The following information is for general guidance only. Details will vary significantly depending on your circumstances, choice of surgeon and hip operation.
Why might you need a hip replacement?
- Hip replacement is performed when the smooth lining of the hip joint (cartilage) wears away and the roughened bony surfaces of the thigh bone and pelvis rub against one another.
- This causes pain (usually felt as groin pain), stiffness, and sometimes deformity. Other conditions such as rheumatoid arthritis or hip fractures may also lead to cartilage damage.
- A hip replacement will only be suggested when all other treatments have been tried first. These may consist of painkillers or anti-inflammatory drugs, physiotherapy, and the use of a stick.
- By replacing the damaged surfaces, the joint is made smooth again, allowing return of movement, correction of deformity and, in almost all patients, complete pain relief.
- See - Total Health Hip Replacement Guide
Preparations needed for a hip replacement
- The expected stay in hospital is for 5 to 14 days. However, this varies considerably – depending on circumstances as described in the articles on this website.
- Allow 6 weeks off for recovery.
- Before admission, you should keep as mobile as possible and make every attempt to avoid becoming overweight.
- If any other medical conditions develop whilst waiting, your surgeon should be notified.
- You should obtain a list of drugs that you take, and any allergies you may have, from your general practitioner, and give this to the doctor when you are admitted to hospital.
- In hospital there will often be a delay before your operation, during which various tests will be run.
What happens during a hip replacement operation?
- The operation is carried out under a full (general) anaesthetic.
- In some patients a general anaesthetic may be hazardous. In this case an anaesthetic can be injected into the spine which will anaesthetize the lower body. A sedative may also be given.
- At operation, a cut is made on the side of the buttock (depending on your surgeon’s philosophy to this approach), the worn top of the thigh bone (femur) is removed and the worn socket lining of the hip joint is smoothed.
- Depending on materials recommended by your surgeon, a plastic lining is fixed into the socket and a new metal ball on a stem is fixed into a hole made in the femur.
- The new ball is then placed in the socket.
- There are fundamentally two types of hip replacement. In one, the parts are fixed in place using special cement. In the other, the parts fit the holes very closely and do not require cement.
- The wound is closed with stitches or staples.
- You will wake up in the recovery ward, as special equipment is kept here to ensure that everything is satisfactory before returning to the ward.
Possible complications during a hip replacement
- A hip replacement is a major operation and complications may occur.
- There is the risk of the anaesthetic, and immediately after the operation there may be problems with bleeding or deep bruising.
- In men, especially, there may be some difficulty in passing urine and a catheter may have to be inserted into the bladder.
- There is a risk of a blood clot forming in the legs (deep venous thrombosis) which may require drug treatment.
- Rarely, one of these clots may travel to the lung (pulmonary embolism).
- This may require drug treatment, or in very rare cases, further surgery.
- Such is the risk of blood clots that some surgeons will use preventive anticoagulant treatment to thin the blood. This has been shown to reduce the likelihood of developing a clot.
- Immediately after surgery, several complications may affect the hip joint.
- The most common of these is that the ball may dislocate if certain movements are made. Before the operation you will therefore be advised which movements must be avoided. A pillow placed between the legs will prevent you making these movements unconsciously.
- Rarely, the wound may become infected and antibiotic treatment is then needed.
- Different types of artificial hip joint wear out at different rates and this should be discussed with your surgeon.
- Your artificial joint may become loose. This is sometimes planned and a further operation will be required to fix or change the components.
After a hip replacement
- The operation is quite painful and painkillers will be given by injection, by mouth or by an epidural injection. This involves the insertion of a needle into the lower spine.
- You will have a drip in your arm, to replace blood and fluid lost.
- You may have drainage tubes from the wound which drain blood away into bottles which are removed after a few days.
- Initially, a physiotherapist will help you to walk with a frame or crutches, but after several weeks you will be able to walk with one or two sticks.
- Occasionally the surgeon will advise the use of crutches for a longer period, to allow an uncemented hip joint to settle properly.
- When you leave hospital you will be able to use the stairs and to sit on the toilet, but will be advised to avoid certain positions such as squatting or bending your knees up in bed, as these may lead to dislocation.
- You must avoid sitting in low seats, reaching to put on shoes and crossing your legs.
- An appointment will be made for a routine specialist check up after several weeks. You will need further checks to see how you are progressing.
- The time taken to return to work will vary with your age and job. People with clerical jobs may return after 5 to 6 weeks, whilst others with more physical jobs may have to wait for up to 6 months.
- In time, the movement of your hip will improve and activities will return to near normal. You should be able to drive after about 3 months, but should check with your surgeon and avoid cars with low seats.
- Gentle exercise classes are helpful under supervision and, provided you do not make extreme movements which involve bending your hip joint too far, you should be able to dance. Gardening is possible and gentle sport such as tennis is allowed. Vigorous exercise may cause the joint to loosen.
- After 6 weeks to 3 months, sexual activity can be resumed, provided that extreme positions are avoided. Finally, you should make every attempt to avoid becoming overweight.
If a hip replacement is not performed
- If the hip is not replaced, it continues to wear, the pain becomes worse, and stiffness and deformity increase.
- Eventually the pain may become severe enough to lead to the use of crutches or, in severe cases, a wheelchair. However, the condition is not life-threatening.
Effects on family of a hip replacement
- You will clearly need help for a couple of weeks until fully independent.
- Your physiotherapist will be in the best position to advise your friends and family what they can do to help in the meantime.
See Also - Hip Conditions and Senior Orthopaedic Consultants
