Question 1

How do I know I have a problem with my hip?

Accepted Answer

Hip pain is common in patients of all ages. The most common reason is osteoarthritis (wear and tear within the joint) occurring as people age. Patients know best how their own body feels, and often describe a pain in the front of the upper leg or groin region, with associated stiffness and difficulty performing activities and movements that were once easy and pain-free. As these symptoms and the pain worsens, and patients feel their function and ability is changing, they are welcome to seek specialist advice and guidance. It is what we as healthcare professionals are here for!
Several other reasons exist leading to hip pain, for example muscular pains around the hip joint and attachment points, inflammation and pain around the side of the hip, lower back pain felt radiating around to the hip area, cartilage problems around the hip socket, developmental problems of the hip to name but a few. Each of these conditions have their own unique symptoms and sensations, and the investigation and treatment of these is part of what hip specialists “super-specialise” in.  
When patients feel their pain or symptoms are worsening, and begin to worry about what to do next, book in to see a hip specialist to talk things through. Be reassured that Mr Bick will take your questions and problems seriously and help you make informed treatment decisions.

Question 2

How do I book in to see Mr Bick?

Accepted Answer

Appointments can be made through Lauren Orchard, Mr Bick’s secretary here: Lauren@theorchardgroup.org.uk

Alternatively, the private hospital telephone teams can book appointments into the next suitable clinic slot. 
Online bookings are also available through the Spire Hospital website here:

(https://appointments.spirehealthcare.com/?c=C6065776&_gl=1*1wur4wt*_gcl_au*MTI2MjkwMjU0OS4xNzU5MTU0MTM2*_ga*MTM3ODcyOTQyLjE3NTE4ODk1ODE.*_ga_P3SX1ED653*czE3NjMzMjY1ODYkbzQkZzEkdDE3NjMzMjY2MDgkajM4JGwwJGgw)

Nuffield Hospital Online bookings can be done here:
Mr Simon Bick

Question 3

Do I need a referral?

Accepted Answer

No, a formal referral or letter is not required to see Mr Bick. Many patients book an appointment on the advice of their GP, physiotherapist, chiropractor or other allied professional for advice on treatment options. If you do have a referral letter or further information related to your appointment, please bring it with you. Mr Bick’s secretary will contact you beforehand to ensure the process is as smooth as possible, for example to arrange xray or image transfers to the relevant hospital or clinic.

Question 4

What happens during the consultation?

Accepted Answer

Consultations as a new patient are normally booked in for approximately 30-minute appointments, and 10 to 20 minutes for follow-ups. During this time Mr Bick will talk through with you your hip problem, symptoms, expectations and aspirations. A tailored examination will take place looking at hip range of motion, painful areas and positions, muscle strength and balance control. Relevant investigations are performed on-site during the clinic (for example xrays if needed) and reviewed and discussed with you straight away. Mr Bick will discuss treatment options and plans with you, taking your considerations into account, and allow you to decide on what treatment options are best suited to you.

Question 5

Are you able to access xrays taken at other centres?

Accepted Answer

Yes, images can be transferred using a secure software system called PACS which allows xrays and scans to be uploaded onto the destination hospital’s computer systems. Mr Bick’s secretary will discuss this with you before your appointment and arrange transfer if needed.

Question 6

Are there treatment options without surgery?

Accepted Answer

Yes, there are multiple treatment options for hip problems that don’t require surgery. These are important to consider in the decision-making process, to be fully informed of all options available to you. Supported by care from physiotherapists, biokineticists, sports therapists, dieticians, chiropractors and osteopaths, many hip problems can settle and improve. 
Cortisone (steroid) injections are also useful in helping relieve pain due to arthritis, and Mr Bick can discuss these with you.
It is a big commitment to proceed with a major surgical procedure and the recovery afterwards, often made easier by the knowledge that you have tried everything possible to help your hip problem beforehand.

Question 7

What happens if I’m listed for surgery?

Accepted Answer

Once you have decided to proceed with surgery, Mr Bick’s secretary will contact you to select a suitable date for surgery to fit in with your preferences. Once this is decided, the hospital where your surgery will take place will book you in if needed for a pre-assessment appointment a short time before your surgery. The waiting time for surgery is short in the private hospitals, usually only a few weeks, and this time is important for arranging things with your work if needed, planning how you will be transported during recovery, and ensuring you have appropriate help and support from family and friends.
If you are having a cortisone injection, this requires much less planning as it is a quick outpatient procedure. The radiology team leads this, and Mr Bick and his secretary can discuss further details with you.

