Total Hip Replacement

There are a number of conditions which may require a hip replacement. The most common is osteoarthritis. This means that the articular cartilage lining the joint has worn out resulting in a painful stiff joint which may limit activity. The aim of a hip replacement is to alleviate pain and improve function. In general this is a very successful operation with good outcomes.

Are there any alternatives to Hip Replacement?

Alternative treatments may be considered prior to hip replacement. These include painkillers, modification of activities which aggravate symptoms, physiotherapy, weight loss, injections and walking aids. Only when these treatments are considered inappropriate or are unable to control your pain then a knee replacement is considered.

What is a Total Hip Replacement?

Total hip replacement surgery involves removing the arthritic parts of the hip joint and replacing them with a hip prosthesis (artificial joint).

There are different types of hip prosthesis but overall the designs are fairly similar. The stem is implanted into the femur (thigh bone) and the socket is implanted into the pelvis. These components are made of a metal alloy. A head then fits onto the stem and a liner is inserted into the socket. These are the bearing surfaces of the hip joint and comprise either a metal head with a polyethylene(plastic) liner or alternatively a ceramic head and ceramic liner.

NB: There has been recent controversy over the use of “Metal on Metal” hip replacements. Mr P Gill does not use this type of implant and has never done so in the past.

The Patient Journey for Total Hip Replacement

Preassessment

Shortly before your operation you will be asked to attend a nurse led preassessment clinic. This comprises a medical examination including routine tests such as blood pressure, heart tracing (ECG) and simple blood and urine tests. This is to ensure that you are fit for the operation and that nothing needs to be treated prior to your admission

Admission

Patients are normally admitted on the day of surgery. You are advised not to eat or drink for 6 hours prior to your admission. You will seen by the ward staff, the anaesthetist and your surgeon who will mark the correct limb and confirm consent for the procedure.

Operation

The operation may be carried out either under general anaesthetic (patient asleep) or a spinal anaesthetic (patient awake). The choice of anaesthetic will be discussed with you by the anaesthetist. The operation is undertaken via a 12cm incision over the outer part of your hip and takes approximately one and a half hours. Afterwards you will be taken to the recovery area. Once you are awake and well enough you will return to the ward.

Post operatively

After the operation you will have a dressing over your hip, an intravenous drip for fluids and an oxygen mask. You will be given antibiotics, medication to thin the blood to help prevent clots and pain killers. The physiotherapist will get you out of bed later the same day and commence exercises and walking. The following day you will have a blood test and x-ray. Once you are eating and drinking satisfactorily the drip is removed. You will continue your exercises and increase your walking distance initially with the help of a frame but moving quite quickly on to crutches and eventually to sticks. Most patients will be in hospital for between three and five days. Prior to discharge the physiotherapist must be satisfied that you can walk safely with an aid and that you can manage stairs. Your wound will be checked and redressed and if you are generally well you may return home. In general you should be able to return home in a standard car.

Return Home

When at home it is important you continue your exercises. Out patient physiotherapy will normally be arranged. You will feel quite tired during the first few weeks partly due to difficulty sleeping as your hip will be quite sore and swollen and you will need to take regular pain killers in the early period at home. You will normally be reviewed by your surgeon between two to six weeks after the operation. You should plan not to drive for about six weeks and you may be able to return to work between six and twelve weeks postoperatively depending on your recovery and the nature of your work.

What are the risks of Hip Replacement Surgery?

The risks of surgery are very small. Even so it is important you are aware of them. The risks include:

Infection

There is a small risk of infections. Precautions are taken to prevent infection including the use of intravenous antibiotics during and after the operation. A very small percentage of joints may become infected at some stage and may need to be replaced.

Thrombo-embolism

A deep vein thrombosis (DVT) may form in the calf veins and may extend up to the thigh. Precautions are taken to reduce the risk of DVT. These include early mobilisation post operatively, support stockings and medication to thin the blood which is taken for a period of about ten days. If a clot forms, a part of it may break off and travel to the lungs. This is called a Pulmonary Embolism (PE). A PE is potentially life threatening so DVT prevention is taken seriously.

Leg Length Difference

Hip replacement surgery can occasionally result in a slight difference in leg length. If it does occur it rarely causes problems with normal walking or other activities.

Dislocation

A total hip replacement is more at risk of dislocation than a normal hip joint. This is particularly during the first six weeks after the operation as the soft tissues are healing and you are regaining muscle strength. The risk is small but the physiotherapist will explain to you certain movements and positions you should avoid to reduce this risk further.

Fracture

Fracture of the femur can occur during hip replacement surgery particularly where the uncemented type of prosthesis is used. If this does occur it is usually treated at the time of the operation. On occasions it may be identified on review of the post operative xray. It generally heals well but may slow your recovery to some extent.

Nerve Injury

The sciatic nerve is a large nerve behind the hip joint and on rare occasions this can be damaged during hip replacement surgery. This may result in weakness of the leg.

Loosening

Over a period of time a hip prosthesis may loosen and need further surgery to correct this. The majority of hip replacements would be expected to last 20 years or more although a small percentage will fail early.

The aim of your hip replacement is to alleviate pain and improve function to allow you to remain active. The level of activity expected depends on your general level of fitness but includes long country walks, dancing, golf and perhaps doubles tennis. Some patients are able to ski although are encouraged to stick to relatively gentle slopes which are well within their ability.

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