Hip Replacement

Hip Replacement

Hip replacement surgery is an operation to treat hip pain. It is a major operation but one that’s both common and successful.

During the procedure, an orthopaedic surgeon will remove your damaged hip joint and replace it with a prosthesis. This is sometimes referred to as an implant or as an artificial hip. The prosthesis is usually constructed of metal, ceramic, plastic, or a combination of the three.

If you are living with a painful hip joint that’s affecting your quality of life, you’ve landed in the right place. Hip replacement surgery could be the best treatment option to help you take control of your health and get you back on your feet, doing the things you love.

This page explains everything you need to know about hip replacement surgery, including information on hip replacement recovery timelines and the benefits of physiotherapy after surgery.

Why have a hip replacement?

The main goals of hip joint replacement are relief of unrelenting pain, to improve quality of life and allow return to normal function (e.g., walking, cooking, sleeping, driving, working).

You may be offered a hip replacement to treat your osteoarthritis but the decision to have the operation is yours. The operation has been done routinely for over 50 years and carries great success, more so than replacement of any other joint in the human body: it also has the quickest recovery time and is the most durable.

Satisfaction rates from hip replacement are widely recognised to be around 90% and all operations carry some risks. It is sensible to proceed when the anticipated benefits are judged to outweigh those risks.

What are the risks?

The vast majority of people having hip replacement are very happy with their result but, as with any surgery, there are risks involved. Despite being relatively rare, these risks are important to have knowledge of during the decision-making process.

If you want to know more about the potential risks please click here.

These risks apply to all hip replacements, regardless of where and by whom they are performed.

  • Chronic pain (1 in 20)
  • Infection (1 in 250)
  • Acute kidney injury
  • Blood clots (1 in 150 leg, 1 in 250 lung)
  • Nerve injury (1 in 100)
  • Leg length difference (1 in 100)
  • Dislocation of hip joint (1 in 100)
  • Blood loss requiring transfusion (1 in 300)
  • Fracture (1 in 100)
  • Wear or loosening of the implants (95% last more than 15years)
  • Stiffness
  • Of anaesthetic – allergic reaction, stroke, (1 in 1000), heart attack (1 in 500), chest infection (1 in 650)

What is involved?

You attend a pre-assessment clinic a week before admission and are admitted to hospital a few hours before surgery. The operation commonly occurs under a spinal or sometimes a general anaesthetic. In addition to a spinal anaesthetic (which numbs your legs) sedation is given if desired so that you can be “asleep” or unaware during the operation. Antibiotics are given just before your operation to help prevent infection, and medications that minimise bleeding (tranexamic acid) are also given.

The operation takes just over an hour typically and involves removing the worn hip joint ball and socket, then carefully recreating the normal mechanical alignment of your hip joint by sculpting the bones to accommodate the replacement implants in the optimum orientation. The deep tissues and skin are closed with sutures and glue and then a waterproof surgical dressing and bandage are applied. All the stitches are absorbable under the skin and I do not use clips or skin sutures, so the wound is sealed and there is nothing to be removed later. After the operation, you return to the ward and are given a light meal. Intravenous “drips” and urinary catheters are not routinely used.

Once your spinal is worn off (usually within a couple of hours) you are encouraged to walk with supervision and to get dressed in your own clothes.

What happens afterwards?

There is no doubt that hip replacement can be a painful operation to recover from, and those that work hard and are self-motivated tend to have the best outcomes. The pain will improve and regular exercises and walking will ensure that your hip function and movements are good in the longer term.

Good pain relief is certainly important in the early stages, and you will be provided with painkilling medications by the hospital. I aim to promote early walking (on the day of surgery) which is in fact the best pain relief of all, and significantly reduces the risk of blood clots.

Our physiotherapists will help you walk and climb stairs with crutches and provide exercise instructions for home. The majority of my patients go home the day after surgery (selected patients may be able to go home the same day as surgery – see daycase joint replacement).

Our physiotherapists will provide you with an exercise prescription to help you regain your muscle strength and walking ability quickly after the operation. Most of the work can be done yourself in your own home, and our physiotherapists will contact you and/or arrange to see you after you go home to ensure you are making good progress.

You will go home with a waterproof dressing (allowing you to shower) and painkillers and blood thinner medications to prevent blood clots. It is expected that you will have a degree of bruising and swelling around your hip and down your leg (often around the ankle) but this is seldom of any concern and will resolve over a few weeks to months.

It takes 6-12 weeks to recover from hip replacement and improvements can continue for sometimes up to a year afterwards.

Are there age limits?

There are no strict upper or lower age limits on hip joint replacement, and I judge every person on their own symptoms and limitations, as well as their general health. Provided your expectations are realistic, age is no barrier.

What is a hip replacement made of?

Most modern hip replacements are made from a metal (can be cobalt chromium alloy, or titanium alloy) stem inserted into the femur, on top of which is attached either a ceramic ball or a metal alloy ball.

The socket is usually replaced with a tightly fitting metal shell (onto which the bone subsequently grows) containing either a ceramic or an ultra-high molecular weight polyethylene plastic insert. The ball is designed to fit perfectly inside this insert.

Components are usually held in place in the bone using either an acrylic cement containing antibiotics or a press-fit without cement.

What surgical approach is used during a total hip replacement?

There are a number of different ways to reach the hip joint, and all have their advantages and disadvantages. No single approach has been shown to be universally superior to the others. The approach I have always used for all hip joint replacements is the posterior approach. This is a safe and reliable proven approach allowing excellent visualisation of the anatomy and with which I have a great deal of experience and have always had excellent results.

Importantly, this approach avoids detachment of the important hip abductor (gluteus medius) muscles, which can be surgically detached in other approaches (damage to these vital muscles this carries a risk of long-term limp). The posterior approach avoids this and the risk if limp is less. The posterior approach also lends itself well to enhanced recovery techniques and daycase joint replacement.

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