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UpgradeA hip replacement is a common type of surgery where a damaged hip joint is replaced with an artificial one (known as a prosthesis).
Total Hip replacement surgery is an operation that involves replacing a damaged, worn or diseased hip joint with an artificial joint. Adults of any age can be considered for a hip replacement, although most operations are carried out on people over the age of 50 years.
Hip replacement surgery is a very successful operation in the right patient. It is a good option, but should also be the last option.
Hip replacement should be considered by people with a painful degenerative hip joint. It is usually performed when the hip joint is affected with advanced osteoarthritis or other degenerative condition including inflammatory arthritis. Hip replacement surgery should be considered when non-surgical treatment options like adequate analgesia, physiotherapy, activity modification weight loss, use of a walking stick etc. have been exhausted.
Although, the most common cause of hip joint problem is arthritis, there are other causes such as congenital abnormalities and deformities due to accidents that may require a hip replacement.
The hip joint is one of the most complex joints in the body and is a major weight-bearing joint. It allows us to bend, straighten and rotate, while the ligaments and muscles give stability and balance. Most hip conditions tend to be treated conservatively, at least initially. However, many hip joint problems are progressive and surgery may be inevitable.
Hip replacement surgery is usually performed either under a general anaesthetic (you're asleep throughout the procedure) or under a spinal or epidural anaesthetic (you're awake but have no feeling from the waist down). Spinal or Epidural anaesthesia is generally safer than General anaesthesia, provides better pain relief and the recovery is quicker.
After your initial consultation, your Consultant Orthopaedic Surgeon will give you the details of the clinical condition of your hip joint, review the radiographs of your hip joint with you and then give you the treatment options, both non-surgical and surgical in the form a Total Hip Replacement. If you and your surgeon decide that your hip joint is bad enough to consider having a Total Hip Replacement, you can choose to proceed to having your hip joint replaced with an artificial hip joint. After you have made the decision to have a Total Hip Replacement, you will be given all the details, including the benefits and risks associated with a Total Hip Replacement.
You will be admitted to hospital on the day of your operation. Once you have been admitted, you will be checked by a nurse to confirm your identity, your fasting status, your medication, ensure blood test results are available etc. You will be measured for anti-embolic stockings(TEDs), which promote circulation in the legs and prevent the formation of Deep Vein Thrombosis (DVT) or blood clots. Your Consultant Orthopaedic Surgeon will see you to discuss what will happen and answer any questions you may have.
You will be seen by a physiotherapist before your operation. They will assess your physical condition and prepare a programme to assist you in your post-operative recovery. You will also be measured for crutches.
Before being taken to the operating theatre, you will be asked to change into a rear-fastening gown and wear the TED stockings. You maybe given medication to make you more relaxed. You will be escorted to the operating theatre, anaesthetist will administer the anaesthetic and the operation will be performed.
A cut is made down the side of your hip to expose the hip joint. The head of your thigh bone is resected and replaced with either a metallic or a ceramic head, with a shaft going down your thigh bone. The socket of hip joint is shaved and replaced with either a plastic socket or a metallic socket with a ceramic liner. Adjustments are made to ensure that your hip joint is stable, that your leg lengths are equal and the tension in the muscles around the hip joint is restored. The wound is closed with either stitches or clips and a dressing is applied.
The procedure usually takes between 60-80 minutes, but the whole exercise of taking you down to theatre, giving you the anaesthesia, carrying out the operation, allowing you to recover and return back to the ward could take between 2 to 3 hours.
Hip Replacement surgery is a very successful operation and often considered as the “operation of the century”. The objectives of Hip replacement surgery is to improve your pain, mobility and quality of life.
After you have decided to have a hip replacement, you will have to attend a pre-operative assessment clinic. Here, a registered nurse will assess your fitness for surgery and also give you information on what to expect during your stay in hospital. They will carry out blood tests and/or an ECG and may send you for X-rays. Don’t be alarmed if you must undergo one or more of these investigations – they are undertaken to assess your general health and your fitness for surgery. Your doctors need to know that you are physically able to cope with the surgical procedure.
It is important to discuss any medication you are taking with the nurse. If you are taking blood-thinning tablets, you may have to discontinue them for some time before the operation as they can increase the risk of bleeding and can interfere with your surgery and recovery. You may be told not to take aspirin, ibuprofen and all herbal or homeopathic medicines for several days before your operation. You should take your normal medication up to and including the day of surgery unless you have been given specific instructions by your anaesthetist or your surgeon.
