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Hip replacement Surgery....

Direct Healthcare International make your hip replacement surgery simple and straight forward with our fully inclusive package offering total care, minimally invasive surgery, physiotherapy and journeys to and from the airport. We can even arrange flights and wheelchair assistance throughout your journey.

Our hip replacement surgery takes place in Belgium where our partner hospitals are renown for their clinical excellence and skills. This enables you to benefit from this excellent treatment at far lower prices than equivalent private surgery.

Hip replacement surgery is a surgical procedure in which the damaged or worn parts of the hip joint are replaced with new artificial parts. Nowadays this has become a commonplace procedure.

The prosthesis (artificial hip) used in modern hip replacement surgery is extremely durable and can be expected to last for many years. your hip replacement will improve mobility, relieve pain and improve function of the hip joint thus improving quality of life.

Which type of hip replacement Surgery?

Should you choose to have a Total Hip Replacement or Hip Resurfacing Surgery known as The Birmingham Hip?

Firstly a little explanation:

What is Total Hip Replacement (THR)

Total hip replacement involves removing the top of the femur.	The cup implant is fitted into the prepared hip socket
Inserting the tapered hip prosthesis into the femur	The femoral head is fitted to the prosthetic stem
The femoral head is inserted into the cup implant	The finished hip replacement

Total hip replacements allow good mobility, but may slightly reduce the range of movement of the leg. If it is your intention to return to full active sports a hip resurfacing should first be considered, however the latest technology in total hip replacement with a Magnum head known as Metal-on-Metal Hip Replacement allows for an increased level of activity such as golf and even tennis! This is an ideal solution for an active person over 70 years of age.

The reasons why candidates have a preference for resurfacing are addressed further on.. Candidate that are unsuitable for resurfacing are: Males over 70 and females over 65 (with week or thin bone stock) Those with a degenerative bone disease such as AVN or arthritis

Hip replacement prosthesis may be constructed of various materials but is usually made of forged steel rather than cast steel (these would be prone to break). The exterior of the unit is rough and porous so that the unit when press fitted will combine with the bone, which actually grows into the unit. This creates an immensely strong bond, which is hard to separate (rather like barnacles on a ship). Most surgeons will haver a prefrence for a carefully engineered and measured press fit as teh final result is stronger and longer lasting. Were the bone stock is thinner then a cemented fit is preferred as the cement will reinforce the weekend bone struckture.

What is a Hip Resurfacing?
With Hip Resurfacing instead of the Femur being cut through just below the head, the head of the femur is capped with a ball cap. This cap is then inserted into the cup implant which is press fitted into the prepared hip socket

The head of the femur is capped with a ball cap.

The cap is inserted into the cup implant which is press fitted into the prepared hip socket.

Indications are that this is an extremely durable solution for young and active patients that wish to keep full natural mobility and return to full active sports.

Hip resurfacing is suitable for Women below the age of 65 and Men below the age of 70 where the condition and strength of the bone is suitable.

Hip resurfacing ensures a faster recovery time than conventional hip replacement. The patient is able to resume a normal active life sooner.

Direct Healthcare International fit Zimmer prosthetics. Zimmer is in our opinion the best and most widely used prosthesis with over 300,000 units successfully fitted.

We have no known instances of a hip-resurfacing unit dislocating.

Total hip replacement with a Magnum head (Metal on metal) the ideal solution for an active person over 70 years of age

In metal-on-metal hip replacement the articulating surfaces are made from cobalt-chrome. Cobalt chrome offers high wear resistance and has much smaller debris particles than the metal-on-plastic polyethylene plastic articulation. Metal-on-metal implants have been available in Europe for more than 20 years. Metal-on-metal implants are made by several manufacturers. Hips by Wright Medical, Zimmer (Metasul) and Biomet (M2a and M2a Magnum), and DePuy ASR XL are FDA approved in the US.

Metal-on-Metal Hip Replacement - Using a Large Diameter Femoral Head The precision of modern machining and strength of cobalt chrome make it possible to replace a femoral head with a large head diameter prosthesis that matches the patient's natural femoral head. That means more natural hip mechanics and removes nearly all of the long-term risk of dislocation. The typical hip replacement replaces a 50-mm femoral head with a metal ball that is 24-28 mm. The latest metal on metal new large heads are up to 50 mm to increase wear and provide the stability of a normal hip.

Metasul®
The Strength of Metal-on-Metal

Developed and refined in Europe for over 40 years, Metasul has helped over 140,000 patients worldwide. In 1988, after rigorous testing at 15 independent clinical sites in the United States, Metasul was cleared for use in the United States.
In the Metasul implant, the conventional plastic polyethylene insert has a cobalt chrome metal inlay. This helps minimize wear over time, potentially increasing the longevity of the implant.

