Q Why have a hip replacement, rather than a resurfacing?
A In women above the age of 60 years, where resurfacings have been performed, there have been one or two failures, usually because of menopausal osteoporosis (thinning of the bones) causing a fracture next to the prosthesis. It is therefore not generally recommended for women older than this to have hip resurfacings - hip replacement is more advisable. There are certain configurations of anatomy, which are not amenable to resurfacing. In many people, as they get older, too much damage has been done to the bone structure for a resurfacing to find a good foundation.

Q What are the benefits of a large metal head hip replacement?
A A metal headed metal-on-metal hip replacement has a large hard bearing, nearly the same size as the original head of the femur, which moves freely within the socket. It is a great deal more stable than the more ordinary hip replacement head gliding in a plastic socket - this is usually half the size of the metal head and much more prone to dislocate. The plastic wear particles that accumulate around a metal-on-plastic hip replacement, eventually cause the body to set up a rejection reaction which undermines and loosens what was a previously well-fixed hip replacement. This can happen at between 12 or 15 years onwards in people of retirement age, and earlier than this in younger people - their increased activity creates more wear, dust and thus the rejection reaction occurs earlier.

Q Are there any other advantages of a metal-on-metal hip replacement?
A As they don't dislocate easily, the patients appreciate their stability and they get better quicker because they are more confident that there is little risk of dislocation occurring.

Q What is the general complication rate?
A There is a less than 1% risk of developing a deep infection in the first year after a hip replacement - generally in a large orthopaedic hospital this is 0.3%. In people of retirement age, one would expect 90% of all replaced hips to last more than 10 years but for failures to begin from 12-15 years onwards. In younger patients, below retirement age, the figures are not so good and are being addressed by newer material and harder bearings.

Q What are the consequences of having a metal-on-metal bearing in the body?
A Metal-on-metal bearings containing chromium, cobalt, molybdenum and nickel do produce a very modest amount of wear. The wear particles are absorbed, to an extent, within the body; skin and other tissue samples taken remotely from the operation site are found in all patients to show very minor traces of these elements. It is worth remembering, in the same context, that dietary supplements containing all of these elements are on sale in health food shops and their effects are not thought to be harmful enough to warrant any form of restriction upon their sale. Women of childbearing age may be concerned that these metal particles could harm the unborn baby. So far there is no definite evidence that any such harm has ever occurred. Some investigations into this problem have been carried out and whilst some mothers with these traces of metal in their tissues have borne babies, there have not been any problems yet detected and, more importantly, the metal elements do not appear to cross from the mother's circulation to the baby's circulation, as far as we know.

Q What's the difference between a total hip replacement and a hip resurfacing procedure?
A A total hip replacement is a much more invasive operation in that the top of your femur, or thighbone, the size of a golf ball, has to be removed so that the prosthesis, or false joint, may be fitted. When a resurfacing is performed, the arthritic bone is simply shaved away and the new ball and socket, or prosthesis, is fitted over your existing bone and cemented into place.

Q How many Birmingham hip resurfacing operations have Mr O'Hara and Mr Pearson performed?
A In excess of 750.

Q How long will I be in hospital?
A Approximately 7 nights. If you live locally we ask you to attend a pre-assessment clinic where you will be assessed for siutability for surgery and have a blood sample taken for cross-matching purposes, so that if weI need to give you a blood transfusion we have blood perfectly compatible with your own available. However, if you live out of the area, we admit you the day before surgery so the blood sample may be taken and cross-matched and any necessary tests performed. You are then admitted on the day of your operation. We don't believe in admitting you the day before, as no matter how nice a hospital is nobody wants to stay there longer than absolutely necessary and apart from having to do the paperwork and maybe some minor tests, such as an x-ray or ECG (but only on older patients), there is nothing to be done and people tend to just worry about their forthcoming surgery unnecessarily. The operation is then carried out and approximately 24-36 hours later you will be mobilised, using a Zimmer frame. The Physiotherapists will visit you in your room and start you on a course of exercises. You will not be discharged until you can manage to go up and down some stairs using two sticks.

Q What sort of anaesthetic will I have?
A The operation is performed under a general anaesthetic, which is administered by a Consultant Anaesthetist, who is fully conversant with hip surgery and who will be happy to talk to you when you are admitted to hospital if you have any particular fears, concerns, or worries.