Question 8

What is a hip replacement made of?

Accepted Answer

Hip replacements are ball-and-socket joints usually made up of 4 parts: a metal shell that press-fits into the hip socket of the pelvis, a medical-grade polyethylene (plastic) liner that locks into the shell, a ceramic ball-bearing that is supported by a metal stem or spike that sits inside the central part of the top of the femur (thighbone). Each component is carefully selected to match the anatomy of the hip joint in each patient, and there are multiple sizes available to choose from to fit the varied anatomy of different hips. This is guided by a digital software templating system that allows for planning of accurate sizing and positioning of the components prior to surgery.
Some stems are placed in a cement bed which then sets during the operation, others are press-fit into the top of the femur. The choice for this stem option is complex based on patient age, bone quality, bone shape, and digital templating. 
The hip replacements that Mr Bick uses have excellent longevity results, tightly monitored by national data registries and implant evaluation panels.

Question 9

Why do I need a pre-assessment appointment?

Accepted Answer

Planning for safe elective surgery is of utmost importance. The pre-assessment appointment is run by specialist nurses and anaesthetists to screen and test your health in preparation for smooth, safe surgery.  Any medical conditions you may have are checked and optimised as required, as are the medications you may be on.  
Part of this appointment process is blood tests to look at your iron levels, kidney function and blood type. The pre-assessment team will talk through what is needed of you in the build-up to surgery, and the specialist therapy teams will assess your specific rehabilitation needs in hospital and on discharge. As much of the paperwork is completed as possible during pre-assessment to allow a seamless admission on the day of surgery.

Question 10

How can I prepare for surgery?

Accepted Answer

Being in the right condition both physically and mentally makes a big difference to your experience of the surgery, admission and recovery. This means making sure that your health and wellness are as good as possible, that your skin is clean and without cuts or scratches, that your diet and weight are optimised, and that your preparations are completed ready for your return home. 
Increasing your dietary intake of multivitamins, iron (meats, leafy green vegetables) and albumin (eggs) before surgery can aid your recovery.
Stopping smoking is essential to improve wound healing and physical recovery.
Losing weight before surgery with careful diet control, exercising where able and even with weight loss injections can reduce your risks in surgery and help with a faster and easier recovery. Your BMI (Body Mass Index) will be measured using your height and weight to calculate this.
Familiarising yourself with any specific post-operative exercises that the therapists have given you will help with the techniques and habits after surgery.
Setting goals for your recovery, for example a planned vacation or sporting challenge, and planning timeframes to return to work, driving and hobbies/sports will help by having positive things to look forward to achieving.

Question 11

What medicines are stopped before surgery?

Accepted Answer

Most medicines can be continued until the day of surgery. The common exception to this is blood thinners that need to be paused temporarily before surgery, and the timings of this will be confirmed at the pre-assessment appointment as will any changes to your medications that are required around surgery. 
Rarely, patients who use certain immune-modifying medications for inflammatory or autoimmune disorders such as rheumatoid arthritis need to stop these several weeks before surgery. Please ensure that your up-to-date medication list is shown to Mr Bick and the pre-assessment team.

Question 12

What do I do on the day before surgery?

Accepted Answer

The day before surgery can be a nervous time for many. Try pack your personal belongings, books/tablets/chargers, toiletries, clothes, medications and paperwork well beforehand. Complete any required washing regimes or ointments that the pre-assessment team have shown you. Get some exercise or fresh air if possible and try get to bed early. Double-check the timings of any fasting instructions given to you, and stay hydrated.

Question 13

What happens on the day of surgery?

Accepted Answer

Please make sure you do not eat after your fasting time (i.e. No tea/coffee/juice/food for 6 hours before surgery) as this can delay or postpone your surgery. Only sips of water are allowed up to 3 hours before surgery, or as directed by your anaesthetist. You should have a family member or friend bring you to the hospital, they are usually able to wait with you until you are taken to theatre.
Once you have been checked into hospital, the ward staff will settle you into your room, take your observations, and run through multiple safety checks. You will change into a hospital gown as directed by the ward team, non-slip slippers are useful. The therapy teams may discuss your therapy and equipment needs for after surgery if not already completed. The anaesthetist will review your anaesthetic plan with you, and Mr Bick will see you to mark your surgical site for theatre, answer any further questions you may have, and complete any outstanding paperwork.

