What is hip replacement surgery and how can it help me?

In England and Wales there are approximately 160,000 total hip and knee replacement procedures performed each year. Hip replacements have been performed in the UK since the 1960s, a procedure that involves replacing the hip joint with an artificial one.

Hip replacement surgery is most often carried out to treat pain caused by osteoarthritis and, in most cases, artificial replacement joints last for 20 years.

What is hip osteoarthritis?

Osteoarthritis (arthritis) of the hip is the most common form of arthritis, causing pain, swelling and stiffness from long term damage to the joint surface cartilage.

How is it caused?

Osteoarthritis is often caused by age related wear and tear, but it can also be caused by abnormalities of the hip due to other conditions such as hip dysplasia, avascular necrosis, or femoroacetabular impingement (FAI).

What are the symptoms?

These include:

  • A dull ache in the hips, which may come and go and also affect the groin, buttocks and thighs
  • In some cases, pain may make it difficult to walk long distances without limping
  • Going upstairs and bending down to tie shoes or cut toenails may also be more difficult
  • Night pain can disturb your sleep

How is it diagnosed?

After discussing your symptoms, the specialist will usually back up the diagnosis with X-rays and MRI or CT scans to show the extent of damage to the cartilage and to see if there’s an underlying cause.

What happens during hip replacement surgery?

During hip replacement surgery, the worn or damaged joint surfaces are replaced with smooth artificial surfaces (prosthesis) which are implanted into healthy bone. The operation can improve your ability to walk by relieving pain and stiffness and usually takes up to two hours to complete.

Is it right for me?

Although hip replacement surgery may be the best treatment for your symptoms, and is the only ‘cure’ for hip osteoarthritis, it is only advised when pain is significant affecting your everyday life. In a few cases, arthroscopy can be performed to treat ‘catching’ of the joint in patients up to around their mid-40s. However, although this can relieve the problem in the short term, there is strong scientific evidence that arthroscopy doesn’t provide long term symptom relief.

Before you make the decision to go ahead it’s important to:

  • Discuss all your options with your consultant, as well as with your GP and family
  • Discuss your expectations from surgery with your surgeon
  • Ask questions and raise any concerns you may have
  • Weigh up the risks and benefits so that you can make your own informed decision

Alternative treatments

We only advise our patients to have hip replacement surgery after other treatments have proved unsuccessful. These include:

  • Painkillers or anti-inflammatory medication
  • Weight loss if necessary
  • Physiotherapy to reduce stiffness and improve muscle strength
  • Hip arthroscopy

How can I help improve the results of my surgery?

Research carried out by the World Health Organization (WHO) has shown that patients who have the knowledge, skills and confidence to manage their own condition enjoy better outcomes.

Your experience of having hip replacement surgery is likely to be more positive if you:

  • Make sure you’re well informed so that you understand the procedure and are well prepared
  • Understand what your limitations will be following surgery
  • Make sure you plan in advance so that you have some practical help and support in place
  • Make any necessary adjustments around your home
  • Carry out your rehabilitation exercises as advised – starting before your surgery
  • Follow the advice of your healthcare team to help speed up your recovery

The hip joint

The hip is a ball and socket joint between the pelvis and the thigh bone. The upper end of the thigh is the ball part and fits into the socket in the pelvis.

All the surfaces of the bones are covered in articular (chondral) cartilage, which is a smooth, tough and rubbery surface that allows the bones in the hip joint to move easily against each other with minimal friction.

What are the risks of hip replacement surgery?

All surgery carries risks and these will be discussed with you in detail. Complications following hip replacement surgery are rare. However, the following risks need to be considered.

The chance of infection is less than 1% and can usually be treated effectively with antibiotics. Usually only the skin is affected, but if bacteria get into the hip itself then it may be necessary to have a further operation to wash it out with saline solution and give stronger antibiotics via a drip. On very rare occasions it may be necessary to remove the hip replacement completely to allow the bacteria to be treated. It is then re-replaced, either during the same operation or after an interval of four-six weeks. Treatment of infected hip replacements is highly specialised

Blood clots
Blood clots can occur after any operation but are more likely to occur following lower limb orthopaedic operations. To reduce the risk of blood clots, you’ll be encouraged get up and walk around as soon after your operation as possible, often on the same day. We will also assess your risk of developing a blood clot and, in some cases, you’ll be prescribed blood thinning medication. You’ll also be given some foot and ankle exercises immediately after surgery and will also be advised to wear special socks for six weeks after surgery.