Patients are placing more demands than ever before on their hip implants.

Like any piece of equipment, a conventional polyethylene hip insert can wear down over time.
The motion of a hip implant relies on the articulation of a metal head within a plastic polyethylene cup in the hip socket. The problem with polyethylene is that it can wear over time. Microscopic particles may break off and settle around the implant and surrounding tissue. The body’s immune system rejects this polyethylene debris, often causing osteolysis or "eating away" of the bone.
As the patient loses bone in his or her hip, the implant may become loose and no longer function properly. The patient then must undergo major surgery once more to replace the implant.

Metasul offers the promise of greater longevity than traditional hip implants. The Metasul System has a metal inlay inside the polyethylene insert. This is known as metal-on-metal articulation because the metal ball rubs against the metal inlay as the patient moves. The body’s natural synovial fluid lubricates the metal surfaces. Microscopic analyses have shown that even scratches are actually smoothed over by the gliding movements of the components.

Rigorous testing has shown that Metasul’s wear particles are so small that they cannot be measured using the same methods for measuring polyethylene wear particles. This suggests that the volume and size of the metal particles are such that they may be more readily cleared by the body, thus potentially diminishing the local immune response that leads to osteolysis (bone loss).
As life expectancies continue to increase, so will the demand for long-lasting implants. Metasul is ready.

Hip Resurfacing is the first preference for the young and active!
Today’s younger candidates prefer Hip Resurfacing rather than Total Hip Replacement. There are several reasons why candidates have a preference for resurfacing these are addressed further on.

Total Hip Replacement is recommended when a candidate is unsuitable for resurfacing such as:

• Males over 70 and females over 65 or those with week or thin bone stock


• Those with a degenerative bone disease such as AVN or sever arthritis

The prosthesis is usually made of forged steel. The exterior of the unit is rough and porous so that the unit when press fitted will combine with the bone, which actually grows into the unit. This creates an immensely strong bond, which is hard to separate (rather like barnacles on a ship).

The ball may be titanium coated, cobalt chrome plated or ceramic (there is sometimes concern from patients as to whether the ceramic ball will break but providing the unit is properly engineered this is extremely unlikely). The advantage of ceramic is that it is both extremely robust and has a very low friction coefficient leading to a low wear rate.

Sometimes the cap may be ceramic but these in rare cases have been known to break under excessive stress conditions. One popular combination is a ceramic ball and composite cap with a metal liner, these are found to have less wear. Modern units can wear at the rate of 1 micron a year; some years ago wear rates were more likely 200 microns a year so great improvements have been made. One thing to be weary of is ensure that your surgeon is fitting a leading manufacturers unit not a generic copy such as those that you may receive in cheaper surgery. If it is possible find out what the surgeon will be fitting and do they fit a very good standard of unit. If you are a private patient that is paying their way you should be able to ask these questions and receive a satisfactory answer. Government health services will fit units from a standard procurement list. This list may be quite limited by the number of models and sizes, as health services seek discounts by bulk purchasing methods. In addition the prosthesis on the procurement list may be dated as it takes time for new products to be accepted. Zimmer is our organisations brand of choice simply because we consider them the best on the market, they have an excellent proven track record and are the largest makes in the market. Incidentally their units are also the most expensive but when choosing prosthesis we always choose the best.

To summarise, some things to look out for are:
Is the unit cemented or press fit? - Total Hip Replacements can be either cemented or press fit. This can apply to either sections or just one this is then called a hybrid. Some surgeons have a preference for cemented however the cemented fit is generally used when there is a weakness in the bone stock. Typically this may be due to hormonal activity brought on by the menopause or some form of degenerative bone disease. Lately it has been reported that continuous and heavy use of ibuprofen may also cause thinning in the bones. The press fit (in our opinion) is stronger as the bone grows into the rough porous exterior of the prosthesis.

What is a Hip Resurfacing?
Today more and more people are hearing about the benefits of hip resurfacing over conventional hip replacement. This relatively new technology started with the invention of the “Birmingham Hip replacement” approximately 15 years ago.

• With Hip Resurfacing instead of the Femur being cut through just below the head, the head of the femur is capped with a ball cap. This cap is then inserted into the cup implant which is press fitted into the prepared hip socket
  
• Indications are that this is an extremely durable solution for young and active patients that wish to keep full natural mobility and return to full active sports.
  
• Hip resurfacing is suitable for Women below the age of 65 and Men below the age of 70 where the condition and strength of the bone is suitable.
  Hip resurfacing ensures a faster recovery time than conventional hip replacement and the patient finds that they can return to normal life sooner.
  
