Total Hip Replacement

01About the operation

The hip is a ball-and-socket joint: the rounded top of the thigh bone sits in a cup-shaped socket in the pelvis. Both surfaces are lined with cartilage, a tough, smooth tissue that lets the joint glide. When that lining wears thin or is damaged, bone grinds on bone and the hip becomes painful and stiff.

A replacement is usually considered when pain and stiffness are affecting everyday life and other treatments have stopped helping. Osteoarthritis is the most common reason. The operation can also help when the hip has been damaged by rheumatoid arthritis, or by a fall or other injury.

It is done in hospital, and full recovery takes a few months. The new joint is expected to last 15 years or more.

02Treatments to try first

Surgery isn’t usually the first step. Your GP or specialist will normally suggest other options first, such as:

• losing weight, if you’re overweight, to take some load off the joint
• regular low-impact exercise, such as walking, cycling or swimming, and exercises to strengthen the muscles around the hip; a physiotherapist can help with these
• a walking aid
• supportive footwear or shoe insoles
• painkilling tablets, gels or creams
• a steroid injection into the joint to ease pain and swelling

If these no longer keep your symptoms under control, a hip replacement may be the next step.

03Getting ready for surgery

Waiting times for joint replacement can be long, and the time is worth using. Being as fit as you can before the operation may lower the risk of complications and help you recover faster. That can mean:

• doing the strengthening exercises you’re given, before and after the operation
• losing weight, if you need to
• stopping smoking
• eating well and keeping alcohol within the recommended limits

The pre-admission check

A few weeks before surgery you’ll usually be seen at a pre-admission clinic, to make sure you’re well enough for the operation. You may have blood and urine tests, X-rays and an ECG (a tracing of your heart), and you can meet the team and ask questions.

Getting your home ready

• Line up help with shopping, cooking and other everyday jobs.
• Move things you use often to where you can reach them easily.
• Fill the freezer with ready meals.
• Arrange lifts: you won’t be able to drive for at least six weeks.
• Talk to your employer about time off and a plan for going back.
• Get equipment that makes life easier, such as a raised toilet seat or a long-handled grabber. The hospital team can tell you where to find it.

04The operation

Most people come into hospital on the day of surgery. The operation is done under either a spinal anaesthetic, which numbs you from the waist down while you stay awake (often with a sedative to help you relax), or a general anaesthetic, which puts you to sleep.

It usually takes one to two hours. The exact technique depends on how badly the hip is damaged, what caused the damage and your general health. Some operations can be done through smaller incisions, known as a minimally invasive approach, but this isn’t suitable for everyone.

Step by step

1. 1An incision is made at the side or back of the hip.
2. 2The joint is opened and the damaged ball at the top of the thigh bone is removed.
3. 3A new ball, usually metal and sometimes ceramic, is fixed to the top of the thigh bone.
4. 4The socket is shaped and fitted with a new cup, usually plastic and sometimes ceramic.
5. 5The new ball is fitted into the new socket.
6. 6The wound is closed with stitches or clips and covered with a dressing.

You’ll then be looked after in the recovery area until the anaesthetic wears off, with pain relief as you need it.

Types of hip replacement

Total hip replacement

Both the ball and the socket are replaced. This is the most common type.

Partial hip replacement

Only the ball is replaced and the socket is left as it is. Recovery tends to be quicker, but the joint doesn’t usually last as long. It may be offered after a serious hip injury, or to people who are frail or in poor health.

Hip resurfacing

Instead of removing the ball, the surgeon trims its surface and caps it with metal. It needs strong bone, so it’s generally offered to people aged around 50 or younger.

The National Joint Registry

After the operation you’ll be asked whether details of you and your new joint can be added to the National Joint Registry (NJR). The registry monitors joint replacements to improve patient safety and results. You can see Mr Syed’s NJR surgeon profile (opens in a new tab).

05Recovery

Recovery takes several months, and how quickly you progress depends partly on your age and general health. Following the advice you’re given makes a real difference.

In hospital

Your hip will be sore at first, and you’ll have regular painkillers. You may have a thin tube (a drain) in the wound for a short time. Nurses and physiotherapists will help you get up and walking as soon as possible, with a frame or crutches to begin with.

Going home

You can go home once the wound is healing well and you can get around safely, which for most people who are generally fit is one to three days after the operation. Before you leave, a physiotherapist or occupational therapist will go through everyday tasks with you and give you exercises for home. Keeping them up in the early weeks pays off in long-term strength and movement.

Some pain and swelling in the leg and foot is normal and usually settles over a few weeks. Stitches or clips normally come out after about 10 days, and you’ll have a check-up six to twelve weeks after the operation.

06Risks and complications

Hip replacement is generally a safe operation, but like any surgery it carries some risks. Your surgeon will go through them with you before you decide to go ahead.

Blood clots

A clot can form in a leg vein (deep vein thrombosis, or DVT) after surgery. Occasionally part of it travels to the lungs (a pulmonary embolism), which is serious. You’ll usually be given compression stockings to lower the risk, and clots can be treated with blood-thinning medicine.

Infection

There’s a small chance the wound becomes infected. This is usually treated with antibiotics, but an infection that reaches deep into the joint may need another operation.

Difference in leg length

The operated leg can end up slightly longer than the other. Surgeons take care to avoid this, and any difference is usually too small to notice; occasionally a raised shoe on the other side helps.

Damage to nerves or tissue

A nearby nerve, blood vessel or ligament can be damaged during surgery. This is uncommon, and can usually be repaired at the time or heals afterwards.

Dislocation

The ball can occasionally slip out of the socket, either soon after surgery or years later. It’s uncommon, but can cause pain, swelling, or clicking from the joint, and may need further surgery.

Wear

Over many years the parts can wear, causing pain or swelling. A worn joint may need to be replaced in a second (revision) operation.

Metal-on-metal implants

Some older hip replacements used a metal ball in a metal socket, which can wear in ways that cause health problems. If you have one, you should have regular check-ups, and contact your GP or care team about new hip pain, reduced mobility, or clicking or popping from the joint.