Robotically assisted total hip replacement

A robotic hip replacement is a procedure to remove the worn-out parts of your hip and replace them with undamaged artificial surfaces. The difference between this procedure and more traditional techniques is that it's carried out with assistance from a robotic arm, which allows for much higher degree of accuracy.

Most hip replacements are carried out for degenerative hip disease (hip osteoarthritis), however robotic hip techniques are also very successful in the treatment of inflammatory hip disease (like rheumatoid arthritis), problems with the blood supply to the hip (avascular necrosis) and problems with the shape of the hip (hip dysplasia).

Robotic techniques are not typically used to treat acute fractures of the hip, as these are typically emergency procedures. However, if the fracture fixation fails, the robot can be used in the revision of screws and/or plates to a total hip replacement.

The robot is a tool used by the surgeon. Hip replacement surgery is a complex and intricate procedure that requires precision. Using a robotic arm allows for more accuracy in the planning of the procedure, meaning that the implants fit better and are in exactly the right place for each individual patient. This accuracy also minimises any damage to other structures around the hip.

You can find out more about how Mr Miles uses robotic surgery by clicking the button below:

Before your operation, you’ll meet Mr Miles for a consultation. He’ll discuss your medical history, examine your hip, or hips, thoroughly, and organise any appropriate X-rays or scans to see whether surgery is the right option for you.

He’ll talk to you about any additional health problems you may have that might need attention before surgery. Typically these will include heart or kidney problems.

Depending on your circumstances, there may be certain steps you can take before your procedure that will help. These include:

• Stopping smoking – this can significantly reduce the chances of blood clots.
• Exercise – if your muscles are weak, a gentle exercise programme can help you to recover more quickly after surgery. This is called prehabilitation.
• Blood sugar control – if you have diabetes, making sure your blood sugar control is good in the weeks running up to surgery will reduces your risk of infection'

The team at The Wellington Hospital will arrange a pre-operative visit to carry out blood tests, a preoperative electrocardiogram (ECG), and take details of allergies and other medical problems. We’ll check your current medicines and let you know if you need to stop or change any of them (typically this will be the case with blood-thinning drugs).

After that, you’ll have a CT scan of your hip and pelvis to create the 3D image that Mr Miles will use to plan your surgery.

Before you have your procedure, it’s a good idea to find a physiotherapist in your area who can help you with your recovery. If you’re unsure of where to start with this, just let us know - we’re more than happy to help.

When we contact you with the date and time of your procedure, we’ll let you know how long before surgery you’ll need to stop eating and drinking.

On the day of your surgery, you’ll be able to choose between a general and a spinal anaesthetic (like an epidural used in childbirth). If you choose a spinal, you’ll also be offered sedation, so you’ll be pretty much asleep.

Your surgery will be performed by Mr Miles, using the robot as a guide tool. This allows him an incredible degree of accuracy, while programmed virtual boundaries provide resistance and cut off the motors if the surgeon comes outside of the cutting zone. This greatly reduces any risk of accidental damage to the rest of the bone and nearby structures.

With the help of the robotic arm, Mr Miles then inserts the implants accurately into the site chosen on the pre-operative plan.

• More accurate placement and alignment of your hip implant, based on the surgical plan
• Reduced risk of subsequent wear and tear or dislocation
• A more natural feeling hip
• Reduced risk of unequal leg length
• Preservation of healthy bone
• Less bleeding during the procedure
• Faster recovery 

Immediately after the operation, you’ll be taken into the anaesthetic recovery area, where we’ll monitor you closely for around 30 minutes. After this, we’ll take you back to the orthopaedic ward, where you’ll be looked after by nurse specialists, orthopaedic nurses and joint replacement specialist physiotherapists.

You’ll be able to put your weight on the hip straight away, but your muscles will be weak and sore. We’ll start you with a zimmer frame, before progressing quickly onto crutches. As soon as you’re steady, you’ll be able to come off the crutches.

The length of stay in hospital will vary depending on your general health and age, whether you live alone and what you feel most comfortable with. Some people want to go home straight away, while others prefer a little more time and help adjusting. It can be as little as 24 hours or up to four days in hospital. We’ll make sure you’re fully able to walk, get dressed, use the bathroom and negotiate stairs before you go home.

Some patients need a little more help after the acute hospital stay. If that’s the case for you, we can recommend some excellent rehabilitation care options.

You’ll also need some preventative treatment to avoid blood clots. The team will advise you on the most appropriate treatment – typically thromboembolic stockings plus injections or tablets. You’ll be given all of these, along with appropriate pain relief medication to take home with you.

Your wound will be closed with glue, and will need to be checked around two weeks after surgery. We’ll arrange an appointment and give you all the details before you leave. We’ll also arrange a post-operative follow-up with Mr Miles around six weeks after surgery, and give you contact numbers for the ward, the nurse specialists and the administrative team. Should you need advice after you return home, they’ll be happy to help.

Robotic hip replacement surgery is a safe procedure but, as with all operations, there are some risks and possible complications. These include:

Common complications: (2-5%)

Pain, bleeding, DVT (deep vein thrombosis), dislocated joint, loosening/wear of the hip, altered leg length

Less common: (1-2%)

Infection

Rare: (less than 1%)                        

Altered wound healing, bone damage, blood vessel damage, nerve damage, pulmonary embolism (PE), death