What is a Hip Replacement?
A hip replacement, or arthroplasty, is the surgical procedure in which the diseased parts of the hip are removed and replaced with an artificial joint. The new hip joint, also called the prosthesis, is made up of two parts:
- One to replace the head of the femur (the ball part of the thigh bone) which fits into the acetabulum
- Another which replaces the acetabulum (the socket) and is fitted into the pelvic bone.
What should you expect from your Hip Replacement?
Due to the advances made in recent years, the majority of patients find that after their hip replacement they experience significant pain relief and improvement in movement. This means that they find everyday functions such as sitting, walking and driving much more comfortable than before.
However, the results will not be immediate and after your stay in hospital a full recovery can be expected to take between 3 and 6 months depending on the type of surgery you have, your overall health and how well you rehabilitate.
How long the replacement hip lasts can depend on many factors, although it is true to say that most patients will never need to have another operation. The amount of activity you undertake may have a bearing on the life of the joint, as will your weight. Overall a replacement hip might be expected to last fifteen to twenty years.
The Operation
You will have a general anaesthetic, or occasionally for medical reasons, a regional (spinal anaesthetic) and sedation. The operation will take between 1 and 2 hours.
The operation begins with an incision of about eight inches long over the hip joint. The ball and socket are removed and the new artificial parts fitted.
Your hip replacement may be put in with a grout referred to as bone cement – a “cemented” procedure. Alternatively an “uncemented” procedure is used in which the artificial joints have thousands of tiny holes that allow the bone to grow into and hold the new parts in place.
On occasion a “hybrid” replacement is used, which consists of a cemented ball and an un-cemented socket. The type of hip replacement you receive will usually have been discussed with you prior to the operation.
You may need a blood transfusion due to blood loss during the operation.
After the operation
You will be transferred to the recovery room where you will remain until Professor Haddad and the anaesthetist are satisfied that you have recovered sufficiently before you are transferred back to the ward.
You will have:
- A drip, (a fine tube) inserted into a vein in your arm that supplies fluids or blood.
- The dressing on your hip will have a tube attached to it which helps remove any blood from the hip joint, but the tube will be removed after a day or two.
- Your movement will be quite restricted as your hip will be held in place with a special pillow.
Pain relief
Good pain relief is important and some people need more pain relief than others. It is much easier to relieve pain if it is dealt with before it gets bad.
Pain relief can be increased, given more often, or given in different combinations. You should ask for help when you feel pain.
Physical activities after your operation
A physiotherapist will visit you regularly throughout your stay in hospital to advise and assist you with a series of exercises.
These will help with breathing and circulation as well as building strength back into your leg muscles.
Your range of movement will increase in the days following your surgery and you will soon be able to sit up, stand and then take a few steps
You will get out of bed and start walking either on the same day of the surgery or the next day.
You will receive injections of a drug such as Heparin which helps prevent blood clots.
General precautions
The hip replacement that you have had is an artificial joint. It is therefore important that you take necessary precautions to prevent complications.
Listed below are some precautions to be taken particularly in the first 6-8 weeks are. Your physiotherapist will discuss these and others with you in greater detail prior to your discharge from hospital as well as during your follow up visits post surgery.
- Contact your doctor if you notice any redness, leaking fluid or have an increased pain in the operated area
- Do not bend the hip more than a right angle as this could cause the hip to dislocate or pop out of the joint.
- Avoid low chairs and toilet seats.
- Do not bend down to the floor to pick up objects.
- Do not force the hip to bend to reach your toes such as to clip your toe nails or put on your stockings.
- Do not twist the hip.
- Do not cross your legs.
- Do not lie on your side for the first 6 weeks.
- In the longer term, there is a small risk of spread of infection to the hip should you have an infection anywhere else in the body, if you are undergoing an operation, internal examination or even dental work.
Remember to inform your doctor/dentist, if you need to undergo an operation, internal examination or even dental so that they can consider putting you on antibiotics as preventative a measure.
Possible Complications
This is a very successful operation, but there are some risks associated with any procedure. For a hip replacement they include:
Anaesthetic – Modern anaesthetics are generally very safe. The anaesthetist will explain any particular risks to you.
Infection – There is a small risk of infection of the joint following the operation but you will be given antibiotics to help prevent this. If after you get home you notice fever, increased pain, swelling and redness around the wound, please phone contact our office.
Deep vein thrombosis (a blood clot in a leg vein) – You may have anti- coagulant medication and support stockings to help prevent it. A symptom of this may be an acute pain in your calf. Please contact us urgently.
Dislocation – The risk of dislocation is at its highest when the muscles around the new hip joint are still healing and relatively weak.
A hip that dislocates more than once may need to be operated on again so it is very much in your interests to follow the advice you are given.
Other recognised complications include fractures and nerve injuries both of which are fortunately rare.
All patients will need a full blood count on day 1 and again days 4 and 7 if still in Hospital for thrombocytopenia although the incidents of HIT with low dose prophylaxis seems to be much lower than initially feared.
Hip Replacement Programme
It is generally accepted that hip resurfacings and hip replacements should be kept under surveillance so that potential problems are identified at an early stage.
The hip review programme has been established to monitor the performance of your artificial hip.
The Review programme consists of three elements
- Regular questionnaires via post/ e-mail to monitor how your artificial hip is affecting your lifestyle
- Clinical examinations to assess joint movement, muscle function and walking ability
- X-Ray examinations to check on the condition of your artificial hip and bone around it
Below is a summary of when each review should take place
- X- ray and clinical assessment 1 year after surgery
- X- ray every two years after that
- Yearly questionnaire
Repeat clinical assessment at 5 years, 10 years and 15 years…..
Please talk to Professor Haddad before your operation if you have concerns about possible risks.
We hope the information provided has been of benefit to you. For further information please contact us on 0207 935 6083.