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Leaflet: Hip replacement surgery

Musculoskeletal (MSK) Services

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Last updated: November 2018

Hip replacement surgery

What is it?

Hip replacement surgery, otherwise know as a total hip replacement (THR) is a procedure undertaken when the integrity of the hip joint fails. This can be as a result of arthritis of various types or following fracture. It is usually done because the joint becomes too painful and stiff to function properly e.g unable to walk any distance. Diagnosis of joint changes is usually established with an appropriate clinical examination and X- Ray, although on occasion further evaluation or imaging may be required.

During the procedure the femoral head (ball) is removed and replaced and a cup is seated in the acetabulum (socket) giving new weight bearing surfaces for the hip joint. There are several different components that can be used for THR surgery with a combination of materials used and fixation strategies. The decision of which is best for you will be made by your consultant orthopaedic surgeon. This decision will be based on many factors (e.g other medical conditions, severity of joint changes, normal functional level) and can be discussed at your request.

Just because you have painful arthritis does not mean you have to have a hip replacement. As with any treatment option there are risks involved and deciding if the procedure is right for you is a risk versus benefit decision.

You may also consider continuing with conservative measures. This may include relative rest and activity modification, pain killing medications, and physiotherapy all of which can achieve good levels of pain relief and improved function.

There is also the option of steroid and local anaesthetic injections. While these are less invasive than surgery they do still carry some risk and may not be appropriate for everybody.

Your clinician will be able to discuss these options with you.

What are the risks of THR?

All surgical procedures carry risk and THR is not excluded. There is less than a 1% risk of severe complications such as a blood clot, stroke, infection or death. More common complications include approximately one in 10 people having persistent pain after THR that cannot be resolved. All the potential risks and complications will be fully explained to you pre operatively by your surgeon. It is important to consider these factors before committing to having the procedure.

Where will it be done?

There are several locations throughout the region where the surgery can be performed. Depending on other medical conditions you can be referred through the e-referral system allowing you to choose where and when you are seen.

Alternatively you can request a specific hospital or surgeon if you prefer. Your MSK clinician can guide you through this process but will not be able to recommend a specific hospital or surgeon.

Will I have an anaesthetic?

Many THR are done using an epidural injection. This means a nerve blocking agent is inserted into the spine making you numb from the waist down. This means you will not feel the procedure but can be awake. Often you are given a sedative as well which will make you feel drowsy during the operation. The benefit of this over general anaesthetic is that you can recover from the procedure more rapidly and subsequently mobilise more quickly. Evidence has shown this to have very positive effects on the short and long term recovery rate after THR. It also eliminates the risks associated with having a general anaesthetic.

In some cases this is not possible and a general anaesthetic is required. The decision about the type of anaesthesia used in your case will be in conjunction with you, your surgeon and the anaesthetist prior to you having surgery.

How long will I be in hospital?

Your length of hospital stay will depend on several factors such as the reason you require the THR, your normal mobility level, and any other medical problems you may have. However typically your hospital stay will be two-four days. Prior to going home you will need to be seen to be mobilising safely with the physiotherapists and able to achieve essential functional tasks with the occupational therapists in addition to having recovered medically from the procedure.

How long will it take to recover?

THR surgery can be a painful procedure and it is normal for mobility in the short term to be quite challenging. Despite this early mobilisation has been shown to be the best means of recovering quickly. There may be variance in individual cases in this regard and you should follow your surgeon’s and physiotherapist’s advice. Normally by six weeks post operation you will have achieved your pre-operative mobility level. It can take up to 12 months to fully recover from the surgery and reach your maximal post operative potential.

What after care will I receive?

During your hospital stay you will be seen by the physiotherapists who will be able to provide you with some exercises which you will be asked to continue to complete at home. You will also be shown how to walk using mobility aids which you can continue with at home. You will then be seen at approximately six weeks after your surgery by the surgical team. In most cases outpatient physiotherapy is not required. If there are any problems outstanding at discharge the ward physiotherapist may organise some outpatient physiotherapy, or this can be organised at your six week check if required. Normally time is a great healer after THR and you will steadily recover as you mobilise further and continue with the exercises given on the ward.

What can I do while waiting for my operation?

There is often a wait to have your surgery which can be a few weeks or several months depending on many factors. It is important in the interim time to maintain good muscle power around the hip. This will make the post operative recovery period a little easier. You can achieve this through both general exercise and specific muscle strengthening activities. General exercise can simply be taking short walks, but if this is not possible using a swimming pool or exercise bike may also be of benefit. Below are some specific muscle strengthening exercises you can complete. Only complete these if you feel safe to do so. These may cause some discomfort, this does not mean you are causing further problems. However it is not expected to cause significant pain through exercise.

Exercises:

  • Sit on a comfortable chair slowly bend and straighten your knee. Repeat 10 times.
  • Sit on a chair slowly bend and straighten your ankle. Repeat 10 times.
  • Stand, holding on for support, and slowly raise one leg to the side and then relax back to the middle. Repeat 10 times.
  • Stand, holding on for support, and slowly raise one leg behind you. Repeat 10 times.
  • Stand, holding on for support, and slowly raise one knee forward toward your chest. Repeat 10 times
  • Stand, holding on for support, and slowly bend you knees as far as comfortable and then push back up straight. Repeat 10 times.

For further information about hip pain and exercises, visit Versus Arthritis.