Do I need surgery?
Hip replacement (also known as hip arthroplasty), is a surgical procedure to replace a damaged or worn-out hip joint with an artificial joint.
The procedure is recommended only for those who are experiencing severe pain, stiffness, limited mobility and a reduced quality of life for conditions such as osteoarthritis, rheumatoid arthritis and post-traumatic arthritis.
What are the alternatives to surgery?
- Painkillers
- Weight loss
- Physiotherapy
- Steroid injections
- Walking aids
Why have a hip replacement?
The main aim of hip replacement is to improve pain. The majority of patients are pain-free following hip replacement.
Stiffness in the hip will also improve but this is a slower process than the pain-relief which is quite quick.
People often report a dramatic increase in their quality of life following hip replacement as a result of their decreased pain and improved mobility.
How long does a hip replacement last?
Mr Brock uses hip replacements from the company Stryker (Exeter cemented femoral stems, rimfit X3 cemented cups, trident I & II uncemented cups, metal and ceramic 28/32/36/dual mobility heads). They can be utilised using a manual technique or by using robotic surgery. The implants Mr Brock uses have an excellent track record and survivorship in National Joint Registries.
Most hip replacements will last 20 years or more. This number is decreased if you are (i) younger (ii) overweight (iii) participate in manual labour or heavy exercise.
What is the process like?
Mr Brock will see you in clinic. He will take a detailed history about your symptoms and medical history. He will perform a physical examination and request x-rays of your hip. If you are having a robotic procedure you will also need a CT scan of your hip.
The benefits and the risks of hip replacement will be discussed in clinic. You will also have a pre-assessment appointment where your fitness for surgery will be assessed.
You will come in on the day of your procedure fasted. Mr Brock will see you that morning and make sure you are happy to procede with surgery. The anaesthetist will also talk to you.
You will receive a spinal anaesthestic and sedation prior to your surgery. The procedure takes between 45 minutes and 2 hours depending on the complexity.
You will then be transferred to the ward for rehabilitation and monitoring.
How long am I in hospital?
Mr Brock is able to offer day-case surgery for hip replacement for some patients (please see day case section).
Otherwise, patients are usually in hospital between 1 and 3 days. You are seen by physiotherapists and occupational therapists to determine that you are safe to go home prior to discharge.
You are seen at two weeks by a nurse to check your wound. The sutures are all dissolvable.
You will then be seen back in clinic at six weeks. If you are doing well, you will be discharged at that point, but on some occasions you will be seen at 3, 6 and 12 months.
When can I return to work?
Whilst everyone is different, most people with desk-based jobs will be back at work after six weeks. People who do a lot of standing or manual work may need three months off work.
Some people that do heavy manual work will need to discuss with their employer doing less vigorous work on a long-term basis.
Looking after your hip replacement
You need to be careful with your movements in the first six weeks after surgery as this is when the risk of dislocation is highest. You should avoid extremes of movement. The physiotherapist will go through this with you.
Swelling in the leg is common after hip replacement and this will improve with time and increased movement. If this persists it is worth seeing a medical professional to ensure there is not an associated blood clot (deep vein thrombosis).
You will start mobilising with sticks and usually by six weeks the majority of people can walk unaided again.
You will be safe to drive when you are able to perform an emergency stop. This is generally at around six weeks following surgery. It is important to check with your insurance company that you are covered during your recovery.
Can I still exercise after hip replacement?
Yes. Low-impact sport is preferred such as swimming, cycling, golf and cross-training. Sport that has a high risk of falling and extreme movement should be performed with caution as there is a risk of dislocation. Higher-impact sports done regularly may reduce the lifespan of the hip replacement.
What are the risks of hip replacement?
Most operations are successful. However, hip replacement is a major operation and there is a risk of complications. Fortunately, most complications are minor and can be successfully treated.
Blood clots affecting the leg (deep vein thrombosis) and lung (pulmonary embolism) can occur following surgery as a result of the changes to the way the blood flows and clots during and after surgery. We try to minimise the risk of this by fitting special compression stockings to the other leg during surgery and by giving you medication to thin the blood for the first 28-32 days following surgery. Blood clots can be treated effectively with medication. In rare cases a blood clot on the lung (pulmonary embolism) can be fatal.
Leg length discrepancy following hip replacement can occur. Normally it is the operated leg that feels longer. This sensation usually improves in the first six months as the muscles around the pelvis readjust. If this continues an orthotic in one of your shoes may be required.
Dislocation of the hip occurs in 1 in 100 patients. This is more common in the first six weeks following surgery. If this happens several times revision (re-do) surgery may be indicated.
Infection in the hip replacement can occur in 1 in 100 patients. This can occur early following surgery or at a later date. Treatment involves an operation to wash the hip out and antibiotics. In some instances revision (re-do) surgery is required.
Nerve and vessel damage is uncommon. A nerve injury occurs in less than 1 in 100 patients and is usually temporary. A blood vessel injury occurs in 1 in 1000 patients and usually needs further surgery to repair.
Fracture to the bone during surgery is rare but is normally associated with patients who have weak bones (osteoporosis).
The hip replacement can wear out / loosen over time and require more surgery. At 25 years, it is estimated between 58-78% of hip replacements are still functioning. Factors that increase the wear rate are (i) younger age (ii) being overweight (iii) participating in manual labour or high-impact sport.