DR



DR JAN DE VOS

Orthopaedic Surgeon

Suite 3 Tel: 012 8070335

Wilgers 546 Consultation Rooms Fax: 0128070337

Hip Surgery Information:

1. You are responsible for obtaining the authorisation number from your medical aid. (AT LEAST 5 WORKING DAYS BEFORE PLANNED OPERATION IF NOT AN EMERGENCY) Please make use of the pre-admission service at the Wilgers hospital. They will book your bed, open your file and contact your medical aid for the authorization number. The contact number is 012 807 8122 / 3. Your surgery will be cancelled if we are not provided with an authorization number before your surgery date.

2. Phone our office the day before the planned operation to confirm the time for admission and when to stop eating and drinking, including chewing gum. Please do not smoke 6 hours before or directly after operation, as you may feel nauseous after surgery.

3. On the day of admission please bring the following: Authorisation number, ID document, medical aid card and RELEVANT X-RAYS. (Please do not give our quotation to the hospital personnel. This is only for your information).

4. Bring your chronic medication with you and hand it over to the ward sister.

5. Bring an overnight bag with clothes and toiletries.

6. Crutches or a wheel chair will be supplied in the hospital if necessary. You are welcome to bring your own if you prefer.

7. Please leave all valuable items at home if possible.

8. Preferably hormone replacement therapy (specifically estrogens) must be stopped one month before the planned operation and for three months thereafter, as taking it increases the risk of blood clots forming.

9. Any herbal medicine or medicine with herbal ingredients e.g. Ginkgo Baloba must be stopped at least two weeks before the planned operation as this can lead to abnormal bleeding.

10. Disprin, Ecotrin, Aspirin and anti-inflammatory medication must also be stopped two weeks before the planned operation. Plavix needs special consideration, stop 3 weeks prior to surgery, but confirm with the prescribing doctor whether it can be stopped. Phone the practice and inform us regarding the usage of Plavix.

11. Hormone replacement therapy (specifically oestrogens) must be stopped one month before the planned operation and for three months thereafter, as taking it increases the risk of blood clots forming.

12. Warfarin must be stopped 8 days before surgery and probably be replaced with something as Clexanne. Please inform the personnel in my office for a relevant prescription if necessary. A blood test (INR) must be done 4 days after Warfarin was stopped. If the INR has not returned to normal, the INR must be tested 2 days later again. Please ask the lab to send the results to us.

13. In order to reduce the risk of, or prevent infection your skin must be intact. Please consult us once you become aware of this problem (or the hospital staff if you are admitted already. Surgery will be postponed if you have skin ulcers / lacerations etc.

14. You are welcome to contact the anaesthesiologist’s firm, Van Zyl & Partners for an estimate and possible co-payment on their account. (Tel 012 333 7726).

15. You are welcome to contact the physiotherapists prior to your surgery re an exercise programme before and after surgery as well as their tariffs. (Goller & Kok Physiotherapy 0123486265).

16. An Orthotist will supply you with specific items if needed e.g. crutches. You are welcome to contact them re enquiries and cost. (Meintjies & Neethling Tel 012 8072773)

17. During surgery or thereafter stock or instruments that are used might not be

covered, by your specific medical aid plan. It is impossible to know beforehand

what all medical schemes and their specific plan types cover, things that they

require might also not be available in the hospital, or not be appropriate for the

treatment of your specific condition . You will unfortunately be responsible

for the costs involved as well as the cost of any motivation letter required.

Arthroscopic Hip surgery

What is hip arthroscopy?

Hip arthroscopy is mainly done to treat conditions in the hip joint for example labrum tears due to impingement or to remove loose bodies (pieces of cartilage or bone) that may be present in the joint and can cause cartilage damage. Damage to the cartilage might cause the patient to require a hip replacement.

Hip arthroscopy is thus mainly done in young patients without cartilage damage in the joint, to alleviate pain and to prevent or postpone possible hip replacement surgery.

A hip arthroscopy is done by making 2 to 3 small incisions close to the hip joint and inserting a camera and other instruments in order to assess the hip joint and treat the cause of the hip pain. This is done by suturing or debriding a torn labrum, or to cut away access bone that cause impingement, or to repair muscles or ligaments.

