Reasons for Having a Hip Replacement

A hip replacement may be recommended if hip pain and stiffness is having a big effect on your life and other treatments have not worked.

Osteoarthritis

The most common reason for a hip replacement is problems caused by osteoarthritis. This is a condition that causes joints to become painful and stiff. The hip usually moves smoothly because the ends of the bones are covered with a layer of tough tissue called cartilage. When cartilage wears away or is damaged, the bones rub against each other, making the joint painful and stiff.

Other Conditions

Other conditions that can also be treated with a hip replacement include:

• Rheumatoid arthritis — a condition where the immune system causes joint damage, pain and stiffness
• Pain and stiffness caused by damage to the hip after a fall, injury or accident

The Outcome

During a hip replacement, the damaged parts of your hip are replaced with metal, ceramic and plastic parts. Hip replacements are usually very successful and most people will have less pain and better movement following the procedure.

Common Alternatives to a Hip Replacement

There are other treatments you can try first before having a hip replacement. Your GP or doctor will talk to you about non-surgical treatments to help manage your hip pain and stiffness.

Treatments Tried First

These may include lifestyle changes and some types of pain relief, such as:

• Weight loss to reduce the strain on your hip if you are overweight
• Low-impact exercise such as swimming, walking or cycling, and muscle strengthening in the hips — a physiotherapist may advise and support you
• Using walking aids
• Wearing special footwear or insoles for your shoes
• Pain relief medicines, gels or creams
• Hydrocortisone (steroid) injections — an injection into the hip joint to help with pain and swelling

If you have tried these approaches and they have not helped, your doctor may discuss having a hip replacement with you.

How to Prepare

Before your hip replacement, your doctor will talk to you about the things you can do to prepare. This might include advice on muscle strengthening exercises, losing weight if needed, stopping smoking, and following a healthy diet while sticking to recommended weekly alcohol limits.

It's important to do these things while you wait, as waiting lists can be long. These steps may lower your risk of complications and speed your recovery.

Pre-Admission Clinic

You will probably be asked to attend a pre-admission clinic a few weeks before the operation to make sure you are well enough for surgery. This may include:

• Blood tests
• X-rays
• A urine test to check for infections
• An electrocardiogram (ECG) to check your heart health

You may also meet the care team so you can learn more about the operation and ask any questions you may have.

Preparing Your Home

It is a good idea to prepare for when you get home after your operation. You might want to think about:

• Asking for help with day-to-day activities
• Making sure things you use often are easy to reach
• Stocking your freezer with cooked meals
• Arranging transport — you'll be unable to drive for at least 6 weeks
• Speaking to your employer and making a plan for returning to work
• Borrowing, hiring or buying helpful equipment such as a raised toilet seat or a grabber tool

What Happens During Surgery

If you are having a hip replacement, you will usually go into hospital on the day of the operation. You will either have a local anaesthetic in your spine (you are awake but will have no feeling from the waist down), or a general anaesthetic (you are asleep during the operation). The operation usually takes about 1 to 2 hours.

Total Hip Replacement

A total hip replacement is the most common type. The "ball" of the hip joint (the top end of the thigh bone) and the "socket" (the connected section of hip in your pelvis) are both replaced with metal, ceramic or plastic parts.

The main steps are:

1. The surgeon makes a cut in the back or side of your hip
2. The damaged hip joint is taken apart
3. The top end of the thigh bone (ball joint) is cut off and removed
4. A new metal or ceramic ball is fitted to the end of the thigh bone
5. The hip socket is drilled out and a new plastic or ceramic socket is fitted
6. The new hip is put back together
7. The cut is closed using stitches or clips and covered with a dressing
8. You are taken to a recovery room to fully recover from the anaesthetic

Partial Hip Replacement

A partial hip replacement involves only removing the "ball" of the joint, leaving the socket in place. This usually has a faster recovery time but does not last as long. It may be offered if you are in poor health, are frail, or have had a serious hip injury.

Hip Resurfacing

Hip resurfacing involves removing the surface of the ball joint and placing a metal cover over it, rather than removing the whole joint. It does not work well for people with weaker bones and may be offered to those aged around 50 or younger.

Recovery in Hospital

After surgery you will spend some time in a recovery room and will be given medicines to help with the pain. Nurses and physiotherapists will help you start walking as soon as possible so you can go home quickly. You will need crutches or a walking frame at first.

Recovery at Home

If you are generally fit and surgery went well, you can usually go home around 1 to 3 days after the operation. A physiotherapist or occupational therapist will advise you on daily activities and home exercise programmes before you leave. Full recovery may take several months.

Possible Complications

A hip replacement is a common and safe procedure. However, as with any surgery there are risks. Your doctor will explain these to you before you consent to the operation.

Blood Clots / DVT

Blood clots or DVT (deep vein thrombosis) are possible after a hip replacement due to changes in blood flow during surgery. Compression stockings are usually given to reduce this risk. In rare cases a clot can travel to the lungs (pulmonary embolism), which is a serious emergency.

Wound Infection

There is a small chance of wound infection after surgery, usually treated with antibiotics. If infection spreads into the joint, further surgery may be needed.

Leg Length Difference

Surgery can sometimes result in the replaced leg being slightly longer. Surgeons work to avoid this, and the difference is often so small it isn't noticed. A raised heel on the other shoe can help if needed.

Hip Dislocation and Wear

The replacement hip can occasionally dislocate, causing pain or swelling. Modern replacements are designed to last at least 15 years, but can wear over time. If the joint dislocates or wears out, further surgery may be required.

Metal-on-Metal Implants

If you have an older metal-on-metal hip implant, you should have regular check-ups. Contact your GP if you notice new hip pain, reduced mobility, or popping or clicking sounds from the joint.