Question 14

Do I draw my own arrow or mark the side of surgery?

Accepted Answer

No need, Mr Bick will draw an arrow on the correct side of surgery on the day of surgery before you are brought to the theatre area. This will be confirmed with you, matched to your consent form and admission notes, and there are several procedural steps taken to check this with you again prior to the start of anaesthetic. The theatre team has a strict checklist to complete including site of surgery confirmation prior to the start of surgery.

Question 15

What is the Patient Consent Form?

Accepted Answer

This is a document stating your agreement to proceed with the specified procedure or operation, after having had the risks and benefits clearly explained to you, all of your treatment options discussed, and is completed before surgery either in clinic or in the ward. It is signed by both Mr Bick and yourself, and forms the basis of voluntary decision-making that you are in control of.

Question 16

What are the risks of the surgery?

Accepted Answer

All surgeries carry risk, fortunately with modern anaesthetic and surgical techniques these are extremely low. The benefit of pain relief, improved mobility, function and activity levels that specifically hip replacement surgery provides is excellent.
With any open surgical procedure there are general associated risks:  blood loss that may or may not require a blood transfusion, blood clots in the legs or lungs (around 1-2%), heart attacks, strokes, a drop in kidney function, chest infections.
Specific to hip replacement surgery, risks associated with the procedure include: infection around the surgical site (around 1%), dislocation of the prosthesis (around 1-2%), fractures around the implant, long-term wear and loosening of the components, leg length discrepancies, nerve injury (in particular the sciatic nerve running at the back of the hip joint), muscle or tendon injury and ongoing pain.
Mr Bick will explain these to you in further detail, as well as the steps the surgical and anaesthetic teams take to minimise these.

Question 17

Which type of anaesthetic will I receive?

Accepted Answer

Most patients do not want to see, hear, feel or be aware of their operation. 
Mr Bick works with several experienced anaesthetists who practice in both NHS and private hospitals who will help you decide on what type of anaesthetic is safest and best for you. Commonly a spinal injection of local anaesthetic is used in the lower back which numbs the lower half of the body for several hours, combined with intravenous sedating medications that can be altered and increased as required so that you are sedated to the optimal level. A full general anaesthetic without a spinal injection is also possible. For more information on these techniques and the risks involved, please read https://rcoa.ac.uk/patients/patient-information-resources/anaesthesia-risk and feel free to discuss your preferences with your treating anaesthetist.

Question 18

How is the procedure performed?

Accepted Answer

Mr Bick performs hip replacement surgery through what is known as the “posterior approach”, gaining access to the hip joint around the back edge of the upper femur (thighbone). This avoids disturbing the main muscles that control the balance and positioning of the pelvis during standing and walking, and has a lower chance of a limp post-operatively. 
The arthritic hip joint is removed and subsequently fashioned to accept a new artificial ball-and-socket joint using precision tools and surgical instruments. Each implant is selected to match the size and anatomy of the hip joint to create symmetry, balance and to recreate the normal muscle tension around the new hip. Range of motion and joint stability is carefully tested with trial implants before selecting and inserting the final definitive implants.
Each surgical layer is meticulously closed with absorbable (dissolving) sutures, including the skin, once a thorough washout has taken place. Any bleeding encountered is stopped throughout the operation to ensure that the minimum possible blood loss occurs. A splash-proof dressing is applied designed to last the 2 weeks until your wound is checked after discharge.
Mr Bick can give you further information on the surgical techniques and implant details.

Question 19

How long will I be in hospital for after surgery?

Accepted Answer

As short as safely possible. This means different times for each patient based on their age, mobility and recovery after their surgery and anaesthetic. Some patients have recovered sufficiently following surgery and have completed all their physiotherapy and occupational therapy goals to be safely discharged on the same day as surgery, but usually it is a one-night stay in hospital. 
After surgery, blood tests and xrays are performed and your vitals are monitored throughout your admission by the ward teams. The ward teams and therapists aim to get all patients up and out of bed as soon as possible after surgery to improve blood flow, circulation and muscularpains. Once the first physical steps are taken, the first positive psychological steps are taken on the path to recovery.

