Hip Surgery
Procedures performed by Mr. Vioreanu
During first Consultation you will meet Mr. Vioreanu to discuss your hip problem. He will determine what, if any, surgery is required.
The consultation will last as long as necessary, depending on the complexity of your hip problem. Mr. Vioreanu will perform a physical examination and will review all your imaging studies.
There is a fee payable for the consultation. Remember to bring the referral letter from the GP or medical specialist.
Appointments are realistically scheduled for all patients, mindful and respectful of time. The nature of medicine and surgery is not always predictable and delays might happen. Your understanding is appreciated during such circumstances.
Appointments are confirmed with an SMS alert the day prior. A cancellation fee is not charged, however a return phone call of inability to attend is appreciated.
The right time to have hip replacement surgery is when the pain you experience is affecting your quality of life and you really want something done about it. Some people decide to have surgery because they are no longer able to work and this surgery can make a significant difference to their lives. Some cannot walk around the golf course and cannot bear the thought of being unable to play. Others will put up with pain and wait a long time, choosing only to have surgery when they can no longer walk from the bed to the bathroom. It’s a personal and very subjective decision. I always advise patients to take their time, really think it over and have surgery when it suits them.
There are two treatment options.
Risk of not operating
There are no real risks of not having a hip replacement apart from the fact that the pain might get worse with time and if the operation is put off for too long it may become difficult to manage at an age (over 85) when the risks of surgery rise steeply.
Success rate for surgery
The large majority of hip replacements are successful with research showing that 90% of conventional hip replacements are effective for 10 years. This means that one hip in ten fails every year. The probability is that your hip will last 10 to 15 years or longer. However, all hip replacements are artificial joints which may fail and therefore surgery to re-do either one or both components of the hip replacement would be needed. Overall, hip replacement surgery is a very successful procedure. You need to be aware that 95% of patients have no complications and are very happy with joint replacements.
There are always risks when having surgery, and you need to be fully aware of those risks before making your decision to proceed with surgery. Do not hesitate to ask questions of your surgeon, anaesthetist or of other medical specialists who are managing your health in the lead up to your surgery.
The vast majority of people get through the surgery with no problems at all and will be surprised at how good they feel so soon afterwards. Some will experience minor issues and occasionally there may be more serious complications. These problems are rare and most can be treated quickly and effectively. Below is a list that covers the major risks and complications with Arthroscopic surgery. Additionally, there may be other risks, particularly if you have a complex medical history or particular conditions which need to be managed by a medical specialist.
GENERAL COMPLICATIONS RELATING TO SURGERY
Pneumonia: Patients with a viral respiratory tract infection (common cold or flu) should inform us as soon as possible and will have their surgery postponed until their chest is clear. Patients with a history of asthma should bring their inhalers to hospital.
Deep vein thrombosis and pulmonary embolus: Although this complication is rare following arthroscopic surgery, a combination of knee injury, prolonged transport and immobilisation of the limb, smoking and the oral contraceptive pill or hormonal replacement therapy all multiply to increase the risk. Any past history of thrombosis should be brought to the attention of the Surgeon prior to your operation. The oral contraceptive pill, hormonal replacement therapy and smoking should cease one week prior to surgery to minimise the risks.
Infection. Surgery is carried out under strict germ free condition. Antibiotics are administered intravenously at the time of your surgery. Any allergy to known antibiotics should be brought to our attention. With these measures there is a less than 2% chance of developing an infection within the joint. Most commonly these are superficial wound infections that resolve with a course of antibiotics. More serious infections may require further hospitalisation and surgery with prolonged antibiotic therapy.
Dislocation. Dislocation can occur after hip replacement surgery. Dislocation is more likely to occur during the first 6 weeks after surgery, but can happen at anytime. Dislocation usually occurs when the hip is put into a position that allows the ball of the prosthesis to come out of the socket. In the first 6 weeks it is necessary to take precautions to minimise the risk of this happening. The physiotherapist and the nursing staff will remind you what positions to reduce the risk. If a hip dislocates it is necessary to have it put back into place and sometimes it is necessary to have further surgery on the hip to prevent this from happening again. In the event of dislocation, you will be in pain and will need to call an ambulance to take you to hospital.
