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Hip replacement

Published by Bupa's health information team, September 2008.

This factsheet is for people who are planning to have a hip replacement procedure, or who would like information about it.

Hip replacement involves replacing a hip joint that has been damaged or worn away, usually by arthritis or injury.

Your care will be adapted to meet your individual needs and may differ from what is described here. So it's important that you follow your surgeon's advice.

• Animation - How a hip replacement is carried out
• About hip replacement
• Types of artificial hip
• What are the alternatives?
• Preparing for your operation
• About the operation
• What to expect afterwards
• Recovering from hip replacement surgery
• What are the risks?
• Questions and answers
• Related topics
• Related Bupa products and services
• Further information
• Sources

How a hip replacement is carried out

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About hip replacement

The hip is a ball and socket joint. The ball at the top of your thigh bone (femur) moves in the socket of your pelvis (hip) on a lining of cartilage. If the cartilage wears away, your joint may be painful and stiff.

A new hip joint can help improve mobility and reduce pain.

A hip with arthritis and a hip with a replaced joint

Types of artificial hip

Artificial hip parts can be made of metal, ceramic or plastic. The most common type is a metal ball with a plastic socket.

Hip joints can be fixed in place using a special substance called "bone cement". Alternatively, they may be coated with a chemical that encourages bone to grow into the prosthetic joint fixing it in place. Occasionally the artificial joints may be fixed using bone screws.

What are the alternatives?

Surgery is usually recommended only if non-surgical treatments, such as physiotherapy, taking medicines or using physical aids such as a walking stick, no longer help to reduce pain or improve mobility.

Hip resurfacing is an alternative surgical procedure. In this operation the surfaces of the ball and socket are covered with metal parts.

Your surgeon will explain your options to you.

Preparing for your operation

Your surgeon will explain how to prepare for your operation. For example if you smoke you will be asked to stop, as smoking increases your risk of getting a wound infection and slows your recovery.

The operation usually requires a hospital stay of five days and it's done under general anaesthesia. This means you will be asleep during the operation. Alternatively you may have the surgery under spinal or epidural anaesthesia. This completely blocks feeling from your waist down and you will stay awake during the operation.

Your surgeon will advise which type of anaesthesia is most suitable for you.

If you are having a general anaesthetic, you will be asked to follow fasting instructions. Typically you must not eat or drink for about six hours before a general anaesthetic. However, some anaesthetists allow occasional sips of water until two hours beforehand.

At the hospital your nurse may do some tests such as checking your heart rate and blood pressure, and testing your urine.

Your surgeon will usually ask you to sign a consent form. This confirms that you understand the risks, benefits and possible alternatives to the procedure and have given your permission for it to go ahead.

You will also be asked to consent to placing your name on the National Joint Register, which is used to follow up the safety, durability and effectiveness of joint replacements.

You may be asked to wear compression stockings to help prevent blood clots forming in the veins in your legs. You may need to have an injection of an anti-clotting medicine called heparin as well as, or instead of, stockings.

About the operation

A hip replacement usually takes up to two hours.

Your surgeon will make a cut (10 to 30cm long) over your hip and thigh. He or she will then separate the ball and socket (hip joint).

The top end of the thigh bone is removed and a ball on a stem is placed into the thigh bone. The hip socket is hollowed out to make a shallow cup and an artificial socket is placed into it. The artificial part of the thigh bone can then fit into this socket.

Your surgeon will close the skin cut with stitches or clips and cover it with a dressing.

What to expect afterwards

You will need to rest until the effects of the anaesthetic have passed. You may not be able to feel or move your legs for several hours after an epidural anaesthetic.

You may need pain relief to help with any discomfort as the anaesthetic wears off.

A special pillow may be placed between your legs to hold your hip joint still and stop it from separating (dislocating).

For the first day or so, you may have an intermittent compression pump attached to special pads on your lower legs. By inflating the pads, the pump encourages healthy blood flow and helps to prevent deep vein thrombosis (DVT). You may also have compression stockings on your legs. These help to maintain circulation.

Starting from the day after your operation, a physiotherapist (a specialist in movement and mobility) will usually guide you daily through exercises designed to help your recovery.

You will stay in hospital until you are able to walk safely with the aid of sticks or crutches. This is usually about five days.

When you are ready to ready to go home, you will need to arrange for someone to drive you home. You should try to have a friend or relative stay with you for the first week.