• Direct Healthcare International fit the Zimmer hip-resurfacing unit. We believe it is the best and most widely used prosthesis with over 300,000 units successfully fitted.
  
• There are no known instances of a hip-resurfacing unit dislocating.

What is Durom™ Hip Resurfacing
Since 1988 MetasulTM has been successfully used for total hip replacement. Today’s metal on metal technology is the result of over one and a half decades of intense development, research and clinical evaluation forming the foundation for the latest evolutionary development – DuromTM Hip Resurfacing.

Advanced engineering and materials technology coupled with Swiss precision manufacturing has resulted in this exceptional Hip Resurfacing prosthesis. Developed for the younger and more active patient, it is designed to provide high levels of joint stability whilst removing as little bone as possible. The articulating components are made of MetasulTM alloy ProtasulTM-21 WF, the first wrought-forged CoCr resurfacing prostheses, which is the same material used to restore mobility of over 500,000 patients.

Design detail
In designing the femoral component, many important factors needed to be considered. Bone conservation, precise positioning and an optimum cementing technique were of utmost importance. The guide pin, whilst removing less bone than comparable systems, allows for an ideal physiological transfer of load, whilst ensuring accurate positioning of the prostheses. The unique grooves, on the inner side, allow for even pressurisation of cement into the cancellous bone (a spongy type of bone with a very high surface area found at the ends of long bones), but avoids a taper effect, providing additional rotational stability.

Minimal thickness with maximum strength!
The acetabular cup is a flattened hemisphere, offering a greater range and freedom of movement. With a constant wall thickness of 4 mm throughout all sizes, thecup maintains an inner diameter as large as possible, whilst maintaining maximum implant strength and minimum bone resection. A coating of pure titanium, using a plasma spray under vacuum and static load is applied to the outer surface. This unique manufacturing method gives a surface roughness of 20–50 microns with a porosity of at least 25%, shown in vitro testing to significantly improve primary stability. As shown in laboratory tensile tests the adhesive strength of the titanium coating of 66.2–76.5 MPa, significantly exceeding FDA requirements of 22 MPa

Lower wear rate!
The high carbon CoCr alloy is produced by a forging rather than a casting process. This means that the size of block carbides is up to eight-times smaller compared to cast CoCr prostheses. The resulting lower surface roughness subsequently leads to a lower wear rate when compared with cast CoCr alloys. Co-28Cr-6 Mo-0,2C/ProtasulTM-21 WF (ISO 5832-12): a carbide-containing and therefore low-wear cobalt chrome alloy was chosen for MetasulTM.

The key to successful resurfacing!
As with almost any joint replacement system, precise and easy-to-use instruments are key to a success.
In developing of the DuromTM Hip Resurfacing the engineers not only focused on implant design and material technology but also concentrated on the surgical procedure, and how to resurface the hip in the best way possible. As a result, an ingenious method to accurately and precisely position components was conceived.

Low wear and greater joint stability
The large diameter of the MetasulTM ball head offers low wear coupled with greater joint stability and a high range of motion. This is available in combination with the extensive range of cemented and un-cemented femoral implants from Europe’s largest manufacturer of joint prostheses.
Designed to outlast a "conventional" hip prosthesis
The Durom Hip Resurfacing has been specifically designed for use in young active patients who are likely to outlast a "conventional" hip prosthesis. Emphasis has been placed on a high quality bearing surface, preservation of bone stock and durable fixation of the components.
The Metasul bearing surface is a proven low wear, low-friction articulation, having been implanted in over 300,000 patients since 1988. No other metal-on-metal bearing has such a track record.
The Durom acetabular and femoral components have been designed to allow maximum preservation of bone stock. The wall thickness of the acetabular component is as low as practically possible and the cup subtends an angle of 165°, similar to the natural acetabulum. These features facilitate preservation of the acetabular bone stock.
The sophisticated femoral instrumentation permits very accurate positioning of the femoral component, allowing the smallest possible femoral implant to be used, which in turn, allows the insertion of the smallest possible acetabular component, again preserving acetabular bone stock.
The Porolock Ti VPS surface coating of the Durom acetabular component is vacuum plasma-sprayed pure titanium. This coating is associated with reliable bone in-growth, ensuring long-term secondary fixation. The carefully controlled vacuum spraying process results in a very high adhesive strength between the chrome cobalt substrate and the Porolock Ti VPS coating, reducing the risk of the generation of titanium 3rd-body-wear particles.
The femoral instruments produce an even cement mantle of approximately 1 mm, reducing the risk of fatigue failure of the bone cement. The recesses within the femoral component enhance rotational stability of the implant.