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Instruments used to perform a hip arthroscopy may include small blades, rasps, coblation instruments to stop bleeding or anchors to suture a torn labrum or muscles. Not all medical aids or in some cases options chosen by patients on their medical aids cover these instruments, although authorisation is given for the procedure and the patient or person responsible for paying the account will be held liable for payment of these instruments, that will be billed to the hospital account. Please enquire from your medical aid what your specific situation is.

It is also not possible to determine exactly which instruments will be needed during each individual’s surgery beforehand. Only when the surgeon can see inside the joint with the camera inserted, can be decided on the best instruments to treat the specific problem. If your medical aid does not allow for internal prosthesis of arthroscopy instruments to be used, you might be liable for payment thereof.

Anatomy of the hip joint:

The hip is a ball and socket joint and is also the largest weight bearing joint in the human body. It is formed by the femoral head (the upper part of the thigh bone which is formed to look like a ball) that fits into the acetabular cup (a cavity at the base of the pelvis). The hip joint is stabilised by muscles, ligaments, to enable us to walk, run and jump etc.

The surface of the femoral head and the acetabulum is covered with cartilage. The function of the cartilage is to act as a type of cushion to enable hip movements to be without pain. Around the acetabulum there are other structures to also stabilise the femoral head in the acetabulum of which one is the labrum that forms a vacuum in the joint. When some of the structures in or around the joint are damaged due to sports injuries, illness, so called “wear and tear”, accidents or other deformities, movement might be painful or difficult. Pain caused by a hip problem usually presents as pain in the groin and upper leg.

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Hip impingement and labrum tears:

Impingement in the hip means that there is not enough space for the femoral head to move in the acetabulum. Some of the structures in the joint is then impinged and cause pain or restricted movement and may also cause damage to the labrum or articular cartilage. If conservative treatment e.g. physiotherapy or anti-inflammatory medication does not alleviate the symptoms, arthroscopic hip surgery might be suggested.

Impingement may also occur when the acetabulum or femoral head have formed abnormal bony structures. (In the acetabulum it is called a Pincer lesion and on the femur a CAM lesion.) These abnormal bony structures cause impingement between the femoral head and the acetabulum and may cause a labrum tear. Labral tears usually need to be repaired surgically.

[pic]

Cartilage damage to the hip joint:

If the above mentioned impingement or labrum tear is not treated, it may lead to cartilage damage to the femoral head or the acetabulum. This is called osteoarthrosis and the only way to treat this condition is with a hip replacement.

Arthroscopic procedures of the hip are therefore usually suggested to younger patients to try to prevent cartilage damage due to impingement or labral tears.

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Hospital Admission / day of surgery:

1. Upon arrival at the hospital, go to “Reception” for administrative procedures. After that you will go to the Orthopaedic ward. Unfortunately more forms await you; please complete the anaesthetic questionnaire and the consent document, ensuring that you sign for the correct operation and side (left or right limb).

2. The anaesthesiologist will visit you and prescribe pre-medication, which will calm the nerves and make you drowsy.

3. A theatre gown and pants will be supplied. Please put this on.

4. You will be taken to the theatre complex’s waiting area. A close relative / friend can accompany you. From here you will be taken to the operating theatre where the anaesthesiologist will start the anaesthetic (general / nerve block) as discussed with you by him/her. Surgery time depends on the procedure, anything from 2 to 4 hours

5. After the surgery you will be taken to the recovery area and monitored / treated until ready to go back to the orthopaedic ward.

6. Your vital signs will be monitored in the ward. Pain medication will be used, if neccessary ask for more. A sleeping tablet is recommended, if not offered by the staff, ask for it.

First day after surgery:

1. I will visit you the morning after surgery (usually between 07.00 and 08.00), accompanied by a physiotherapist and nursing personnel. Your vital signs, surgical area (wound) and general condition will be evaluated as applicable. The surgical procedure will be discussed, sometimes photographs taken in theatre will be used to explain to you what we found and did. These photographs will be stored in your clinical file in my office. The rehabilitation programme will be discussed.

2. The physio will visit you later with additional information, help you with mobilisation and exercises.

3. You will be discharged between 11 and 12 o’clock.

4. Remember to take your X-rays home with you.

5. A sick leave letter will be given to you in the ward.

6. Appropriate medication or a script for the medicine will be given to you.

7. The wound dressing might be changed before discharge.

Postoperative period:

1. Crutch usage: Flat foot weight bearing with about 10 kg of pressure with the aid of crutches with the goal of returning to full activity as soon as possible. The length of flat foot weight bearing status will be determined by the procedure we have done.