Q Do I need physiotherapy after I have been discharged from hospital?
A No, not usually. The best things to do are as much walking as possible, to cycle (if you can) and when your wound has healed to go swimming. All of these are wonderful exercises to tone up your muscles, which will have wasted somewhat due to the development of pain and lack of use of your leg.

Q How long will I be off work?
A Usually about six weeks. It is also worth remembering that in the small print of most insurance policies there is a clause that says you will not be insured to drive for six weeks following surgery involving a general anaesthetic. It's at about this time you will be fit to return to work, although some people with sedentary jobs do manage to return earlier.

Q Do I need to make any special arrangements at home?
A It's always a good idea to have somebody who can look after you in the first few days/weeks. Making cups of tea and coffee can be difficult when still using a crutch or stick. Sometimes it is useful to have a tall stool, with non-slip feet, in the kitchen to rest against when making a drink: this leaves your hands free to deal with the kettle, cup, etc., and you will then be able to take your cup and walk with your stick, back to your chair. You may also need help with putting socks and shoes on in the first few weeks - bending down that far often causes problems initially. This includes the elasticated TED stockings, which can prove difficult if you live on your own.

Q How long will it be before I am " back to normal "?
A Everybody differs, but after the first six weeks, if you continue with your walking and if possible other exercises, you will see a slow and gradual improvement and by six months things will be going pretty well for you.

Q How often do I see the surgeon after my operation?
A You will be seen at six weeks post-operation, a further six weeks, i.e. three months post surgery in some cases, six months and a year after your operation, at which time, if all is well, you will be discharged from our care.

Q Why should I have the operation performed now?
A Hip dysplasia is not a benign or harmless condition. It is known that, from studies of patients who have presented with hip dysplasia over the years, once the joint is symptomatic it is most unusual for symptoms to get better while maintaining activities, although some people will get relief of symptoms by restricting activities. It is possible to defer operation by reducing activities. Unfortunately, many such people come to the clinic 10 years later than is ideal and they have often put on weight because of their chronic mild physical disability. The operation itself then becomes harder to do. The joint is at greater risk of having deteriorated to a level that the operation no longer works. The rehabilitation is a great deal slower because the person has lost fitness before the operation.

Q Why should I have a triple pelvic osteotomy, rather than a hip resurfacing or hip replacement?
A A modern triple pelvic osteotomy, for people whose hips are suitable, is a much better bet in the long-term than any form of operation that replaces the joint surfaces. Once you have lost your joint surfaces and replaced them, you can never have them back. A well-performed osteotomy, if carried out in time, can be expected to have a 75-80% survival over a 20-year period: this is better than the survival yet achieved for any hip replacement or resurfacing. A triple pelvic osteotomy therefore offers a very good chance of buying a significant amount of time before replacement is, if ever, required.

Q What about the post-operative treatment after osteotomy surgery?
A After discharge from hospital, for the first 6-12 weeks, there will be a fairly busy period when you will be seen by the Physiotherapist several times each week. During the first six weeks you will not be encouraged to put full weight on the joint, but partial weightbearing is encouraged. All forms of exercises, including hydrotherapy, are carried out during that time. When not going to physiotherapy and hydrotherapy, the hip will benefit from being "walked" into shape.

Q How long will I be attending the clinic after osteotomy surgery?
A The vast majority of people who have a successful triple osteotomy carried out are discharged from the clinic soon after their metalwork is removed at about a year afterwards. People, of course, are free to come back to be seen if any problems occur later on.

Q What about removing the metalwork after osteotomy surgery?
A The metalwork needs to be removed through the same wound through which it was inserted, but it doesn't usually need the whole wound to be reopened. It is not necessary to relearn how to walk and use the muscles afterwards because there is only a very short period of discomfort afterwards - usually solved by perhaps a week or two of the use of Paracetamol. You will only be in hospital for one night when this procedure is carried out.

Q Why do I need to have the metal work removed after osteotomy surgery?
A It is usually worth taking the metalwork out because it isn't really meant to be there. It is stiffer than the bone and if you really want to have a spring in your step, dance the night away or indulge in contact sports, you almost certainly need it removed. If you think it isn't important in the short-term to have it removed, if it's left in for much more than a year, it becomes rather difficult to remove.