Hip Replacement Surgery

A hip replacement, or arthroplasty, is the surgical procedure in which the diseased parts of the hip are removed and replaced with an artificial joint. The new hip joint, also called the prosthesis, is made up of two parts; One to replace the head of the femur (the ball part of the thigh bone) which fits into the acetabulum; Another which replaces the acetabulum (the socket) and is fitted into the pelvic bone.

What should you expect from your hip replacement?

Due to the advances made in recent years, the majority of patients find that after their hip replacement they experience significant pain relief and improvement in movement. This means that they find everyday functions such as sitting, walking and driving much more comfortable than before.

However, the results will not be immediate and after your stay in hospital, a full recovery can be expected to take between 3 and 6 months depending on the type of surgery you have, your overall health and how well you rehabilitate.

How long the replacement hip lasts can depend on many factors, although it is true to say that most patients will never need to have another operation. The amount of activity you undertake may have a bearing on the life of the joint, as will your weight. Overall a replacement hip might be expected to last fifteen to twenty years.

What happens during hip replacement surgery?

A hip replacement is a major surgical procedure. To begin the surgery, patients will usually be given a spinal anaesthetic (where there is no feeling from the waist down) or a general anaesthetic so that they are asleep throughout. An opportunity to discuss the merits of each type of anaesthetic with the anesthetist will be given to the patient before the operation.

During surgery, Mr. Williams will make an incision at the level of hip to remove the damaged hip and will then replace the hip joint with a prosthesis. Your hip replacement may be put in with a grout referred to as bone cement – a “cemented” procedure. Alternatively, an “uncemented” procedure is used in which the prosthesis has thousands of tiny holes that allow the bone to grow into and hold it in place.  The type of hip replacement you receive will usually have been discussed with you prior to the operation. Mr. Williams only uses implants which meet the highest level of independently evaluated UK standards called ODEP 10A* implants.

It should also be noted that Mr. Williams is a strong advocate of modern enhanced recovery protocols (ERAS) which includes infiltrating the operated area with local anesthetic to improve the post operative experience.

Click here for an animation of total hip replacement.

What happens after the operation?

You will be transferred to the recovery room where you will remain until Mr. Williams and the anesthetist are satisfied that you have recovered sufficiently before you are transferred back to the ward.

Pain relief after the operation

Good pain relief is important and some people need more pain relief than others. It is much easier to relieve pain if it is dealt with before it gets bad. Pain relief can be increased, given more often, or given in different combinations. You should ask for help if you feel pain.

Physical activities after your operation

A physiotherapist will visit you regularly throughout your stay in hospital to advise and assist you with a series of exercises. These will help with breathing and circulation as well as building strength back into your leg muscles. Your range of movement will increase in the days following your surgery and you will soon be able to sit up, stand and then take a few steps. You will get out of bed and start walking either on the same day of the surgery or the next day.

You will receive injections of a drug such as Heparin which helps prevent blood clots.

What general precautions should be taken?

The hip replacement that you have had is an artificial joint. It is therefore important that you take necessary precautions to prevent complications.

Listed below are some precautions to be taken particularly in the first 6-8 weeks are. Your physiotherapist will discuss these and others with you in greater detail prior to your discharge from hospital as well as during your follow up visits post surgery.

• Contact your doctor if you notice any redness, leaking fluid or have an increased pain in the operated area
• Do not bend the hip more than a right angle as this could cause the hip to dislocate or pop out of the joint.
• Avoid low chairs and toilet seats.
• Do not bend down to the floor to pick up objects.
• Do not force the hip to bend to reach your toes such as to clip your toe nails or put on your stockings.
• Do not twist the hip.
• Do not cross your legs.
• Do not lie on your side for the first 6 weeks.
• In the longer term, there is a small risk of spread of infection to the hip should you have an infection anywhere else in the body, if you are undergoing an operation, internal examination or even dental work.

Remember to inform your doctor/dentist, if you need to undergo an operation, internal examination or even dental so that they can consider putting you on antibiotics as preventative a measure.

Possible Complications?

Hip replacement surgery is a very successful operation, but there are risks associated with any procedure, which in this case include:

• Anaesthetic – Modern anaesthetics are generally very safe. The anaesthetist will explain any particular risks to you.
• Infection – There is a small risk of infection of the joint following the operation but you will be given antibiotics to help prevent this. If after you get home you notice fever, increased pain, swelling and redness around the wound, please phone the ward at Werndale directly.
• Deep vein thrombosis (a blood clot in a leg vein)  – You may have anti- coagulant medication and support stockings to help prevent it. A symptom of this may be an acute pain in your calf. Please contact us urgently.
• Dislocation – The risk of dislocation is at its highest when the muscles around the new hip joint are still healing and relatively weak. A hip that dislocates more than once may need to be operated on again so it is very much in your interests to follow the advice you are given.

Other recognised complications include fractures and nerve injuries both of which are fortunately rare.

Are there any limitations?

Patients will only be offered hip replacement surgery if the surgeon deems them well enough to cope with the operation and the rehabilitation. The recovery program involves lots of physical therapy and encourages you to exercise regularly to regain the use of the joint and surrounding muscles.

Mr. Williams will be able to answer any question you may have regarding the procedure and the rehabilitation before surgery in your consultation.

Hip replacement follow-up program

It is generally accepted that hip replacements should be kept under surveillance so that potential problems are identified at an early stage. The surgical wound will need to be reviewed by a nurse 10-14 days post operativley. A member of Mr. Williams team will also telephone you a few days after discharge to check that all is well. At 6 to 8 weeks post operativley, Mr. Williams will review your progress during a follow-up consultation.

Following this, below is a summary of when each review should take place

• X- ray and clinical assessment 1 year after surgery
• X- ray every two years after that
• Yearly questionnaire

Repeat clinical assessment at 5 years, 10 years and 15 years…..

A discussion will be had whether you would like the long term follow up to be performed at BMI Werndale or within the NHS.

Additional Information

Please talk to Mr. Williams before your operation if you have concerns about possible risks or have any outstanding questions

For additional information, it may also be worth reading the excellent NHS Guide to Hip Replacements.

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