More than 76,000 people get new hips in England and Wales every year but many face long recovery periods of painful rehabilitation. One surgeon - and his engineer brother - have come up with a unique method to improve this routine operation.
James Wootton, an orthopaedic surgeon at the Wrexham Maelor Hospital in Wales, is one of only a few surgeons to use a different technique to help patients get back on their feet and out of hospital as fast as possible.
The Direct Anterior Approach (DAA) technique means the replacement hip is fitted without cutting through muscle or tendons.
It is regarded as less invasive but it can pose a number of practical and cost problems in theatre which has discouraged many surgeons from adopting this technique.
"DAA surgery usually requires either a number of trained scrubbed assistants, sometimes trainee surgeons, or an expensive and cumbersome piece of equipment for manipulating and positioning the patients leg during the procedure," said Mr Wootton.
With this in mind Mr Wootton set his engineer brother Malcolm a challenge 12 months ago to design a device which helps to fit the new hip at a fraction of the cost of current products.
Malcolm Wootton, a Derbyshire-based engineer, who spent years designing equipment for the motorcycle industry, came up with the device called a Flote table which could fit any standard operating theatre.
Over three years Mr Wootton has carried out more than 400 of these procedures. The Flote table has helped him refine his technique and halve the length of time his patients stay in hospital.
During surgery the patient lies on his or her back and the foot is secured in a lightweight boot attachment. This allows the technician to move the leg easily and repeatedly, flexing the hip to the correct position so the surgeon can properly and accurately fix the new hip using X-ray.
"I came at this with a completely blank page. My brother told me what he wanted the table to do, plus a few extras," said Malcolm Wootton.
"What we have come up with can be packed away in a flight case and put in the back of my car. Everyone we have shown it to has been impressed, which is unheard of in this business," he added.
"Using this device and this type of surgery my brother's average length of stay (for his patients) is roughly two days, so that is a potential saving of tens of thousands of bed days in hospital."
"It's the whole package of reducing patients' length of stay, reducing their post-operative requirements for physiotherapy, there's no home adaptations, there's very little occupational therapy required and when managers, anaesthetists and surgeons see this I think they are likely to adopt it."
Steve Cannon, the Royal College of Surgeon's spokesman on orthopaedics, said the biggest hurdle for the Wooton brothers was that so few surgeons use the DAA technique.
Mr Cannon said practical problems in theatre such as the extra manpower required and the cost of cumbersome equipment have been major barriers for surgeons in the past, even resulting in some abandoning the technique after they'd been trained to use it.
He said surgeons were more interested in the longevity of the implant and added there were still some question marks over the precision of the DAA technique.
But the Woottons believe that aspect is covered with the Flote table's carbon fibre components which enable Mr Wootton to use x-ray as a guide.
Pat Murtagh, an 83-year-old patient of Mr Wootton's, said he arrived for his surgery in tremendous pain, only able to shuffle a few feet with his arthritic hip using a zimmer frame.
"You can hear my hip cracking every few steps," he said. "It's very important to keep active and not just sit around in the house all day like I've been doing for the last 18 months, which is why I'm here."
The pensioner was seen again two hours after his operation, reporting his pain had dropped from 10 to a 2 on the pain scale and was up and walking on the ward later that day. He is now recovering well at home.
Eight weeks after his surgery Raymond Root, a 58-year-old painter and decorator, was able to hop on a leg he couldn't walk on before.
Mr Root, who suffered two years of pain which forced him to give up work, is now looking for a new job.
"Going from not being able to walk at all and being in so much pain that you just can't think, to nothing, it is just amazing," he said.