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Meet our specialists

Mr Dean Michael

Mr Dean Michael FRCS (Tr & Orth) is a consultant trauma & orthopaedic surgeon specialising in all aspects of lower limb surgery.
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Mr Rishi Chana

Mr Rishi Chana is a consultant trauma & orthopaedic surgeon specialising in lower limb surgery. He has a particular interest in enhanced recovery surgery and rehabilitation.
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Mr Joshua Jacob

Joshua Jacob
Mr Joshua Jacob is a consultant trauma & orthopaedic surgeon specialising in lower limb surgery.
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What our patients say

“I wish to thank you for my hip operation, my doctor was annoyed at how well I am doing, you did an excellent job.”


“Many thanks to you and all the staff for making my stay with you as successful and pleasant as it could be. Without exception, everyone proved to be always very professional and cheerful, which made light work of my hip.”


“Thank you very much for my new hip. It is fantastic to be pain free again and I am just so amazed at how quick my recovery has been. I am now planning a walking holiday in the Greek Islands for the new year.”

Hip

Home  /  Procedures  /  Hip

Surrey Orthopaedic Clinic offers a comprehensive dedicated specialist service for the diagnosis and treatment of hip and groin pain, sports hip injuries and treatment of osteoarthritis.

The hip joint

To really understand hip replacement surgery it is important to know what the normal joint is like.

The hip joint is a “ball and socket” joint and it is one of the strongest – if not the strongest – joint in the entire body. It is the ball-and-socket shape that makes the hip so mobile.

Hip joint surrounded by large, powerful muscles

In the diagram, on the left you can see that the hip joint is totally surrounded by large, powerful muscles. This is why pain from these muscles can mimic pain coming from the hip joint which lies underneath it.

On the right side of the image you can see a cut-away of the hip joint itself, clearly showing the “ball-and-socket” joint.

The head (“ball”) of the femur, the long bone of the thigh, is securely held in the “socket” of the joint by strong ligaments. The surfaces of the ball and socket of the hip are covered in very smooth, slippery “articular cartilage” and there is very slippery, lubricating fluid (“synovial fluid”) in the gap between the two bones. This is why in a normal, healthy joint the bones can move easily over each other without rubbing against each other and without pain.

Are you worried about a painful hip?

Over the years have you noticed decreased mobility and increasing discomfort? Maybe there’s even something strange about it, with pain in the buttock, groin or front of your thigh?

Maybe it’s been going on a long time, and gradually you find you cannot do as much as you once used to. Perhaps you find it difficult to walk, or climb the stairs or lean forward when you’re sitting down. You may even have developed a limp from the discomfort.

Perhaps you’ve fallen recently, when before you were always steady on your feet?

The Good News is you’re in the right place.

At Surrey Orthopaedic Clinic our consultant orthopaedic surgeons are all specialists – in other words we all specialise in treating problems of the bones and joints – but our hip specialists only treat patients within their particular area of expertise. And we have not only one but three consultants – Dean Michael and Rishi Chana – who between them provide a comprehensive service to diagnose and treat almost every conceivable problem that affects the hip joint.

But what could be causing the pain?

The commonest causes of pain in the hip and groin are:

  • Arthritis
  • Bursitis
  • Muscle/ligament strain (often due to sports injuries)
  • Labral tears

It may be that you already have a good idea what the problem is. You may have already been told that you need a hip replacement, or perhaps you have had a hip replacement in the past and wonder if there’s a problem with it now.

Of course, it is impossible to know what is causing your pain without talking to you and a thorough examination.

What happens in arthritis?

In arthritis the surfaces of the ball and socket no longer glide smoothly over each other but now rub against each other. This causes damage to the articular cartilage and the bones resulting in pain and stiffness which in time can be very disabling.

Is Arthritis the only cause of hip pain?

No. There are small pockets of fluid around the hip called “bursae” and these can become inflamed and cause pain too. This is very common but it is not always clear what has caused it in the first place. It can sometimes be difficult for a doctor who is not an expert in conditions of the joints to distinguish “bursitis” from problems in the hip joint.