Indications for hip resurfacing
Hip resurfacing is most appropriate for physically active patients with good bone quality and adequate femoral and acetabular bone stock. Such patients will generally be under the age of 65. However patients with the following indications are also suitable for hip resurfacing.

• Primary Osteoarthritis
  
• Posttraumatic Osteoarthritis
  
• Secondary Osteoarthritis
  
• Avascular necrosis of the femoral head if remaining bone stock is adequate
  
• Inflammatory arthritis if bone quality is adequate
  
• Patients with a deformity of the femur and/or internal fixation device that would make insertion of a stemmed femoral component difficult
  
• Patients with a high risk of dislocation

Contraindications for hip resurfacing
Patients with the following indications are NOT suitable for hip resurfacing.

• Active infection
  
• Malignant tumors
  
• Insufficient acetabular or femoral bone stock
  
• Poor bone quality (for example, osteoporosis, osteomalacia)
  
• Anticipated non-compliance of the patient, alcohol or drug abuse
  
• Decompensated renal insufficiency
  
• Known allergy to one of the constituents of the implant

The Direct Healthcare International Hip Replacement Program

Planning your Journey
Our staff will assist you in planning your journey. This is especially necessary when undergoing hip and knee surgery to ensure that you return home in comfort.

Before Surgery
Please read this brochure carefully or information on how to best prepare for your surgery.

Once you have Arrived
When you arrived hospital staff will great you and ensure that you are settled in the privacy of your own room in the family B&B unit. You will be asked your dietary preferences and be given a short guide to the hospital and its facilities.

Your Hospital Stay
The next day after the preliminary consultation, your consultant surgeon will carefully assess your condition and will decide with you which surgery is best suited. There is a short pre-surgery questionnaire to complete and it is likely that some investigations will be done at this stage, such as a blood test and x-rays.
You will be fully briefed on what to expect and how to prepare for your operation. The surgeon will ensure that you are comfortable and explain all about your surgery. The anaesthetist will visit you and answer any questions you may have.

After Surgery
A physiotherapist will visit and instruct you in a program of exercises to assist your restoration to peak physical condition. Within a short while you will be safely on the road to recovery!

The typical program
Our program offers you the opportunity to swiftly obtain the corrective surgery you need, taking advantage of the benefit of our experience and expertise in the field of orthopedic surgery.
Our orthopedic surgery program takes you step by step through the procedure; from your outgoing journey and preparation, through to your physiotherapy program and aftercare pathway leading to full health and fitness.

Total Hip Replacement and Hip Resurfacing

• Day 1 - Arrival + settle in to the hospital’s family B&B unit
  
• Day 2 – consultation + preoperative x-rays + blood tests
  
• Day 3 – Admission to hospital bed + surgery + possible overnight in ICU
  
• Day 4 – In hospital + first day of physiotherapy
  
• Day 5 - In hospital + physiotherapy
  
• Day 6 - In hospital + physiotherapy
  
• Day 7 - In hospital + physiotherapy
  
• Day 8 - In hospital + physiotherapy
  
• Day 9 - In hospital + physiotherapy
  
• Day 10 - In hospital + physiotherapy
  
• Day 11 - Postoperative check and departure

An additional weeks stay with physiotherapy is available on request. This is particularly suitable to those of senior age or where the muscle activity has reduced in recent months leading to low muscle streangth.

The DHI Fully Inclusive Surgery Option

• MRSA test
  
• Comprehensive consultation and full clinical workup incl X-Rays, CT Scans and bone density scans where appropriate.
  
• Surgery (all hospital, surgery & anaesthetist's fees)
  
• Return flights (UK, Denmark & Ireland), Eurostar or Ferry for two (door-to-door pickup is available in many areas).
  
• Complete Chauffer service (to & from airport, Eurostar or Ferry, hotel to hospital transfers)
  
• B&B accommodation at St Rembert’s Hospital for a friend or family member
  
• DHI Additional Medical Cover (terms & conditions apply)
  
• Post operative visit by a DHI physician to your home (UK only)

The DHI Basic Surgery Only Option

• MRSA test
  
• Surgery (all hospital, surgery & anaesthetist's fees)

Optional extras available are

• MRSA test
  
• Airport pickup and transfer service (to & from airport, Eurostar or Ferry)
  
• B&B accommodation at St Rembert’s Hospital for a friend or family member
  
• DHI Additional Medical Cover (terms & conditions apply)
  
• Post operative visit by a DHI physician to your home (UK only

To return you to peak physical condition after surgery the following exercise programs should be followed

Exercises to get you fit for surgery

Exercises after surgery