You can expect to be in hospital for 1-2 days. Remember to bring the following items with you into hospital:
After your operation, you'll be moved from the operation theatre to the recovery room for a short period of time. You will be monitored closely in the recovery room by nursing staff. You will be visited by your anaesthetist and your surgeon, and you'll be told how the operation went.
You may feel hazy or groggy as you come round from the anaesthetic and or sedation. You will given oxygen (through tubes in your nose or a mask) to help you feel better.
It is not uncommon to feel sick or vomit after you've been given anaesthesia or sedation. Your nurse may offer you medicine to help with sickness. You may also have a sore throat and a dry mouth. You will be nursed upright and you may be offered a glass of water or even a hot drink.
Your blood pressure will be taken regularly by using an automatic cuff that squeezes tightly at regular times. Your temperature will also be taken and you will be kept warm using a thermal blanket. You will begiven intravenous fluids, which may include antibiotics, prescribed to prevent infection. You may have a plastic suction tube inserted into the hip replacement to drain excess blood from the area.
Once your observations are stable and pain under control, you will be taken back to the ward, where the nurses will continue to monitor you. If you have any pain, be sure to inform the nurses of your discomfort.
In-patient stay
After you arrive on the ward, you will be given food to eat as soon as possible. It is important that you maintain your nutritional levels to enable you to recover well after a hip replacement operation. You must eat first before you start walking. The length of post-operative hospitalization is1-2 days on average depending on your general health.
Mobilization after your operation
You will be encouraged to walk with a zimmer frame after the sensation and strength returns in your legs with assistance from the nursing and therapy staff. You can put full weight through the operated leg. You will practice climbing stairs before you leave hospital.
Coping with pain
You will always have some pain after having surgery. Tell your nurse as soon as you start to feel any pain so they can give you painkilling medication as soon as possible. This will stop the pain from getting worse (medication can take 20 minutes to start working).
Avoiding blood clots
The sooner you start walking, the better. Lying in bed for prolonged periods of time can cause some of your blood to pool in your legs. This puts you at risk of a blood clot.
Doing leg exercises early can help prevent a blood clot. These exercises may be as simple as bending your knees or ankles and rotating your feet.
You may be given special support stockings to wear after surgery to help your blood circulation. Your nurse or doctor will explain how you should use these. You will be given an injection to thin the blood to help reduce the risk of clots.
Blood tests
You will have routine blood tests on the first day after your operation. However, if you are having your operation as a day-case- hip replacement surgery, you will not have any blood tests.
Drain
Your drain will be removed on the first day after your operation. However, if you are having your operation as a day-case- hip replacement surgery, your drain will be removed just before you leave hospital. On some occasions, your surgeon may decide against using a drain.
Deep vein thrombosis prophylaxis
You will be encouraged to wear well-fitting anti-embolic stockings for six weeks after your operation.
You will receive blood-thinning injections during your inpatient stay.
You will be given blood-thinning tablets to take orally for four weeks after your hip replacement operation.
Leaving hospital
You will be discharged from hospital after 1-2 days after surgery. By this time you should be fairly mobile and able to climb stairs with the aid of your crutches. Your GP will be sent a letter giving him information on the hip replacement procedure, your recovery after the operation and your general health on discharge.
It is vitally important that you continue with physio therapy on an outpatient basis. You will be contacted with an appointment for this. You will receive an outpatient appointment to see your Orthopaedic surgeon in three weeks’ time if you had a day-case hip replacement or 6-7 weeks if you had an overnight stay, where your progress will be reviewed.
Discharge advice
You'll also be given advice on the care for your wound, dressings, crutches and the use of painkillers. You will also be given advice on where and when the stitches or clips will be removed.
You will be given the contact details for the ward and you can give the nursing staff a call if you have any concerns after discharge.
Transport home
You won't be able to drive yourself home after surgery. Instead, you could ask your family or a friend to take you home. You will have to have a responsible adult keep a very close eye on you for at least 24- 48hours after having a total hip replacement.
Plan for your stay at home after surgery
It's important to you arrange appropriate care after your operation. Depending on your general health, you will be mobile independently and you are unlikely to require assistance with personal care. However, you will need assistance with cooking, shopping and cleaning for a few weeks after your hip replacement surgery. Your family and friends should keep a very close eye on you for a several weeks after your operation.