Hernias, muscle and ligament strains (“Gilmore’s groin”) and enlarged glands can also cause pain in the groin, which can be mistaken for pain coming from the hip by the inexperienced.

Another common problem is “referred pain”. Because of the way the nerves of the body send information to the brain, the brain sometimes misinterprets where the pain is actually coming from. For this reason a patient may complain of pain in the hip when the problem causing the pain is actually in the back!

Another thing we often see is patients complaining of pain in the knee yet the problem actually lies in the hip. This is why it is so important to see an expert who can accurately diagnose what the underlying problem is and the true source of your symptoms.

What causes osteoarthritis of the hip?

We don’t yet fully understand why some people develop osteoarthritis and others do not. It is certainly linked to previous injuries and childhood hip problems, and worsened by being overweight, although many people develop the condition and no cause is found.

Why is arthritis of the hip important?

Simply put, because of the pain and stiffness it causes. With time, stiffness increases and mobility decreases and this can have a significant impact upon your mobility and ability to live an independent and active life. It can also be quite painful, although some people with very bad osteoarthritis do not have much pain, yet others with only mild osteoarthritis can have very significant pain.

In short, the point of treating hip arthritis is to firstly relieve the pain and secondly to allow you to live as full and active a life as possible.

How are hip problems diagnosed?

First and foremost the most important thing is that you are seen and assessed by a doctor who is a recognised expert in hip problems. Here at Surrey Orthopaedic Clinic we have three experts on problems of the hip who will see you personally. This is because the hip is complex and reaching the correct diagnosis is so important to planning the correct treatment. As we have already seen there are a number of causes of hip and groin pain, and not all of these are due to a problem in the hip. It is fairly common to have pain that is due to a problem elsewhere in the body, such as the back, that is causing the pain in the hip.

What happens when I see the consultant?

The first thing you can expect is your doctor to listen to your story about what has been happening – to take a detailed “history” of your symptoms. He will also ask about any history of injury as well as any other health problems you may have.

He or she will then examine you thoroughly to see exactly what the problem is.

At this stage, although your consultant will have a pretty good idea what is the problem with your hip, he will want to arrange further tests to confirm the diagnosis and to make sure there are no other problems which could be the cause. The tests he is likely to consider will include:

An X-Ray

An X-ray of the hip is a simple test that gives much information about the bones of the hip joint and is often all that is needed to make a diagnosis.

Hip X-ray showing normal hip jointsHip X-ray showing normal hip joints

A hip X-ray showing osteoarthritis in both hip jointsA hip X-ray showing osteoarthritis in both hip joints

A CT (“Computed Tomography”) Scan

This is an advanced series of X-rays of the hip which are turned into three- dimensional images by computer. The CT scan is very good at showing “hard” structures such as bone, and sometimes is necessary when planning treatment, such as if the “socket” part of your hip joint is shallow.

An MRI Scan

An MRI (“Magnetic Resonance Imaging”) scan. This is a special scan that does not use X-rays but is especially useful at showing soft tissues and fluid. It is good for looking at the muscles and ligaments around the hip. It is also very useful in picking up a condition called avascular necrosis of the hip, which is commoner in younger people as a cause of their hip pain.

Arthroscopy

An arthroscopy of the hip joint is a relatively new procedure in which a small camera is passed through a small cut in the upper leg and into the hip joint. Often small procedures can be done through the arthroscopy, which saves you from the discomfort and recovery time of a bigger operation.

The scans above are all quite painless and done as an outpatient. An arthroscopy however involves you being put to sleep with a gentle anaesthetic so that the surgeon can pass a tiny camera into the hip through a small nick in the skin. This allows him to look directly into the hip and to see what the problem is directly. You might ask why this is necessary with all the other scans at our disposal, but the fact is that firstly no scan is 100% accurate and perfect (neither is arthroscopy, for that matter) but also we can sometimes treat certain problems within the hip using the camera (the “Arthroscope”) and so avoid a bigger operation. If your surgeon thinks you would benefit from an arthroscopy he will of course discuss it with you fully beforehand.

Blood tests

The commonest problem with the hip joint is osteoarthritis otherwise known as “wear-and-tear” arthritis, but there are other potential problems such as rheumatoid arthritis that can affect the hip too. A blood test is often useful to distinguish between the two problems.