Question 20

Will I need physiotherapy?

Accepted Answer

Each patient receives one-on-one physiotherapy input from the specialist ward therapy teams, teaching them: how to safely walk, transferring from standing to bed or chair, positioning in the bathroom, and the techniques of using stairs. This is tailored to what specific mobility needs you will require both in and out of hospital, and the therapy teams then decide on whether further follow-up physiotherapy is required once you are discharged from hospital. It is useful to consider and plan your post-operative physiotherapy appointments before your surgery takes place as the first few weeks following surgery are a busy and important time for your recovery.

Question 21

Do I need to use crutches or special equipment after surgery?

Accepted Answer

Crutches (or walking sticks) are used after surgery for a few weeks until you feel strong and stable enough to discard them when walking. In hospital, a Zimmer frame may be used which is more stable but bulkier to use. Walking sticks and trekking poles are often easier to use once you start walking further, as these can fold up to be more portable.
As much planning as possible is done before surgery by the therapy teams to ensure you have all the equipment you may need at home for after your surgery. This includes gadgets such as toilet seat raises, chair raises, graspers and shoe-horns, and you will have a bespoke assessment of your needs by the therapy teams. These are used for up to six weeks following surgery, until you feel able to safely stop using them.

Question 22

How much care or support will I need after discharge?

Accepted Answer

Once you are home it is advisable to have someone stay with you for up to a week following surgery if you live alone. Your family and friends will need to help you with tasks in and out the house, for example: shopping, tending to your pets and garden. Having help allows you to focus on the recovery and rest you will need, and to afford you the time to focus on your mobility and exercises.

Question 23

Can I drive after surgery?

Accepted Answer

Driving is possible after usually 6 weeks following right-sided surgery, to allow for sufficient recovery in muscle strength for you to perform an emergency stop. Left-sided surgery can have a shorter recovery time, especially if an automatic vehicle is driven. Let your insurance company know of your surgery and recovery timeframes, Mr Bick can provide you with confirmation that you are able to recommence driving at the six-week follow-up appointment if needed.

Question 24

How long will it take to recover?

Accepted Answer

Recovering after your surgery occurs in three main phases: The first being the 2- 6 weeks where your wound is healing and the swelling and discomfort around your surgical site are improving. Gentle activities (including your post-operative physiotherapy exercises) and walking are encouraged as you are able. 
The second phase is starting to increase your muscle strength and endurance with increased exercise amounts and adding in resistance work if needed. This can start as soon as your wound is completely healed, and can be built up slowly over several months. Recovering from a major operation takes time for your body to recover, and rest is as important as exercise in the first few weeks.
The final phase is where positions and activities are becoming second-nature, a return to planned activities and sports starts, and the previous limitations from your hip become a thing of the past. Most patients feel back to normal around 6-12 months after hip surgery, and many cannot remember even which side was operated on at the end, such is the dramatic improvement they have made in their recovery.

Question 25

How much pain will I have?

Accepted Answer

Every effort is made during your hospital stay to make sure you are as comfortable and pain-free as possible. Having an operation will always result in pain or discomfort around the surgical site, but this lasts only a short while and there are multiple treatments and medications taken both intravenously and orally that can help. Patients often notice that their arthritic pain or deep-seated hip pain is quickly abolished following hip surgery, allowing them to rapidly start their rehabilitation and recovery. 
Each patient experiences and responds to pain in a different way, Mr Bick and his team work with you to manage this whilst in hospital according to your needs and wishes.

Question 26

Do I need to have stitches or staples removed?

Accepted Answer

No, Mr Bick uses dissolvable sutures in each layer of your surgical site that do not need removal. You will have a splash-proof dressing designed to last the 2 weeks from surgery until you have your wound inspected and the dressing removed. This can be performed at your GP or local healthcare facility, or Mr Bick can arrange for this to be performed at the hospital outpatient clinic if more convenient.

Question 27

When will I have a follow-up appointment?

