This information has been designed to give you and your family a basic understanding of what a Thompson’s Hemiarthroplasty is and what you can expect to happen before and after the operation. This information is intended as a guideline, you may have many more questions, which the doctors, nurses, physiotherapists and occupational therapists will only be to happy to answer.

Why is the operation necessary?

The hip is a ball and socket joint, where the upper end of the femur (thigh bone) and part of your pelvis meet. The end of the femur (ball) fits into the acetabulum (socket) and allows the smooth action of a normal hip joint. This smooth action depends on the joint being stable. This is provided by ligaments and muscles and also by the smooth surfaces and fluid within the joint.

Following a fractured hip a Thompson’s Hemiarthroplasty may be undertaken, this involves replacing the femoral head (ball) with a prosthesis. The purpose of the joint replacement is to replace the damaged joint head due to hip fracture and provide stability and increased movement, thus reducing the pain that you may be suffering.

You will be admitted to the ward from the Accident and Emergency Department. The nursing staff will meet you and explain the layout of the ward and introduce you to your named nurse. They will ask you a number of questions, so that they can cater for any individual needs you may have.

The ward doctor will see you and arrange for your pre-operation tests. These are usually an examination, an X-ray, blood tests and an ECG (heart trace).

In rare cases traction may be used to aid pain relief prior to your operation. This involves a weight and pulley system, attached to the leg with bandages. If this is required the staff will explain this fully to you at the time.

The surgeon and anaesthetist will see you before your operation to examine you and answer any questions you may have. The surgeon will discuss with you the nature of the surgery, outline the associated risks and obtain your informed consent. The anaesthetist will discuss the type of anaesthetic best suited to you, but usually the procedure is performed under general anaesthetic. A spinal anaesthetic is sometimes used, this means you are numbed from the waist down for the duration of the procedure, a sedative is usually also given to make you feel sleepy. The different forms of anaesthetic will be explained to you and you will be given the opportunity to ask questions.

The physiotherapist will also come and see you before the operation to teach you the exercises you need to do after the operation, to help you to recover. However if you are admitted as an emergency this may not be possible.

The most important preparation is for you to understand what your operation involves and for you to feel comfortable with your decision. Remember that staff are here to answer any questions you may have.

You will not be able to eat or drink for a period of time before you operation, the nursing staff will advise you. You will be helped into a gown and the nurses will complete a checklist in order to ensure you are safely transferred to theatre. A member of nursing staff will escort you to theatre either on a trolley or bed. Once in theatre your care will be transferred to a member of the theatre staff who will check your personal details again and who will look after you until it is time for your anaesthetic.

Once in the anaesthetic room, you will be given an injection in your hand to put you to sleep, if you are having a general anaesthetic. If your anaesthetist has advised you that you are having a spinal anaesthetic this will be explained to you fully.

The diagram below shows how your hip will be repaired

The first 48 hours

After a short stay in the theatre recovery area you will return to the ward. In some cases you may have a triangular pillow between your legs to keep your legs apart. This will keep the hip in a safe position, preventing unnecessary, harmful movement which could cause damage. This pillow, called a Charnley Wedge, is seldom used now. Your doctor/nurse will advise you if this is necessary.

You will usually have a ‘drip’ in your arm which ensures that you get plenty of fluids, as you are unable to take any by mouth for a short time after the operation. Once you are able to eat and drink normally this ‘drip’ will be removed. This is usually on the first day after your operation.

If necessary you may also be given a blood transfusion to replace blood you have lost during your operation and to prevent you from becoming anaemic.
You will also have up to 3 drainage tubes in your wound. These will drain into bottles and prevent any blood collecting around your wound which could cause painful swelling.

These are normally removed 24 – 48 hours after the operation.

You will also have stitches or clips in the wound and these are usually removed 10 – 14 days after the operation.

Many patients worry about how painful hip surgery will be and all staff understand this. It is usual to experience some discomfort and the staff will give you painkillers when you need them to help keep you comfortable. Everyone feels differently and it is important that you tell the nurses if you are in pain.

In some instances it is possible for you to be given a type of pain relief that enables you to control the amount of painkiller you receive yourself (Patient Controlled Analgesia).

Further information about this is available on the ward, and will be explained to you if you are to given this. You will be monitored closely by the nursing staff after your operation and they will keep you comfortable.

Getting up and about

You will remain in bed for approximately one day after your surgery, during which time an x-ray will be taken, if your consultant thinks it necessary. Your surgeon will then decide when you can begin to walk about.

The physiotherapists will help you out of bed and supervise your walking. You will start to walk using a Zimmer frame to support you and progress to using elbow crutches when your walking improves and you feel more confident. You will be supervised until you are safe.

It is beneficial to lie flat on your bed for an hour every day to stretch the muscles over the front of your hip and so help prevent stiffness of your hip joint.