2. Incision care: If the wound cover gets dirty or wet, change the waterproof dressing. Keep your wounds closed for two weeks; thereafter the sutures must be removed.

3. Showering: As long as there is not any drainage from the incision sites, you may resume regular showers. Do not let water run over the covered incision, as the wound dressing may become wet. When sutures have been removed, water may run over the incision site, when complete, dry the area as normal with a towel.

4. Suture removal: The sutures are removed 21 days after surgery.

5. Returning to work/school: You may return to work/school 2 - 4 weeks after surgery if pain is tolerable. Must take time however for physical therapy and exercise. Returning to heavy labour will be determined by your progression with physical therapy and the condition of your hip.

6. Follow-up appointment: either our practice or your local general practitioner must check the wounds three weeks after surgery. I need to see you for a follow-up visit at my practice at six weeks after the operation.

7. Medication:

• Pain killers: As Prescribed (Usually every 6-8 hours when necessary for pain.) This might differ according to each patient’s needs.

• Zofran: Some patients feel nauseous from anaesthesia and other medications. Take one tablet with the first sign of nausea and every 6-8 hours as needed. Please call us if you are experiencing vomiting.

• Xarelto: One Xarelto (10 mg) must be used from day 1 until day 10. You should take it every morning around the same time. It is very important medication to prevent blood clots.

• Cataflam-D: Take Cataflam-D one table three times a day; dissolve it in half a glass of water. This must be taken for two weeks. The reason for this medication is two-fold, 1. As an anti-inflammatory that reduces the swelling and pain, reducing your pain medication need, 2. It will help in preventing a condition called myositis ossificans.

• Postoperative constipation: It is very common to experience constipation after surgery because of the use of pain medications, etc. It is important to drink plenty of water. Adding leafy green vegetables, whole grains and other fibre-full foods such as prunes to your diet can also be of help. If needed take a daily stool softener like Normacol for the first two weeks or as long as you experience constipation. You can purchase this at any pharmacy.

Risks and Potential Complications:

There are several risks to any surgery that must be taken into account. Below a list which outlines some risks, but is by no means a comprehensive list:

1. Infection: Infection risks are decreased with sterile operating environment and antibiotics. Careful handling of incision sites following surgery reduces the risk of infection. If you have any abnormal redness, swelling or increasing pain in the wound area, please contact the practice. In case you are running a temperature above 37,5°C, please contact the practice.

2. DVT (deep venous thrombosis/blood clot): DVT risk is decreased through instituting early motion and medication if indicated in high-risk patients. If you have abnormal swelling or acute pain in the calf or the thigh after surgery, contact the practice.

3. Pain: Any surgical procedure has a potential complication of pain. Medication, ice, rest, compression, elevation and physiotherapy reduce post-operative pain. If the pain is not within expected limits or increasing, please call the practice.

4. Bruising / bleeding: This might occur and is usually not dangerous. Contact office if you are worried.

5. Fluid drainage from arthroscopy wounds can occur, if it increase over time or change colour from a clear fluid, or if you are concerned, please contact my office.

6. Numbness: With hip arthroscopy there is a small chance of numbness in the genitalia postoperatively due to the traction. Also, you may experience some numbness on the upper outer portion of the thigh on the operative leg after surgery. It is due to lateral femoral cutaneous nerve that is close to the surgical area and this nerve may be stretched or bruised during the procedure. The numbness should resolve over time.

Special circumstances:

1. Call our practice or contact your local general practitioner (if you are out of town) if any of the following occurs

a. Fever, chills or sweats

b. Redness and warmth around the incision, non-clearing drainage from the incision or increased pain in and around the incision.

c. Calf swelling, redness, pain or warmth in the leg.

d. Chest pain, difficulty of breathing or coughing.

2. If the Iliopsoas muscle / tendon was released, it can take up to a year before hip flexion power be restored.

3. It can take 8 – 12 months to regain the final effect of arthroscopic hip surgery; return of function, range of motion, reduction of pain / become pain free

4. In cases of arthritic changes, the only solution might be a total hip replacement, which might become necessary over time.

Prior to discharge you will be supplied with the necessary information regarding your specific condition, surgery done, expectations and rehabilitation programme. Please feel free to clarify any uncertainties with me.

Thank you for trusting us to treat you.

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