Fracture. Fracture of the femur or acetabulum (peri-prosthetic fracture) can occur after the surgery particularly if the patient falls. Peri-prosthetic fracture can also result from overzealous rehabilitation in the first few months after surgery. It is important to limit the forces on your hip or knee for the first 2 months after surgery to let the body heal. This complication is more common in elderly people and in people with osteoporosis where the bone is soft. The treatment of periprosthetic fracture may be protected weight bearing or it may be necessary to do further surgery. Fracture can occasionally occur during the surgery, particularly if your bone quality is poor and if this happens, your surgeon will place a wire around the fracture and you will be instructed to use crutches or frame for 6 weeks to give the fracture time to heal. Sometimes a wire is used as a preventative measure during surgery, if the surgeon feels there is a particular risk of fracture after surgery.
Some other rare problems: Squeaking or breakage. Squeaking of hip replacements is a problem occurring in about 1-3% of patients when ceramic bearings are used. Usually it is intermittent and a curiosity only and doesn’t bear any relationship to a patient’s satisfaction in terms of the functionality of the hip. Occasionally it may be frequent enough and loud enough to require further intervention.
Choosing a date for surgery
After the consultation, in conjunction with Mr. Vioreanu's Personal Assistant, you should decide on the time frame and a date that is most suitable to you. You will walk with crutches for around 4-6 weeks after the surgery and may need to take as much time off work. This should be taken into account when planning for a suitable date for surgery.
Forms to be completed and signed
You will receive an information package containing your admission, consent and questionnaire forms, which you will need to complete and send back to us.
Mr. Vioreanu collects information about each surgery for the purposes of patient management, but also uses information for research. You will be given a consent form, which is to be completed and given back to Mr. Vioreanu’s office.
Let us know
You should inform us of any medical conditions or previous medical treatment as this may affect your operation.
It is extremely important that there are no cuts, scratches, pimples or ulcers over your hip as this greatly increases the risk of infection. Your surgery will be postponed until the skin lesions have healed.
Please use HIBISCRUB solution (Chlorexidine 4%) to wash your hip ONCE daily for 5 days prior to surgery. Wash the skin gently and do no scrub the area. You can find HIBISCRUB solution at a retail Pharmacy.
Pre-operative testing
You will need to have a chest x-ray, ECG and blood tests done prior to surgery. These are standard tests for all patients. These are usually done 2 weeks prior to your pre-admission appointment. If it is convenient for you, all these tests can easily be arranged at the SSC. Results need to be back in time for your pre-admission appointment.
Pre-admission clinic at SSC
The hospital will contact you some time prior to your surgery to make an appointment for you at the pre-admission clinic. At this appointment, you will be fully assessed and given all the information you need about your hospital stay and procedure. Test results from your chest x-ray, ECG and blood pathology will be discussed with you and your anaesthetist may come see you at the pre-admission appointment.
Managing your Medications
Prior to your surgery we will discuss your medications with you. You will be given important instructions about what you should and should not take prior to surgery. Please do not hesitate to contact our office if you are unsure about these instructions.
Also, some patients with complex medical conditions will need appointments with other medical specialists to ensure that it is safe to proceed with surgery.
We will let you know if this is something you need to do.
Your Teeth
Tooth decay and mouth infections can be a cause of infection in joint replacement. It is very important you talk to your dentist to address abscess and tooth decay prior to having surgery, as infections in the mouth can cause infections in other parts of the body. Even years after you have surgery, it is important to ensure you are vigilant about dealing with decay in your mouth, or any small infections on other parts of your body.
The night before surgery
Please do not eat and drink after mid-night and try to have a good nights sleep.
