What is hip replacement?
Hip replacement surgery is an operation in which the worn hip joint is replaced with a prosthetic (artificial) joint. Normally both the socket (acetabulum) and ball (femur) are replaced.
Who is suitable for hip replacement?
Hip replacement surgery is normally undertaken for arthritis (wear and tear) on the hip joint, and normally in older patients. However specialist hip surgeons do undertake replacement in younger patients with rheumatoid arthritis, broken hip bones, or inpatients who have a developmental abnormality of the hips. Your surgeon will only recommend a hip replacement if it is the right procedure for you.
What are the benefits of hip replacement?
Hip replacement surgery is primarily undertaken to alleviate pain. Patients can expect to return to active lives after a hip replacement, and many patients with hip replacements take part in sport and other activities. If suitable for you a hip replacement can be expected to return you to an active life..
How long will my hip replacement last?
90% of standard metal on plastic hip replacements will last 10 years. Ceramic hip replacements should last 20 years. We do not yet know how long hip resurfacings will last, however if it wears out then as much bone as possible is conserved so that conversion to a standard hip replacement is straightforward (i.e. hip resurfacing keeps all options open).
Are there any drawbacks to hip replacement?
Like all major surgery there are certain risks associated with the surgery:
Blood clot (thromboses) and emboli. These are reduced by early walking, TEDS (compression stockings) and injections to thin the blood whilst in hospital.
Infection. This is reduced by eradication of sites of infection before the operation, antibiotics during the operation, good surgical technique, and state of the art technology in the operating theatre.
Dislocation. This is reduced by good component positioning by us during surgery (and is one reason we often use computer assisted planning before the operation, and computer assisted checking of component positioning during the operation) and by you following instructions from the physiotherapist during the first 6 weeks.
Leg length difference. The leg often feels longer because the muscles need to recover their coordination, but this usually subsides over a few months. During the operation we must ensure that the muscles are not left too loose so that the hip is stable. Any minor differences are correctable with a small shoe insert. Major differences are unusual.
Preparation before hip replacement / resurfacing
Exercises: perform those that the physiotherapist has shown you.
Overweight: do what you can to lose weight
Smoking increases the risk of chest complications and the chance of blood clots. Smoking also slows wound healing. Please stop smoking for several weeks before and after the operation.
Infection around your new hip can be reduced by eradicating any possible sources of infection. Common areas of concern are the teeth or gums, skin infections, bladder infections, leg ulcers, in-growing toe nails and athletes foot.
Planning after care. Most people go home 4 or 5 days after their operation. You will normally need crutches or a stick for the first 6 weeks and you are not allowed to drive during this time. If you live alone, please ask a friend or relative to come and stay for a few weeks, or for you to stay with them, whilst you recover.
Drugs that should be stopped before the operation include (please check with us): clopidogrel (plavix) (at least 2 weeks before); the contraceptive pill (preferably 6 weeks before), aspirin (1-2 weeks before) and warfarin (usually 5 days before).
Your anaesthetist will see you and perform a further final check of your heart, lungs and general health. He/she will also review any medication you are taking, and the need for any pre-medication. He/she will discuss with you the type of anaesthetic planned (spinal, epidural or general)
Eating & drinking: you will not be allowed to eat for 6 hours nor drink any fluids for 4 hours before the scheduled time of your operation. Relatives are encouraged to ring in on the day of surgery rather than visit.
After your hip operation
A physiotherapist will instruct you in the appropriate exercises:
breathing exercises to lower the risk of chest complications
leg exercises to improve circulation and maintain muscle tone
crutches will be supplied to you and you will be shown how to use them
average stay after the operation is 4 nights or 5 days
What can you do with your new hip replacement / resurfacing?
We aim to give you a pain free hip for all normal daily activities and most low impact sports
Walking: we aim to get you walking within 24 hours of surgery and an unlimited distance by 3 months post operation. Hill walking is usually possible at 6 months post operation.
Sport: some people can carry out more demanding sports such as running and squash but on the understanding that you have a mechanical hip that can wear out with over-use
Work: most patients return to office work at 6 weeks post operation. Returning to heavy work such as farming or building usually takes a further 6 weeks.
Driving & flying: please wait 6 weeks before returning to these activities
Sexual activity: this can resume once the wound has healed. Please avoid positions that may cause dislocation of the hip during the first 6 weeks.
Other activities: gardening, tennis, skiing, sailing can be resumed (at a sensible intensity) between 3 and 6 months.
Is it too soon?
Rule one is ‘keep away from doctors, and surgeons in particular’, so it is almost never wrong to postpone surgery.
What we do know, is that to keep feeling well, everyone needs to take a reasonable amount of exercise. If you can no longer walk for pleasure, or play the ‘age-appropriate’ sport that you really enjoy because of a simply rightable wrong, then there is no harm in getting an opinion.
Is it too late?
Only rarely will we ever say, ‘I wish you had come sooner’, because the wearing out process usually takes a long time, even though a joint may hurt a lot. Here are a few of the exceptions:
1. when a small problem can be sorted out by a small operation, but it is left too long, so a big operation is needed instead.
2. when the femoral head is so badly damaged that a total hip replacement rather than a resurfacing is what has to be done.
Is it bad enough?
We measure how bad things are in a number of ways. First, on a 0-10 scale, how much pain are you in? Is it steadily getting worse? Secondly how much trouble do you get in everyday life and doing the things you enjoy?
Before your operation you will be ‘scored’ using a variety of functional scores. These are principally questionnaire based, and help put your problems in perspective. They also give a helpful comparison for your progress following surgery.