Hip Replacement

What is a hip replacement?

Hip replacement is an operation in which the worn out ball and socket of the hip joint is replaced by an artificial implant. This artificial prosthesis is usually made up of a metal stem, a ceramic head, and a ceramic or plastic socket. See image.

Do you need a hip replacement?

The aim of hip replacement surgery is to relieve the pain you experience in and around your hip. Pain around the hip can be caused by many conditions. The most common being hip osteoarthritis. Other conditions include hip impingement with arthritis, labral tears with arthritis and  avascular necrosis. However hip replacement is only suitable when the pain you experience is associated with X-ray features of loss of hip joint space (loss of cartilage, bone on bone contact).

What are the other alternatives to a hip replacement?

Unfortunately from a surgical perspective there is no other alternative to a hip replacement when indicated.

In cases of early arthritis where there is still some joint space preservation the following options exist.

1. Physiotherapy and exercises
2. Weight reduction
3. Medication such as anti-inflammatories and analgesics
4. Hip injections.

What are the benefits of a hip replacement?

The purpose of hip replacement is to improve your quality of life by relieving pain. It can help improve the stiffness of your joint. Stiffness often causes difficulty in reaching your shoes for example. It may improve your ability to walk and carry out your day-to-day activities better. However in considering a hip replacement you have to be well informed of the risks and the success of this surgery. This will be explained to you in detail during your consultation with me in clinic. A brief overview is given below.

What is the success rate of hip replacement surgery?

Hip replacement is a very successful operation and was described in a well known medical journal [Lancet] as ‘the operation of the century’.

One can assess the success rate by looking at numerous sources of data including the national joint registry. The success of the operation depends on a number of factors including how well the operation is performed, what type of hip replacement is used and the occurrence post op complications. One would expect for the commonly used cemented hip replacement on average approximately 95% of hip replacements to last 15 years.

What are the potential complications?

Fortunately complications following hip replacement surgery are uncommon. Infection is a serious but uncommon complication about 1%. Great care is taken to avoid infection such as the use of clean air theatres and antibiotics before surgery. Should this occur it may require further surgery to eradicate the infection.

Deep vein thrombosis [DVT] or blood clots. This can occur in approximately 2 to 3% cases most commonly in the calf. Numerous precautions are taken such as to use of antithrombotic medication and elasticated stockings. Most often DVT manifests as a painful and swollen calf which is very hard and tender to touch. Should this occur you should get in touch with the hospital ASAP.  Very rarely this clot can dislodge and go to the lungs producing serious complications including death.

Other risks include anaesthetic risks, bleeding, stiffness, leg length difference, dislocation, persistent pain, fracture, nerve and vessel damage. Long term risks of loosening and wear of the joint replacement may necessitate revision surgery. I will discuss all these risks with you during the consultation to reassure you of what measures are taken to reduce the risk to yourself.

Will I have a lot of pain after surgery?

The anaesthetist will discuss with you the best anaesthetic for your operation. The preference is for a spinal anaesthetic. The benefit of this is excellent pain relief which lasts for a number of hours after surgery. This allows you to be sat up in bed soon after the operation to enable you to eat and then take the pain relieving medication before the pain even starts. This method helps to control the pain before its onset and makes the post-operative stay better. Apart from this I use less invasive surgical techniques to minimise the trauma to the tissues around your hip joint and this helps with keeping better pain control.

What is the recovery after hip replacement?

Your expected stay will be 2 to 3 days in hospital. You will be able to walk with the help of crutches or a frame on the day or day after surgery. You will have physiotherapy in the hospital and after discharge. Most patients will have to follow certain precautions after surgery which will be explained to you in depth upon discharge. I will expect you to not be using crutches by four to six weeks. A full recovery may occasionally take up to 3 months.

What precautions do I need to take after surgery?

This will be explained to you by the team following surgery and an information leaflet will be provided but briefly:

Sitting in a low chair should be avoided. Essentially avoid any activity that increases hip flexion beyond 90°. This can be judged by not bending your knee beyond your waist level.

Sleeping on the back is preferable. One can sleep on the operated side without restriction once the wound has healed and the pain has settled. If you sleep on the nonoperated side then you should use a pillow between the knees to stop the legs from crossing each other.

Avoid high impact activity and sport for six weeks or surgery.

How to get the best out of my hip replacement?

General measures such as keeping fit, keeping a healthy weight, controlling medical conditions such as diabetes and obesity will help in improving your outcomes after surgery.

Selecting  a good hospital for the procedure is important to minimise the risks of infection and having an expert team to smooth the post-operative period. I operate in Highfield hospital where you will have exceptional quality care with individual rooms, facilities and caring nursing staff.

Last but not least is the selection of an expert surgeon. This can be difficult for a lay person. A good source of information is your own general practitioner. The National joint registry can give some idea of the experience and number of joint replacements done by your surgeon. Online resources may throw some light on an individual but needs to be critically appreciated. Sometimes the best feedback is obtained from friends or relatives who may have undergone the surgery by me. Patient feedback on this website and Doctify may give you some assurance.