Accepted Answer

At 2 weeks following surgery, you should have a review of your wound and the dressings removed by your GP practice nurse or a healthcare facility local to you, this could also be at the treating hospital outpatient clinic if more convenient. Either the hospital booking team or Mr Bick and his secretary will also arrange for you to be reviewed face-to-face at 6 weeks after surgery. At this appointment, a new xray is obtained if you have undergone a hip replacement and you will have your new hip examined.
Patients that require further follow-up will have a further appointment and xray at the 1-year mark.
If you have undergone an injection, you will have a follow-up appointment usually 3 months after this and will be asked to keep a simple pain dairy during this time.

Question 28

What am I able to do after hip replacement surgery?

Accepted Answer

After surgery, and particularly a hip replacement, the overall aim is to get you back to normal independence and activity as quickly as possible. 
This means you will be able to do all things around your house and garden, walk as much as you are able, as well as perform gentle low-impact sports such as swimming, cycling, rowing, gym activities, and classes of Pilates/Yoga/Tai Chi. You will also be able to partake in gentle racket sports and other sports such as walking football, hill or mountain climbing and even water-based sports such as sailing, paddle-boarding and surf activities. 
Let Mr Bick know if you have a specific sporting aspiration following your surgery.

Return to all of these activities and sports takes time andneeds to be built up to gradually as part of your recovery, and each patient has their own goals and plans which they are encouraged to write down to aid in their sense of achieving goals during recovery.

Information regarding resuming sexual intimacy after your hip replacement can be found here https://hipkneeinfo.org/wp-content/uploads/2024/04/A-Guide-to-Returning-to-Sexual-Activity-Following-Hip-or-Knee-Replacement-Surgery.pdf.

Question 29

What am I not able to do after hip replacement surgery?

Accepted Answer

Hip replacements are robust and designed to last for several decades with normal use, and you are encouraged to use them responsibly. This is to avoid falls, knocks or twists that can lead to pain or other complications requiring further treatment.
Performing high impact or contact sports including running is not advised, as these can lead to a shorter lifespan of your hip replacement. Please feel free to discuss the sports and activities you are planning to participate in with Mr Bick for further information.

Question 30

How long do hip replacements last?

Accepted Answer

The modern hip replacements that Mr Bick uses have excellent longevity and survivorship data. There are tight national controls and careful monitoring of how implants fare over time, for more detailed information see the websites listed on the "Useful Links" tab, specifically the ODEP and NJR details.

Current evidence and survivorship trends suggest that 95% of hip replacements will last 10 years without requiring a re-do (revision) procedure, that roughly 75% will last 20 years, and that roughly 60% will last 25 years.
This does not mean that your hip replacement will simply stop working after 20-25 years as many patients have high-functioning hip replacements for 30+ years and counting. 
There are many factors that make this question an extremely difficult one to answer accurately, as each patient is unique in their body shape, activity aspirations and sporting/exercise levels, and there may be unpredictable events in the future (falls, accidents, illness, etc). One of the decisions you will need to make before embarking on surgery is challenging whether the timing is right for you, knowing that you may require further surgery in the future.

Question 31

What if I have a question or concern after surgery?

Accepted Answer

Once you have been discharged from hospital you are able to contact Mr Bick through his secretary here:  Lauren@theorchardgroup.org.uk
For any advice or answers to questions that you may have, no matter how big or small. We will respond to you as soon as possible, either by telephone or email.

The hospital you have been treated in will usually contact you routinely a few days after discharge to check in with you, please make sure you have been given their telephone number before you are discharged home.
If you require urgent treatment related to your hip through an emergency department (Mr Bick is a consultant at Southmead Hospital in Bristol), please let Mr Bick know as soon as you are able so that he can assist the acute-care teams with your treatment.

Question 32

When can I fly following my hip replacement?

Accepted Answer

You are able to fly short-haul (less than 4 hours) flights after 6 weeks following surgery, and long-haul (more than 4 hours) flights after 12 weeks. This is the minimum time recommended by healthcare providers, as flying increases your risk of circulatory disorders such as deep vein thrombosis (DVT) or other blood clots.
When you fly it is recommended that you: use flight socks or stockings, allow yourself as much legroom as possible, stay hydrated and walk or move about as much as possible.
Your hip replacement may trigger the airport security detectors depending on how sensitive their settings are, most modern airports have full-body scanners designed to safely identify the joint replacements that millions of travellers have. There is no official card, certificate or document you require to prove you have had a joint replacement when passing through airports. Please ensure your travel insurance provider is updated of your hip surgery prior to travel.
Long distance train or car journeys pose less of a risk than flying for blood clots or circulatory problems after surgery, it is still recommended to use flight socks and to plan regular stops to walk and move about during your journey.