Admission to SSC
You will be admitted on the morning of the surgery. Mr. Vioreanu's Personal Assisstant will inform you of the exact time and place to go for your admission.
Do not forget to bring all your relevant imaging studies (Xray’s , MRI’s etc.) and relevant medical letters and tests.
Mr. Vioreanu works closely with a small number of expert anaesthetists to optimise the pain relief and recovery after the surgery. The anaesthetist for your surgery will depend on which day your surgery is scheduled. The anaesthetist will usually contact you to discuss your anaesthetic beforehand. You should discuss with the Anesthesist's preference and benefits of spinal versus general anaesthesia.
Immediately after surgery
You will wake up in the recovery ward and will have a pillow between your legs. You will be given regular pain relief by the nursing staff in the form of an injection or tablet as required.
Mr. Vioreanu will come and discuss the surgery performed. You will then be transferred to the ward. A physiotherapist will visit you in the afternoon of your surgery, or the following day. They will show you some exercises for your leg and get you up for a walk. You will begin walking with crutches and will need to avoid putting full weight through your operated leg. Once you are able to safely mobilise and care for yourself you will be discharged from hospital, usually 2-4 days after your surgery.
You will receive instructions and a prescription for pain-killers and blood thinning medication from our nursing staff prior to being discharged from hospital.
The next few days
If you have any concerns about your post-operative recovery please do not hesitate to contact our office. Mr. Vioreanu will call you back at a suitable time to discuss all your concerns.
Swelling
The swelling in your operated leg may take up as much as 4-6 months to fully resolve. To facilitate this we strongly advise to place 2-3 pillows under your bed mattress to keep the leg elevated at night time.
Bruising
Bruising of the lower leg, calf and sometimes the thigh is not uncommon after Hip Replacement Surgery. It will take 1-2 weeks to resolve.
Crutches
You will walk with crutches for 2-3 weeks after surgery.
Return to work
Sedentary and office workers may return to work approximately 4-6 weeks following surgery.
Mr. Vioreanu will see you 6-8 weeks after discharge from the hospital with new X-Rays. The following appointments will be at 6 months and 9-12 months after surgery respectively. You do need to contact our office to make these appointments. You do not need a referral letter for these appointments.
The enhanced recovery program is about improving patient comfort & outcomes and speeding up a patient’s recovery after surgery.
The program focuses on making sure that patients are active participants in their own recovery process. It also aims to ensure that patients always receive the right evidence based (proven) care at the right time.
This new approach aims to accelerate all aspects of a patient’s recovery process. This includes accelerating their physical, mental and physiological recovery following surgery.
Physical recovery includes restoring a patient’s level of function, strength and range of movement.
Mental recovery includes the elimination of concerns, and the return of self-confidence and the state of feeling balanced and whole.
Physiological recovery takes all the major body systems into account and aims to avoid insult on the cardiovascular, respiratory, renal, gastro-intestinal and haematological systems during your surgery.
After the operation the programme focuses on getting patients out of bed and starting to move their joint as soon as possible with the support of good pain management. This results in patients making a quicker recovery than average and being able to return to active life as soon as possible.
Enhanced recovery surgery:
- Allows patients to recover faster and more comfortably from major surgery
- Allows greater patient involvement in the early stages of recovery
- Gives better patient outcomes
- Reduces hospital stay
Patients never leave the hospital until they are ready and comfortable to walk independently.
All patients will leave the hospital with the ‘Exercise Guide to Knee or Hip Replacement’ book that clearly outlines the expectations and provide specific exercises and advice for each week after surgery.
When at home, all patients can contact our office directly by phone or email if they have any concerns regarding their progress or recovery and they will be attended promptly.
Read more about Enhanced Recovery Program employed by Mr. Vioreanu.
Please download and read the 'Patient's Guide' book containing all the aspects regarding patient's experience before, during and after knee replacement surgery. This book has been written with patient's experience in mind and contains all the information required for the patient to have the a enjoyable and seamless surgical journey.
