The day of your operation

Arriving

You will usually be asked to arrive early in the morning, having followed your fasting instructions. On admission a nurse will check your details, your temperature, pulse and blood pressure, take a final look at the skin over your hip, and give you a gown and compression stockings. You will be asked to remove jewellery, nail varnish and dentures, though you can normally keep glasses and hearing aids until the last moment — do ask.

The surgeon will visit to confirm the plan, answer any last questions, complete your consent form and — importantly — mark your leg with an arrow in indelible pen to show which hip is being operated on. The anaesthetist will also visit to discuss your anaesthetic. This is your last easy opportunity to ask anything, so use it.

Who will be in the room

Theatre is a busy place. Everybody there has a specific job, and many of them are operating department practitioners (ODPs) — specialist practitioners trained specifically for the operating theatre environment.

The theatre itself

The room will be cool and bright, with filtered ventilation designed to keep airborne bacteria away from the wound. Equipment is checked and laid out before you arrive, and instrument trays are opened only when needed. It may feel clinical and impersonal — say so if you feel uneasy, and someone will stay and talk with you.

The safety checklist

Before anything begins, the team pauses and works through a checklist out loud. You may hear part of it. It runs in three stages:

1. Before your anaesthetic — confirming your identity, the correct site and side, your consent, allergies, airway concerns and expected blood loss.
2. Before the first cut — everyone introduces themselves by name and role, the operation is stated aloud, antibiotics are confirmed as given, implants are confirmed as available, and any anticipated difficulties are discussed.
3. Before you leave theatre — instruments, needles and swabs are counted, specimens labelled, implant details recorded, and the plan for your recovery agreed.

Anyone in the room, of any seniority, can stop the process if something is not right. That is by design.

Getting you positioned

Once you are asleep or your spinal anaesthetic is working, the team positions you carefully — usually on your side with supports holding your pelvis, or sometimes on your back. This takes several minutes and is done with real attention, because while you cannot move yourself the team must protect your skin, your nerves and your other joints.

Positioning aids include gel pads, padded supports and heel protectors. The team will:

• Pad bony points to prevent pressure damage.
• Keep your arms, neck and shoulders in a natural position to avoid stretching nerves.
• Apply calf compression sleeves that squeeze gently to keep blood moving.
• Use a warming blanket, because getting cold increases bleeding and infection risk.

Your skin is then cleaned with an antiseptic solution and left to dry, and sterile drapes are placed to leave only the operating area exposed. A clear adhesive antimicrobial film is often applied over the skin itself.

The operation, step by step

The surgery itself normally takes between one and two hours. In outline, the surgeon:

1. Makes the incision — usually 10 to 20 cm over the side or back of the hip.
2. Reaches the joint by moving the muscles aside and opening the joint capsule.
3. Removes the worn ball by cutting through the neck of the thigh bone and lifting the femoral head out.
4. Prepares the socket with a hemispherical reamer until healthy bone is exposed and the shape matches the new cup.
5. Fits the cup — press-fitted into the bone, held with cement or screws as required, and a plastic or ceramic liner clipped inside.
6. Prepares the thigh bone by shaping the hollow centre to accept the stem.
7. Inserts the stem and ball, using trial components first to check the leg length, the tension of the tissues and the stability of the joint.
8. Tests the joint by moving the hip through the positions that might cause dislocation.
9. Closes the wound in layers with stitches, repairing the capsule and muscle, and applies the dressing. Local anaesthetic is often injected into the tissues at this stage.

Equipment and materials used

• Instruments — retractors to hold tissues aside, an oscillating saw, reamers and broaches to shape bone, impactors to seat the components, and trial components for sizing.
• Implants — a stem, a ball head, an acetabular shell and a liner, each recorded by batch number in your notes and reported to the National Joint Registry so they can be traced for life.
• Bone cement — where used, mixed at the table and often loaded with antibiotic.
• Sterile drapes, a stockinette for the leg, and an antimicrobial adhesive film to protect the field.
• Suction, diathermy and swabs to control bleeding and keep the view clear.
• Dressings — an absorbent, waterproof dressing designed to stay in place for several days, managing wound fluid while keeping contamination out.

Drains are used far less often than they once were; most wounds do better without one. If you do have one, it usually comes out within a day.

Waking up in recovery

From theatre you are taken to the recovery area, where a practitioner stays with you continuously. They will monitor your oxygen, blood pressure, pulse and pain, check the dressing, and make sure you can feel and move your feet. You may have an oxygen mask, a drip in your arm, and warm air blankets. Feeling cold, shivery, thirsty or a bit sick is common and easily treated.

Tell the staff immediately if you are in pain — you do not need to be brave, and pain is far easier to control early than late. When you are comfortable, awake and stable, you go back to the ward. Many people are sitting up eating and drinking within a couple of hours, and the physiotherapist may see you the same day.

What gets written down

Everything is documented: the approach used, the implants and their batch numbers, whether cement was used, blood loss, the antibiotics given, the instrument and swab counts, your weight-bearing status and your follow-up plan. This record is what allows anyone caring for you in future — including in ten years' time — to know exactly what is inside your hip.