You will be seen by the anaesthetist before your operation. He will examine you and discuss the type of anaesthetic that will be used. Quite often, a spinal anaesthetic is used. You will not be put to sleep for this, but it ensures that you are relatively pain-free during the operation. For a while afterwards you will have no feeling in your legs and won’t be able to move them. But when the spinal wears off, function and feeling will return. Spinal anaesthesia has the advantage of having a lower risk of developing deep vein thrombosis (DVT).
It is important that you tell your anaesthetist of any medication that you are currently taking, or have been taking over the previous few days. Certain medications may interfere with the outcome of the procedure, so it is important that you disclose the information. This includes:
The anaesthetist will discuss pain management with you, if it has not already been done at your pre-operative assessment.
Your recovery time can vary and often depends on your general health and physical ability.
You may feel tired for up to three months after your hip replacement surgery. The muscles and tissues surrounding your new hip will take time to heal. Your body will need time to recover from a major surgical intervention.
You should be able to stop using your crutches at 4-6 week safter your hip replacement operation, if not sooner. Your pain and swelling will continue to improve with each passing day and week. Depending on the job you do, you can usually return to work 8-12 weeks after your hip replacement operation. You should liaise with your employer and consider a phased return to work with amended duties for at least 8-12 weeks after returning to work.
You can resume driving when you feel safe enough to do so. This is usually around 4 to 6 weeks after your surgery. You should contact your insurance company and inform them of your circumstances. You should be able to help with light domestic chores within a few weeks after your surgery. You should avoid heavy tasks like vacuum cleaning and changing beds for at least 6 weeks after your surgery. You should avoid prolonged periods of standing or strenuous activity for at least 3 months after your knee replacement surgery.
You should be able to engage in sexual activity 6 to 8 weeks, after your hip replacement surgery. You should avoid vigorous sex and kneeling positions. You could try kneeling at 3 months after your hip replacement. However, the majority of the people who have a hip replacement will have to take precautions with kneeling to avoid dislocation of the hip joint (joint popping out). Please discuss with your surgeon
Your new hip replacement will continue to improve for up to 2 years after your operation.
In the long term, it is best to avoid extreme activities and impact sport. You can take up activities like swimming, cycling, hiking, walking, golf, cross-trainer etc. Your Consultant and your physiotherapist can advise you in detail on the do’s and dont’s after a hip replacement.
Looking after your new hip in the recovery phase:
Enhanced recovery
Research shows the earlier you start eating, drinking and walking after your operation, the better is the outcome. All One Health Group Orthopaedic Consultants offer their patients an enhanced recovery programme which is a rehabilitation programme aiming to get you back to full health quickly.
Physiotherapy
To improve the outcome after your operation, you will receive physiotherapy during your inpatient stay and subsequently after your discharge from hospital. However, it is important to treat the recovery as a shared responsibility between the physiotherapist and you.
The therapist will help you return to normal activities, as well as prevent blood clots, improve circulation, increase range of movement, and eventually strengthen the surrounding muscles through specific exercises. You will also be given advice on practical ways to adjust your lifestyle for the first few months after your hip replacement operation.
Prognosis
Your hip replacement will continue to improve, slowly and steadily for up to 2 years. The long term outcome of your hip replacement is extremely good. Generally, 95% of the patients are happy with their replacements and more than 90% of hip replacement joints last in excess of 10years.
Increasing demand for early discharge after elective hip replacement surgery by patients prompted a review of how this could be facilitated at the One Health.
One Health, in collaboration with BMI Thornbury Hospital is the first Independent Healthcare provider in the country to perform Day-Case Hip Replacements.
If you are suitable for same-day-discharge after a total hip replacement, using pre-defined set criteria, your surgeon will discuss this pathway with you at your initial consultation.
Day-case Hip replacement surgery is associated with better outcomes than inpatient hip replacement in the right patients, by improving patient experience/ satisfaction, and avoiding the risks associated with hospital admission, like post-surgical infections, blood clots etc..
Same-Day-Discharge after Hip Replacement surgery is suitable for approximately 10-15% of patients undergoing a Hip replacement. One Health has clear parameters for patient selection and education, enhanced recovery and a well-defined clinical pathway, which are all key to successful day-case-total hip replacement surgery.
Risks and complications with total hip replacement are similar to those associated with other joint replacements.
The most serious complication is infection of the hip joint, which occurs in <1% of patients.
One Health waiting times from consultation to treatment are 3 - 7 weeks on average.
We have over 30 clinics across the UK with 100+ expert consultants, providing a wide range of treatments to help you get better.
One Health waiting times from consultation to treatment are 3 - 7 weeks on average.