During first Consultation you will meet Mr. Vioreanu to discuss your hip problem. He will determine what, if any, surgery is required.
The consultation will last as long as necessary, depending on the complexity of your hip problem. Mr. Vioreanu will perform a physical examination and will review all your imaging studies.
There is a fee payable for the consultation. Remember to bring the referral letter from the GP or medical specialist.
Appointments are realistically scheduled for all patients, mindful and respectful of time. The nature of medicine and surgery is not always predictable and delays might happen. Your understanding is appreciated during such circumstances.
Appointments are confirmed with an SMS alert the day prior. A cancellation fee is not charged, however a return phone call of inability to attend is appreciated.
The right time to have hip replacement surgery is when the pain you experience is affecting your quality of life and you really want something done about it. Some people decide to have surgery because they are no longer able to work and this surgery can make a significant difference to their lives. Some cannot walk around the golf course and cannot bear the thought of being unable to play. Others will put up with pain and wait a long time, choosing only to have surgery when they can no longer walk from the bed to the bathroom. It’s a personal and very subjective decision. I always advise patients to take their time, really think it over and have surgery when it suits them.
There are two treatment options.
Risk of not operating
There are no real risks of not having a hip replacement apart from the fact that the pain might get worse with time and if the operation is put off for too long it may become difficult to manage at an age (over 85) when the risks of surgery rise steeply.
Success rate for surgery
The large majority of hip replacements are successful with research showing that 90% of conventional hip replacements are effective for 10 years. This means that one hip in ten fails every year. The probability is that your hip will last 10 to 15 years or longer. However, all hip replacements are artificial joints which may fail and therefore surgery to re-do either one or both components of the hip replacement would be needed. Overall, hip replacement surgery is a very successful procedure. You need to be aware that 95% of patients have no complications and are very happy with joint replacements.
There are always risks when having surgery, and you need to be fully aware of those risks before making your decision to proceed with surgery. Do not hesitate to ask questions of your surgeon, anaesthetist or of other medical specialists who are managing your health in the lead up to your surgery.
The vast majority of people get through the surgery with no problems at all and will be surprised at how good they feel so soon afterwards. Some will experience minor issues and occasionally there may be more serious complications. These problems are rare and most can be treated quickly and effectively. Below is a list that covers the major risks and complications with Arthroscopic surgery. Additionally, there may be other risks, particularly if you have a complex medical history or particular conditions which need to be managed by a medical specialist.
GENERAL COMPLICATIONS RELATED TO SURGERY
Pneumonia: Patients with a viral respiratory tract infection (common cold or flu) should inform us as soon as possible and will have their surgery postponed until their chest is clear. Patients with a history of asthma should bring their inhalers to hospital.
Deep vein thrombosis and pulmonary embolus: Although this complication is rare following arthroscopic surgery, a combination of knee injury, prolonged transport and immobilisation of the limb, smoking and the oral contraceptive pill or hormonal replacement therapy all multiply to increase the risk. Any past history of thrombosis should be brought to the attention of the Surgeon prior to your operation. The oral contraceptive pill, hormonal replacement therapy and smoking should cease one week prior to surgery to minimise the risks.
Infection. Surgery is carried out under strict germ free condition. Antibiotics are administered intravenously at the time of your surgery. Any allergy to known antibiotics should be brought to our attention. With these measures there is a less than 2% chance of developing an infection within the joint. Most commonly these are superficial wound infections that resolve with a course of antibiotics. More serious infections may require further hospitalisation and surgery with prolonged antibiotic therapy.
Dislocation. Dislocation can occur after hip replacement surgery. Dislocation is more likely to occur during the first 6 weeks after surgery, but can happen at anytime. Dislocation usually occurs when the hip is put into a position that allows the ball of the prosthesis to come out of the socket. In the first 6 weeks it is necessary to take precautions to minimise the risk of this happening. The physiotherapist and the nursing staff will remind you what positions to reduce the risk. If a hip dislocates it is necessary to have it put back into place and sometimes it is necessary to have further surgery on the hip to prevent this from happening again. In the event of dislocation, you will be in pain and will need to call an ambulance to take you to hospital.