Your nurse will give you some advice about caring for your hip and a date for a follow-up appointment before you go home.

Dissolvable stitches will disappear on their own in seven to 10 days. Non-dissolvable stitches and clips are removed 10 to 14 days after surgery.

Recovering from hip replacement surgery

If you need them, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Follow the instructions in the patient information leaflet that comes with the medicine and ask your pharmacist for advice.

The exercises recommended by your physiotherapist are a crucial part of your recovery, so it's essential that you continue to do them.

There are certain movements that you shouldn't do in the first six weeks. For example, you shouldn't cross your legs or twist your hip inwards and outwards. Your physiotherapist will give you further advice and tips to protect your hip.

You will be able to move around your home and manage stairs. You will find some routine daily activities, such as shopping, difficult for a few weeks and you will need to ask for help. You will need to use crutches for about six weeks.

You may be asked to wear compression stockings for several weeks at home.

You can usually return to work after six to eight weeks. But if your work involves a lot of standing or lifting, you may need to stay off for three months.

Follow your surgeon's advice about driving. You shouldn't drive until you are confident that you could perform an emergency stop without discomfort.

Your hip will continue to improve for at least six months.

What are the risks?

Hip replacement is commonly performed and generally safe. However, in order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications of this procedure.

Side-effects

These are the unwanted, but mostly temporary effects of a successful treatment, for example feeling sick as a result of the general anaesthetic.

Your hip will feel sore for several weeks and you may have some temporary pain and swelling in your knee and ankle.

Complications

This is when problems occur during or after the operation. Most people are not affected. The possible complications of any operation include an unexpected reaction to the anaesthetic, excessive bleeding or developing a blood clot, usually in a vein in the leg (DVT).

Specific complications of hip replacement are uncommon, but can include those listed below.

• Infection of the wound or joint. Antibiotics are given during and after surgery to help prevent this.
• Joint dislocation. This is most likely to happen immediately after your surgery and you may need another operation to treat this.
• Difference in leg length. Your leg may be slightly shorter or longer and you may need to wear a raised shoe on the shorter side to correct your balance.
• Hip fracture. Tiny cracks can occur in your bone while fitting the new joint. These usually heal, but sometimes the bone can fracture and require further surgery.
• Unstable joint. The hip joint may become loose and you may require further surgery to correct this.

The artificial hip joint usually lasts for 10 to 15 years, after which you may need to have it replaced.

The exact risks are specific to you and will differ for every person, so we have not included statistics here. Ask your surgeon to explain how these risks apply to you.

Related topics

• Caring for surgical wounds
• Compression stockings
• Deep vein thrombosis
• Epidurals for surgery and pain relief
• General anaesthesia
• Hip resurfacing
• Local anaesthesia and sedation

Further information

• Arthritis Research Campaign
  0870 850 5000
  www.arc.org.uk

Sources

• A new hip joint. Arthritis Research Campaign. www.arc.org.uk, accessed 11 February 2008
• Single mini-incision hip replacement. National Institute for Health and Clinical Excellence (NICE), 2006, Interventional Procedure Guidance 152. www.nice.org.uk
• Minimally invasive two-incision surgery for total hip replacement. National Institute for Health and Clinical Excellence (NICE), 2005, Interventional Procedure Guidance 112. www.nice.org.uk
• Huo MH, Gilbert NF, Parvizi J. What's new in total hip arthroplasty. J Bone Joint Surg Am 2007;89:1874-1885. www.ejbjs.org
• Kwon MS et al. Does surgical approach affect total hip arthroplasty dislocation rates? Clin Orthop Relat Res 2006;447:34-38. www.clinorthop.org/index.html
• Brander V, Stulberg SD. Rehabilitation after hip- and knee-joint replacement: an experience- and evidence-based approach to care. Am J Phys Med Rehabil 2006;85 (Suppl):S98-S118. www.amjphysmedrehab.com
• McLatchie GR, Leaper DJ. Oxford Handbook of Clinical Surgery. 2nd ed. Oxford: Oxford University Press, 2007: 649-650

This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Mr Stephen Cannon, MA, MCh Orth, FRCS, MRCOG, Spire Bushey Hospital, Bushey, and by Bupa doctors. It has also been reviewed by Arthritis Research Campaign. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

Publication date: September 2008