The most common symptom associated with the hip is pain. Below are some of the causes of pain, and treatments that Mr Banim offers for the hip.
Hip arthritis is a painful condition of the hip, which can lead to stiffness and difficulty walking.
The most common cause of arthritis is wear and tear of the joint over a period of time, but sometimes it can be due to an underlying problem with the hip, such as childhood problems, injury and infection.
Depending on how severely the hip is affected, patients often struggle to walk long distances, sometimes even as little as 100 yards. Patients struggle to sleep as they wake with pain, and washing and dressing becomes difficult due to stiffness in the hip.
Treatment depends on how bad the pain is. In early stages simple analgesics, such as paracetamol are effective. Weight reduction and the use of a walking stick will reduce the stresses on the hip and can improve the pain. Some patients also report benefit from the use of glucosamine and chondroitin sulphate. If the pain affects the patients life greatly, then surgery may be considered.
Hip replacement surgery is one of the most successful operations performed. Developed over 40 years ago it has now become widespread with over 60000 operations being performed each year in the UK. Mr Banim does more than 100 a year.
There are a large number of hip replacements available on the market, each with its own advantages. This allows the surgeon and patient to choose the most appropriate design for the patients needs. The most common designs require a cup to be put into the acetabulum of the pelvis, and a stem down the shaft of the femur. This is then held in place either by cement between the bone and implant, or by encouraging the bone to grow directly onto the implant. Other choices include the type of bearing surface, such as ceramic or metal and plastic.
Results and Outcomes
The government plans to publish results for all surgeons so that patients can make an informed decision on who to choose. This is something that Mr Banim agrees with. It is planned that mortality rates and the number of cases will be published (Mr Banim does many more hip replacements than average, and has a lower mortality rate). Another important measure is the number of patients that require later revision, and his results, as collected by the National Joint Register, are also better than average, as shown by the triangle on the graph below.
Another type of hip replacement is the Hip Resurfacing, where a cap is put on the top of the femur with the aim of preserving bone of later surgery. This can be a good operation, but because of current concerns about the release of metal ions and the possibility of ALVAL Mr Banim does not use this type of implant. Recently some types of this implant have been withdrawn from use, but this has not affected any of Mr Banims patients.
With any type of hip replacement there is a risk of complications. These include blood clots and infection, for which preventative treatment is given; dislocation of the joint and altered leg length, nerve damage and bleeding, and eventual failure of the hip replacement if it wears out. However all of these risks are uncommon, and Mr Banim and his team are always trying to reduce the risks.
This is a relatively new technique, but is becoming increasingly useful.
It allows a camera to be put into the hip and debridement (cutting away of tissue) or repair of structures in the hip can be performed. Because the hip is deep inside the body, it is a more challenging procedure than arthroscopy of other joints, but as instruments have improved in the last few years, the procedure has become more predictable.
As more hip replacements are performed on younger patients, the need for revision rises.
In patients where a hip replacement fails, either due to infection or wearing out, revision surgery may be required. This is always complex surgery, where the operation is usually time consuming, the rehabilitation period longer than for primary surgery, and the risk of complications are higher. However, when performed with care, the results can be satisfactory, allowing the patient to remain mobile and independent.