Fracture. Fracture of the femur or acetabulum (peri-prosthetic fracture) can occur after the surgery particularly if the patient falls. Peri-prosthetic fracture can also result from overzealous rehabilitation in the first few months after surgery. It is important to limit the forces on your hip or knee for the first 2 months after surgery to let the body heal. This complication is more common in elderly people and in people with osteoporosis where the bone is soft. The treatment of periprosthetic fracture may be protected weight bearing or it may be necessary to do further surgery. Fracture can occasionally occur during the surgery, particularly if your bone quality is poor and if this happens, your surgeon will place a wire around the fracture and you will be instructed to use crutches or frame for 6 weeks to give the fracture time to heal. Sometimes a wire is used as a preventative measure during surgery, if the surgeon feels there is a particular risk of fracture after surgery.
Some other rare problems: Squeaking or breakage. Squeaking of hip replacements is a problem occurring in about 1-3% of patients when ceramic bearings are used. Usually it is intermittent and a curiosity only and doesn’t bear any relationship to a patient’s satisfaction in terms of the functionality of the hip. Occasionally it may be frequent enough and loud enough to require further intervention.
Choosing a date for surgery
After the consultation, in conjunction with Mr. Vioreanu's Personal Assistant, you should decide on the time frame and a date that is most suitable to you. You will walk with crutches for around 4-6 weeks after the surgery and may need to take as much time off work. This should be taken into account when planning for a suitable date for surgery
Forms to be completed and signed
You will receive an information package containing your admission, consent and questionnaire forms, which you will need to complete and send back to us.
Mr. Vioreanu collects information about each surgery for the purposes of patient management, but also uses information for research. You will be given a consent form, which is to be completed and given back to Mr. Vioreanu’s office.
Let us know
You should inform us of any medical conditions or previous medical treatment as this may affect your operation.
It is extremely important that there are no cuts, scratches, pimples or ulcers over your hip as this greatly increases the risk of infection. Your surgery will be postponed until the skin lesions have healed.
Please use HIBISCRUB solution (Chlorexidine 4%) to wash your hip ONCE daily for 5 days prior to surgery. Wash the skin gently and do no scrub the area. You can find HIBISCRUB solution at a retail Pharmacy.
Pre-operative testing
You will need to have a chest x-ray, ECG and blood tests done prior to surgery. These are standard tests for all patients. These are usually done 2 weeks prior to your pre-admission appointment. If it is convenient for you, all these tests can easily be arranged at the SSC. Results need to be back in time for your pre-admission appointment.
Pre-admission clinic at SSC
The hospital will contact you some time prior to your surgery to make an appointment for you at the pre-admission clinic. At this appointment, you will be fully assessed and given all the information you need about your hospital stay and procedure. Test results from your chest x-ray, ECG and blood pathology will be discussed with you and your anaesthetist may come see you at the pre-admission appointment.
Managing your Medications
Prior to your surgery we will discuss your medications with you. You will be given important instructions about what you should and should not take prior to surgery. Please do not hesitate to contact our office if you are unsure about these instructions.
Also, some patients with complex medical conditions will need appointments with other medical specialists to ensure that it is safe to proceed with surgery.
We will let you know if this is something you need to do.
Your Teeth
Tooth decay and mouth infections can be a cause of infection in joint replacement. It is very important you talk to your dentist to address abscess and tooth decay prior to having surgery, as infections in the mouth can cause infections in other parts of the body. Even years after you have surgery, it is important to ensure you are vigilant about dealing with decay in your mouth, or any small infections on other parts of your body.
The night before surgery
Please do not eat and drink after mid-night and try to have a good nights sleep.