How is osteoarthritis of the hip treated?

There are two main ways of treating osteoarthritis of the hip:

  1. “Conservative management” – in other words painkillers and exercise
  2. Surgery

Once your consultant has assessed you and taken any X-rays or scans that he feels are necessary, he will discuss with you the best way forward. A great deal will depend upon how bad your symptoms are and how much impact they are having on your quality of life.

Hip replacement surgery

Broadly speaking, there are two types of operation for hip osteoarthritis:

1. Total hip replacement

As you might expect, in total hip replacement both the head of the femur (the “ball”) and the “socket” of the pelvis is replaced.

Components of a typical total hip replacementComponents of a typical total hip replacement

Diagram showing what looks like before and after a total hip replacementDiagram showing what looks like before and after a total hip replacement

An X-ray of a patient with a right-sided total hip replacementAn X-ray of a patient with a right-sided total hip replacement

In the x-ray above the metal of the implant blocks the X-rays and so shows up as a dense white shadow on the left hand side of the image.

2. Hip re-surfacing

This is also a type of hip replacement but differs in several important respects. Instead of replacing the “ball” of the femur a hollow metal cap is placed over it. Additionally the socket is also covered in a metal cup to accept the metal ball of the femur.

The advantages with this sort of hip replacement are that patients may have a reduced risk of dislocation after surgery and may be able to return to higher levels of activity, and we find that younger men tend to benefit the most from this procedure.

Also, less bone is removed and replaced during a hip resurfacing. This is desirable in younger people because hip replacements only have a limited “lifespan” before they need to be replaced again. The greater amount of bone that is left is an advantage when the time comes for re-do surgery.

One thing to bear in mind though – and if your consultant feels this is the right procedure for you he will fully discuss this with you – is that with time metal particles can be released into the local tissues and that the long-term results of hip re-surfacing are not yet know.

Typical implants used in hip resurfacingTypical implants used in hip resurfacing

The appearance of the hip joint after hip resurfacingThe appearance of the hip joint after hip resurfacing

What can I expect on the day of surgery?

Unlike the NHS, where I will supervise but may not perform every operation on every patient, privately I see all my patients personally. Furthermore if anyone needs an operation I also perform the procedure personally.

On the day of your operation you will be met at reception by hospital staff and taken to your own room. Here the nurse looking will greet you and you will be seen shortly afterwards by the anaesthetist and the consultant surgeon looking after you.

After your operation you will feel drowsy but will feel little or no pain. I will see that you are well in the recovery suite of the operating theatre and in your room later. If required I will telephone your partner or other relative to let them know that all went well.

Are there any complications after surgery?

It is important to realise that all surgical procedures have the potential for complications and although hip replacement surgery is a very common – and safe – operation it should still not be taken lightly.

Possible complications following hip replacement surgery include:

  • Blood clots in the leg (deep vein thrombosis or DVT)
  • Bleeding at the site of surgery
  • Infection
  • Dislocation of the new joint
  • Pain
  • A difference in leg length
  • Nerve damage

An extra point to bear in mind with hip resurfacing is that there is a slightly greater risk of needing to re-operate on these implants.

You should also be aware that if you have an on-going medical problem such as problems with your heart then surgery can make that problem worse. We want to re-assure you though that when you are seen by your surgeon he will cover all the pros and cons of the surgery as well as specific risks relevant to you. He will also be able to answer any questions you may have.

As you might imagine, training and experience are very important in ensuring a good outcome for patients so I am delighted to say that here at the Surrey Orthopaedic Clinic we have performed many hundreds of hip replacements over the years including many revision cases for failed surgery from other centres. All of us are recognised specialists in this operation and this is reflected in our results as well as our role in training junior surgeons and fellow consultants how to carry out the procedures in the NHS.

Follow-up

A vital part of hip replacement surgery is post-operative physiotherapy, and your commitment to this is vital in determining how well you are going to recover from surgery.

