THR in the UK

In the U.K., we have a National Health Service, which was set up in 1948 to provide healthcare for all citizens, based on need, not the ability to pay. It is made up of a wide range of health professionals, support workers and organisations.

The NHS is funded by the taxpayer. It is recognised as one of the best health services in the world by the World Health Organisation, but there do need to be improvements to cope with the demands of the 21st century.

The waiting times for a THR operation are usually around 12 months, but this does vary from one hospital to another. Your GP will normally refer you to an orthopaedic specialist; this could take up to three months for referral.

X-Rays will be taken, and your specialist will advise whether a THR is necessary. Other options are tried first, such as weight loss, use of anti-inflammatory drugs, physiotherapy; but if there are persistent symptoms of pain from the hip with limited motion, night pain, and severe quality of life limitation, a THR is recommended.

A date for surgery is posted to you, which could mean a long wait. It is always best to ask to go on a cancellation list, although this would mean not having much notice to go in to hospital for your operation.

In my situation, I was already in hospital having treatment for my rheumatoid arthritis. My hips were sheer agony; I couldn’t even stand, never mind walk. Every time I moved, a huge cracking and grinding noise came from my hips; so I was so pleased a cancellation arrived fairly quickly.

Two weeks before surgery, you are called to the hospital for a pre-operation assessment. This involves a very detailed medical examination, to check you are fit enough for the operation and to also check you have no infections.

More and more patients in the U.K. are concerned about contracting an infection called MRSA. Staphylococcus aureus is an important cause of hospital- and community-acquired infection. In hospitals, it is particularly likely to cause wound and blood stream infections with significant attendant morbidity and mortality. The prevalence of methicillin-resistant S. aureus (MRSA) has increased markedly in the past decade, primarily associated with hospital-acquired infection.

If any infections are detected before your operation—even a bad cold—you may find your operation being postponed until the infection has cleared. A cold is caused by virus and does not threaten your hip, but it could cause lung problems after general anaesthesia.

A blood sample is also taken to check your blood type, in case you need a blood transfusion during or after the operation. I didn’t know until after my operation that a lot of my blood was collected during the operation, filtered and given back to me, reducing the need for a transfusion. Not every surgeon uses continuous-loop autologous transfusion.

At the pre-op assessment, you usually see an occupational therapist, who will give you a form to fill out to assess what equipment you will need around the house after your operation. These items include toilet raisers, a chair with arms, a reacher, bed raisers, etc.

After that is completed, you see a doctor who will outline the risks involved with the operation, and you are asked to fill out a consent form. This was very daunting for me, looking at a long list of complications that could happen; but at the end of the day, you must remember that the majority of operations go very smoothly. For me, at this stage, I didn’t care what they did to me—I just wanted to be out of crippling pain.

In the U.K., you normally stay in hospital up to a week after your operation. In my case, I was referred to a rheumatology unit for rehabilitation until I was strong enough to be sent home. This involved an intensive course of hydrotherapy every day, which really helped in my recovery.

You are never sent home until you feel you can manage and that you have been provided with the necessary aids and equipment to help you round the home. You are also provided with a sheet with specific exercises from the physiotherapist. I can really recommend working at the exercises—they do pay off in the end.

I hope this information has helped anyone in the U.K. about to undergo a THR. Please also see my pre-op tips. Good luck and enjoy your new hip.