Admission to SSC
You will be admitted on the morning of the surgery. Mr. Vioreanu's Personal Assisstant will inform you of the exact time and place to go for your admission.
Do not forget to bring all your relevant imaging studies (Xray’s , MRI’s etc.) and relevant medical letters and tests.
Mr. Vioreanu works closely with a small number of expert anaesthetists to optimise the pain relief and recovery after the surgery. The anaesthetist for your surgery will depend on which day your surgery is scheduled. The anaesthetist will usually contact you to discuss your anaesthetic beforehand. You should discuss with the Anesthesist's preference and benefits of spinal versus general anaesthesia.
Immediately after surgery
You will wake up in the recovery ward and will have a pillow between your legs. You will be given regular pain relief by the nursing staff in the form of an injection or tablet as required.
Mr. Vioreanu will come and discuss the surgery performed. You will then be transferred to the ward. A physiotherapist will visit you in the afternoon of your surgery, or the following day. They will show you some exercises for your leg and get you up for a walk. You will begin walking with crutches and will need to avoid putting full weight through your operated leg. Once you are able to safely mobilise and care for yourself you will be discharged from hospital, usually 2-4 days after your surgery.
You will receive instructions and a prescription for pain-killers and blood thinning medication from our nursing staff prior to being discharged from hospital.
The next few days
If you have any concerns about your post-operative recovery please do not hesitate to contact our office. Mr. Vioreanu will call you back at a suitable time to discuss all your concerns.
Swelling
The swelling in your operated leg may take up as much as 4-6 months to fully resolve. To facilitate this we strongly advise to place 2-3 pillows under your bed mattress to keep the leg elevated at night time.
Bruising
Bruising of the lower leg, calf and sometimes the thigh is not uncommon after Hip Replacement Surgery. It will take 1-2 weeks to resolve.
Crutches
You will walk with crutches for 2-3 weeks after surgery.
Return to work
Sedentary and office workers may return to work approximately 4-6 weeks following surgery.
Mr. Vioreanu will see you 6-8 weeks after discharge from the hospital with new X-Rays. The following appointments will be at 6 months and 9-12 months after surgery respectively. You do need to contact our office to make these appointments. You do not need a referral letter for these appointments.
The enhanced recovery program is about improving patient comfort & outcomes and speeding up a patient’s recovery after surgery.
The program focuses on making sure that patients are active participants in their own recovery process. It also aims to ensure that patients always receive the right evidence based (proven) care at the right time.
This new approach aims to accelerate all aspects of a patient’s recovery process. This includes accelerating their physical, mental and physiological recovery following surgery.
Physical recovery includes restoring a patient’s level of function, strength and range of movement.
Mental recovery includes the elimination of concerns, and the return of self-confidence and the state of feeling balanced and whole.
Physiological recovery takes all the major body systems into account and aims to avoid insult on the cardiovascular, respiratory, renal, gastro-intestinal and haematological systems during your surgery.
After the operation the programme focuses on getting patients out of bed and starting to move their joint as soon as possible with the support of good pain management. This results in patients making a quicker recovery than average and being able to return to active life as soon as possible.
Enhanced recovery surgery:
- Allows patients to recover faster and more comfortably from major surgery
- Allows greater patient involvement in the early stages of recovery
- Gives better patient outcomes
- Reduces hospital stay
Patients never leave the hospital until they are ready and comfortable to walk independently.
All patients will leave the hospital with the ‘Exercise Guide to Knee or Hip Replacement’ book that clearly outlines the expectations and provide specific exercises and advice for each week after surgery.
When at home, all patients can contact our office directly by phone or email if they have any concerns regarding their progress or recovery and they will be attended promptly.
Please download and read the 'Patient's Guide' book containing all the aspects regarding patient's experience before, during and after hip replacement surgery. This book has been written with patient's experience in mind and contains all the information required for the patient to have the an enjoyable and smooth surgical journey.