Depending on your mobility before the operation you may require an extra period of rehabilitation.

The Occupational Therapist (OT) will see you on the ward to practice skills which may become difficult after your operation, such as dressing and transfers.

What problems can occur?

No operation is without the risk of complications. Your surgeon and therapist will explain any particular risks/complications of your operation before surgery.

Is the operation always successful?

The surgeon’s expectations of your operation will be discussed before surgery (usually when seen in out patients) so that you understand the likely result, and the risks/benefits of the proposed operation. This information must be taken into account when you make the decision to undergo surgery.

Your discharge

Once you are moving around safely on your own, you will be discharged home as soon as suitable arrangements can be made. Your physiotherapist will ensure that you are able to manage the stairs.

Planning for going home begins as soon as you arrive in hospital, if you have any fears or concerns regarding discharge please discuss these with your named nurse.

Your named nurse will ask you and your carers about your social circumstances, this is just to ensure that you will be able to manage certain tasks when you go home such as washing, dressing and cooking.

If your named nurse feels you and your carer will require extra support she will discuss this with you and with your permission will arrange for you to talk with the hospital social worker and Occupational Therapist/Orthopaedic Discharge Team.

If you live in the Newcastle area you will be assessed by the Orthopaedic Discharge Team (ODT) who will assess your suitability for the scheme which provides a two week supported discharge with nurse, physiotherapy and Occupational Therapy involvement.

Transport home

Please discuss your transport arrangements home with your named nurse before your day of discharge. It is possible in some instances to organise hospital transport, if required.

The day of discharge

On the day of your discharge your named nurse will give you some things to take home, these will include:

• A letter for your GP (in some instances this will be posted) This should be handed in to your GP by either a relative or friend on the next
• working day following your discharge.
• Medication Any medication you have bought into hospital will be returned to you. You will also be given 28 day supply of any new medications. The nurse will advise you on how and when to take these. 
• Dressings You will receive a 7 day supply of any dressings you need and a letter for your district nurse.
• Outpatient Clinic Appointment You will be given an appointment to be reviewed in clinic. If transport is required this can be arranged by contacting your GP providing a weeks notice where possible. If for any reason you are unable to attend your appointment please contact the outpatient department to rearrange the appointment. 
• Stockings If you have been given anti-embolic stockings to wear during your stay, you will receive an additional pair of stockings, which should be worn until your doctor advises (usually around 6 weeks).
• Care Plan If you have a care package arranged you will receive a copy of the care plan from the Social Worker before your discharge home. This is for your own information. 
• Discharge Record This provides details about your stay and is for your own information. 
• Mobility aids It is important that you have your walking aids and any other equipment that you require.
• Patient information Please take home any written information given to you during your stay and please do not hesitate to use the contact numbers if you require any further advice.
• Valuables Please ensure you have all your valuables with you

General advice after discharge

You should anticipate at least a three month period of convalescence at home before you are able to resume your normal activities.

• Walking You will need to use a walking aid for a period of time specified by your consultant. Check the rubber ends on your walking aids regularly. If they are wearing smooth consult the physiotherapy department at the hospital in which you stayed, who will arrange to change them.
• Stairs Before you go home, you will, if necessary, practice climbing up and down the stairs with the physiotherapy always use your crutches on the stairs as shown by the physiotherapist. Remember when going upstairs lead with your good leg (un-operated) and when going down stairs lead with your bad leg (operated).
• Transfers When getting on and off a chair, bed or toilet, always use the arm rest if available and stick your operated leg out in front of you.
• Cars and Driving Do not drive for at least six weeks. Always check with your insurance company before starting to drive again. It is not the responsibility of your consultant to make this decision. He will advise when he feels driving will cause you no harm. 
• Bathing Do not get into the bath for 3 months. If you have a shower, your Occupational Therapist will show you the safe way to use this. You must not get your wound wet until the stitches have been removed. 
• Getting Dressed You will not be able to bend down to your feet. Therefore you will be shown various items of equipment that will help you dress independently and safely. 
• Exercise Do not do any exercises to test how far your new hip will go. Walk about freely little and often throughout the day. Check with your consultant before commencing any activities. 
• Sex You can return to having sex on your discharge from hospital, but do not put your hip in any of the position where you risk dislocating it. For women and men, lying on your back is the safest position initially.
• Work How soon you are able to return to work will depend on the type of job you do and you should discuss this with your GP.
• Pain Take your painkillers as prescribed. Do not take more than the stated dose. Contact your doctor if you have any pain or swelling in your calf or if you have any chest pain.

Follow up

You will not usually receive follow up after your surgery unless specified by your consultant. Once at home if you are not happy or are concerned please contact your
General Practitioner (GP).

Please return all walking aids to the Physiotherapy Department at the hospital in which you stayed, when they are no longer required. All other equipment should be returned to the loan equipment store it came from, ring them and they will collect it.