Physiotherapy after your hip replacement

Physiotherapy is the cornerstone to good recovery and Surrey Orthopaedic Clinic only work with specialist hip physiotherapists who will put together a tailor-made programme for you based upon your own health and level of activity prior to surgery as well as your goals after surgery.

Frequently Asked Questions

It is entirely understandable that you will have concerns regarding hip replacement surgery and here I answer some of the most common questions we have been asked over many years of treating patients.

What are the risks of surgery?

The risks of hip surgery include: deep vein thrombosis, infection, dislocation and bleeding. The likelihood of any problem after surgery is low and most people have no problems at all.

Will I need to be put to sleep for my hip replacement?

Hip replacement surgery can be performed under general anaesthetic or under spinal anaesthesia, similar to when a woman gives birth. You will be seen by one of our expert anaesthetists during your preparation for surgery and he or she will discuss the options with you and advise the best way forward.

How long does the operation take?

Typically 1 ½ to 2 hours.

Is the operation painful?

Some discomfort is of course to be expected after any operation and hip replacement is no different. However the discomfort is usually short-term and I always give my patients pain relief to take regularly during whilst they are recovering from surgery.

How many nights will I need to stay in hospital?

This depends upon the type of procedure you have as well as your own general health. Generally patients stay in hospital for only a few days and we always try and get people home as soon as they are ready to leave, comfortable and able to cope at home. We work closely with our physiotherapists to make sure you only leave hospital when you are ready.

What patients say about Surrey Orthopaedic:

Many thanks to you and all the staff for making my stay with you as successful and pleasant as it could be. Without exception, everyone proved to be always very professional and cheerful, which made light work of my hip.

FR


I would just like to thank you for your care and expertise during my recent hip resurfacing. The physiotherapists seem to be very pleased with my progress and I plan to be back on the golf course in no time.

Mr AR , Woking


I wish to thank you for my hip operation, my doctor was annoyed at how well I am doing, you did an excellent job.

MA


Thank you very much for my new hip. It is fantastic to be pain free again and I am just so amazed at how quick my recovery has been. I am now planning a walking holiday in the Greek Islands for the new year.

Mrs VA, Chobham


Thank you very much for my new hip. It is fantastic to be pain free again and I am just so amazed at how quick my recovery has been. I am now planning a walking holiday in the Greek Islands for the new year.

Mrs VA, Chobham


Patient videos

All videos filmed independently


Name: Victor Catherall, 92
Occupation: Retired
Procedure: Double Hip Replacement
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Name: Thomas Anthony Mulvany, 77
Occupation: Retired
Procedure: Full Hip Replacement
Surgeon: Dean Michael
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Name: John Cook, 58
Occupation: Property developer
Procedure: Full Hip Replacement
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Name: Jennifer Robbins, 69
Occupation: Retired teacher
Procedure: Lumbar Decompression & hip replacement
Surgeon: Dean Michael & Chris Schofield
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The Next Step – Making an Appointment

OK, so you’ve been getting symptoms from your hip and would like to look into the problem sooner rather than later. What should you do now?

To be referred to see either Mr. Dean Michael or Mr. Rishi Chana in our NHS practices make an appointment with your GP and ask him to be referred to see us at Ashford & St Peters NHS Trust

We also see patients privately at our State-of-the–Art facilities at the Surrey Orthopaedic Clinic. If you have private medical insurance cover consult your provider about their policy for seeking an expert opinion. If you are self-funding simply contact our secretary Cassie Valenti on (020) 3130 4056 and she will make an appointment at a time that suits you.

Final word

We hope you have found the information here useful but we think it is important to stress that no-one can reliably self-diagnose their own medial problems or injuries. Even doctors see other doctors and try not to diagnose themselves.

One of the reasons for this is that there are rare but serious causes of pain in the groin and hip that can only be diagnosed by an expert. Also the temptation with any symptom is to wait and see if it gets better on its own. Whilst in general terms this is a good idea it is always wise to be cautious and seek advice sooner rather than later if things aren’t settling in order to get diagnosed and treated early and prevent later problems.

As always, seek professional advice for any health problem you may have – and sooner rather than later.

We hope this page has been useful and we look forward to welcoming you to the Surrey Orthopaedic Clinic.