Question 33

How long should I wait to have my other hip replaced?

Accepted Answer

Should you require your opposite side to undergo a hip replacement, Mr Bick recommends an interval of approximately 6 months between surgeries. This is to allow you body to recover sufficiently from the surgery to have a safe and successful second procedure. You will need to be confident to rely on your first surgery side in all aspects of weight-bearing, positioning and walking, and have all the support structures in place again from your family, friends and employer.
Specifically, this interval gives time for your body to recover its iron stores (iron is important in the oxygen-carrying capacity of your blood) that will have decreased after your first surgery, just as it would take time to recover from donating a unit of blood at a blood donation centre. Iron store replenishment can be boosted through a variety of dietary and medical supplements, and your levels will be checked prior to undergoing your second side to ensure they have recovered sufficiently to safely proceed.
Recovering from your second side surgery is often quicker and easier, as the process and recovery is familiar. Remember to respect and not rush the second recovery, so as to have the best possible experience and outcome.

Question 34

How do revision (re-do) procedures differ?

Accepted Answer

Revision procedures vary in their complexity and the time taken to perform them. A simple revision procedure may require the exchange of just the working components of a modern, well-fixed implant and may take around 2 hours of operating time. A more complex revision procedure can take between 4 and 6 hours of operating time if all the components need to be removed and exchanged. The complex removal and re-implantation of new implants require similarly complex and extensive instruments and kit that is usually performed at an appropriate NHS facility with experience in these procedures. Mr Bick regularly performs revision replacements at Southmead Hospital in Bristol, and each case is carefully planned in detail prior to surgery with the assistance of a weekly multi-disciplinary meeting with other hip specialists in the region.
The increased overall complexity matches the increased overall complication risk rates to around double those of a primary (first) hip replacement. Satisfaction rates are slightly lower as well.
This makes it ever so important to have a successful and effective hip replacement procedure the first time, an ethos in which Mr Bick believes completely.

Question 35

What is the National Joint Registry?

Accepted Answer

The National Joint Registry (NJR) is a national database recording joint replacements in the UK, the largest of its kind in the world with over 4.5 million entries. It monitors how joint replacements (hip, knee, shoulder, ankle, elbow) last over time and which are revised (redone). This allows surgeons and hospitals to look at trends of the survivorship of implants, and which implants perform better than others. Surgeons and hospitals are monitored and reported on in an annual review and report. Please read here for more detailed information: https://www.njrcentre.org.uk/about-the-njr/. 
As a patient you will be asked to give consent to the details of your surgery and implants being collated and added to the NJR, and a patient information leaflet is available here: https://www.njrcentre.org.uk/wp-content/uploads/2024/08/PIL-english-for-web.pdf. The consent form will in no way change the type of operation you receive, and your details are not shared in any way outside of the NJR.

Question 36

Are metal-on-metal hip replacements still being used?

Accepted Answer

Metal-on-metal hip replacements are not routinely used in standard hip replacements and are reserved for a select few patients who would benefit from a hip resurfacing procedure. This is where the surface of the femoral head (ball) is replaced with a metal cap, and the acetabulum (socket) is prepared to have a new metal cup inserted. The combination of the two allows for a larger size bearing to be used creating a more natural hip feeling and greater range of motion than standard hip replacements. The downside is the potential reaction to the microscopic metal particles that are produced as the resurfacing joint replacement works and wears. Although this risk is very low, the local effects can lead to pain, premature loosening of the components and soft tissue reactions (patients may have heard of terms such as “metallosis”, “ALVAL”, “pseudotumour”), and there are other known effects in the body as a whole.
Implant manufacturers have recently developed ceramic resurfacing implants and techniques designed to mitigate this risk of reaction to metal particles and Mr Bick can give you further information on this as well as answer any questions you may have on your component choices.

Frequently asked questions