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Hip replacementPublished by BUPA's health information team, healthinfo@bupa.com, July 2007 This factsheet is for people who are considering having a hip replacement operation. Your care may differ from what is described here because it is adapted to meet your individual needs.
What's involved?A hip replacement operation involves replacing a hip joint that has been damaged or worn away, usually by arthritis or injury. The hip is a ball and socket joint. The "ball" is formed by the top of the thigh bone. This fits into a "socket" (acetabulum), which is part of the pelvis. Normally, the ball moves smoothly in its socket on a lining of shock absorbing articular cartilage. If the cartilage is worn away, it can make the joint painful and stiff. A new hip joint can help improve mobility and reduce pain.
Types of artificial hipThere are many different types of artificial hip parts made of metal, porcelain or plastic. Some need special substance called "bone cement" to keep them in place. Other types of artificial hip parts are coated with a chemical that encourages bone to grow into it to hold the components in place. Alternatively, the artificial parts may be attached directly to the bone with screws. A cemented hip replacement usually lasts for at least 10 years, after which it may need to be replaced. Artificial joints that are fixed directly to the bone may last even longer. What are the alternatives?Surgery is usually recommended only if non-surgical treatments, such as taking medicines to reduce pain and inflammation or using physical aids like a walking stick, no longer help. There are alternative operations depending on how badly your hip joint is damaged - such as a hip resurfacing operation, which retains more of the original bone. Instead of removing the head of the thigh bone and replacing it with an artificial ball, the diseased or damaged surfaces of the hip joint are replaced with metal surfaces. The hip resurfacing operation generally has a quicker recovery time but it is not suitable for everyone. Your surgeon will explain your options to you. Preparing for your operationYour doctor will discuss how to prepare for your operation. For example, if you smoke you may be asked to quit, as smoking will increase your risk of getting a chest or wound infection and slow your recovery. What to expect in hospitalBefore surgery you will talk to your surgeon about the operation and you will be asked 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. 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. The operation
A hip replacement is a major operation that takes up to two hours. It is usually performed under a general anaesthetic. This means that you will be asleep during the procedure and will feel no pain. Alternatively, the surgery can be carried out under an epidural or spinal anaesthesia (using local anaesthetic injected into the lower back) that completely blocks feeling from the waist downward but you will be awake. Once the anaesthetic has taken effect, your surgeon will make a single cut (20 to 30cm long) over your hip and thigh. The length of the cut may be shorter depending on the technique your surgeon is using. The top end of the thigh bone will be removed and a ball on a stem will be placed into the thigh bone. The hip socket will be hollowed out to make a shallow cup and an artificial socket will be placed into it. The artificial part of the thigh bone can then fit into this socket. Your surgeon will close the wound with stitches or clips and cover it with a dressing. What to expect afterwardsYou will be given painkillers to help relieve any discomfort as the anaesthetic wears off. If you have an epidural anaesthetic, you may not be able to feel or move your legs for several hours after your operation. You won't have any pain either. A special pillow may be placed between your legs to hold the new joint still and help prevent dislocation. On the first day, you may have to wear special pads, attached to an intermittent compression pump, on your lower legs. The pump inflates the pads and encourages healthy blood flow in your legs and helps to prevent DVT. You may also have compression stockings on your legs to help maintain circulation. Starting from the day after your operation, a physiotherapist will usually visit daily to help you with 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 will usually be around five days after your operation. Before going home, your nurse will give you advice about caring for your stitches, hygiene and bathing. After you return homeContinue to take your painkillers if you need to, as advised by your surgeon. You may be asked to continue wearing your compression stockings for a few weeks at home. They are difficult to put on and take off and you will need someone to help you with this. 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 should not do in the first eight weeks. For example, you should not bend your hip more than a right angle 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. Follow your surgeon's advice about driving. You shouldn't drive for at least six weeks. You can usually return to work after six weeks. But if your work involves a lot of standing or lifting, you may need to stay off for three months. What are the risks?A hip replacement is a commonly performed and generally safe surgical procedure. For most people, the benefits are far greater than the disadvantages. 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. Side-effectsThese are the unwanted but mostly temporary effects of a successful procedure. After a hip replacement, your hip will feel sore for several weeks. There may also be some temporary pain and swelling in the knee and ankle. ComplicationsComplications are when problems occur during or after the procedure. Most people are not affected. The main complications of any operation are bleeding during or soon after the procedure, infection and an abnormal reaction to the anaesthetic. Some of the complications specific to a hip replacement are listed here.
A hip replacement usually lasts for 10 to 15 years, after which you may need a repeat operation to replace it. However, repeat hip replacements are more complicated than the original hip operation, and the results may not be successful. You should ask your surgeon to explain how these risks apply to you. The exact risks will differ for every person. This is one of the reasons why we have not included statistics here. Further information
Sources
Related topics
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 BUPA doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional. Publication date: July 2007. Expected review date: July 2009.
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