Deep vein thrombosis (DVT)
This is when a blood clot develops in the deep veins in the back of your lower leg; however, some swelling in the leg after surgery is very common. If you’re worried you have DVT, you should see a doctor as soon as possible. The risk of DVT is less than 1% and treatment includes blood thinning medication

Pulmonary embolism (PE)
This is when part of a blood clot that forms in the leg breaks away and is carried to the lung. The risk of this is extremely low (1 in 1000) and treatment is the same as for DVT (see above)

Swelling and bruising around the hip joint and in the thigh and knee is common after hip replacement surgery. The swelling may feel tight and a little uncomfortable. If you’re worried, please contact the clinic for advice

Most people experience some stiffness in the joint after an operation, but this should improve with exercise and physiotherapy

Nerve damage
Small nerves that supply sensation to the skin near the operation site can be damaged leading to scar numbness. Injury to the major nerves supplying the muscles of the leg is a very serious complication but fortunately extremely rare (less than 0.2%)

Unequal leg length
Although the surgeon will try to ensure that your leg length is the same, sometimes surgery can result in slight inequality which may require orthotics to ensure your gait (way of walking) is not affected. Surgeons at the Fortius Clinic use digital X-Ray templating software to reduce the chance of unexpected leg length inequality to a minimum

Wear and loosening of the prosthesis
Modern hip replacements are expected to last at least twenty years. However, over time the artificial hip may wear or loosen and if this happens, a further procedure to change the implants (revision surgery) may be necessary. However, that huge advances in the field of revision hip surgery mean that in most cases the outcome is excellent

This is rare, occurring in around 1% of cases. Once treated, it seldom recurs

Medical problems
There is a small risk of developing a medical problem following surgery. These include heart attacks, strokes and pneumonia. There is also a small risk of dying associated with this type of operation (nationally this figure is 0.4%).

These risks will be discussed with you at the time of consultation with your surgeon.

How we reduce the risks of surgery

You will be screened for bacteria and MRSA before your surgery to reduce the chance of an infection, and during your operation you’ll also be given intravenous antibiotics. If you’re concerned about the risks of surgery, please discuss this with your consultant and/or anaesthetist before you give consent for the operation.

Research has shown that patients who engage more with improving their own health and are well informed have better outcomes. There is more information about preparing for surgery in the next section.

What improvement can I expect after my surgery?

The benefits of surgery include:

  • Reduced pain: most patients who have a total hip replacement have significant pain relief, enabling them to return to their everyday activities. This includes going up or down stairs, getting in and out of chairs, and walking longer distances. It’s normal to have some discomfort following your operation; however, our techniques aim to make the surgery as comfortable as possible, in most cases allowing you to walk on the same day. You will also be given a personalised exercise plan to help you to return to normal as quickly as possible
  • Reduced stiffness: the new joint has highly engineered metal and plastic surfaces designed to allow it to move smoothly and freely
  • Increased mobility: with a combination of reduced pain and improvement in stiffness, your overall mobility is likely to be improved enabling you to return to a more active lifestyle

How long does it take to recover?

You’ll be in hospital for up to four days and will be shown how to walk using crutches (which you’ll need to use for up to six weeks).

After surgery, you will be given a rehabilitation programme of gentle exercises to build up your strength and range of movement and in most cases you should be able to return to light everyday activities within three to six weeks. It has been shown that avoiding certain movements after hip replacement does not protect the hip from dislocation and can even slow down recovery. It’s for this reason that our surgeons do not advise following traditional ‘dislocation precautions’ except in exceptional circumstances.

Your hip replacement should continue to improve for up to a year after surgery, and sometimes longer for younger patients.

How long will I need to have off work?

Depending on the kind of work you do, you may need up to six weeks off work. However, your consultant will be able to advise you about this as everyone is different and your rate of recovery may be different from that of other people. We normally recommend that you don’t work at all for the first two weeks, gradually returning to normal after four to six weeks (if your job mainly involves sitting down). Commuting during rush hour is not recommended for at least six weeks after hip replacement surgery. Manual workers may need up to three months to return to normal.

Which activities could I do?

The aim of surgery is to help you to return to your normal everyday activities without being in pain. This includes going up and down stairs, walking and non-competitive sports including:

  • Swimming
  • Golf
  • Driving
  • Cycling
  • Ballroom dancing

Which activities should I avoid?

An artificial hip isn’t the same as a normal hip and it’s important not to take part in activities that will wear the joint or result in an injury so it’s best to avoid:

  • Jogging or running
  • Contact sports
  • Sports that involve jumping
  • High impact aerobics

You may not be able to do work that involves heavy labour

Fortius Joint Replacement Centre
at Bupa Cromwell Hospital

164 -178 Cromwell Road

E: info@fortiusclinic.com

Appointments: +44 (0)203 693 2119

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