replacements are usually made of a combination of metal and plastic
• plastic allows the 2 bones to slide over each other smoothly
• total: thighbone, shinbone and sometimes kneecap and replaced and resurfaced
• partial: on part of the thighbone and shinbone is replaced (usually the inside part)
• partial knee replacements involve less of the knee being operated on so the recovery time is quicker

Question 10

How long will the replacement last?

Answer 10

• More than 4 in 5 people with total knee replacement can expect the replacement to last 25 years
• 7 in 10 people with a partial replacement can expect it to last 25 years
• Varied depending on how well the knee is looked after

Question 11

What are the possible immediate complications of knee replacement surgery?

Answer 11

1. Bleeding - blood transfusion may be needed
2. Pain
3. Blood clot in leg (VTE)
4. Nerve damage
5. Ligament damage
6. Blood vessel damage (rare)
7. Others:
   - UTI
   - Constipation
   - Chest infection (COPD)
   - Wound infection
   - Painful scar
   - Dislocation of the knee
   - Fracture

Question 12

What are the possible later complications of knee replacement surgery?

Answer 12

1. Failure - about 4-6% of people who have a knee replacement will need to have it revised within 10 years
2. Infection (mostly within the 1st year)