Total Hip Replacement

Hip replacement surgery, also known as hip arthroplasty, replaces a severely damaged hip joint with an artificial ball and socket. For people whose hip has worn beyond repair it is one of the most reliable operations in orthopaedics, removing arthritic pain and restoring movement.

The benefits of hip replacement

Hip replacement can provide several benefits for people with hip joint damage or pain:

• Pain relief: the operation can significantly reduce or eliminate pain in the hip joint.
• Improved mobility: afterwards patients are able to move more easily and take part in activities that were previously difficult or impossible.
• Increased independence: with better mobility and less pain, daily activities can be performed more independently.
• Better quality of life: reducing pain and increasing activity improves overall quality of life.
• Long implant lifespan: with advances in technology and materials, an implant can last more than 20 years.

The procedure

The hip is a ball and socket joint. It allows a great deal of movement while also carrying your weight, which is why it is prone to wearing away — a simplified explanation of why arthritis occurs. Arthritis can be very painful, slowing your walking or even stopping you sleeping. A hip replacement swaps the severely damaged bone for an artificial ball and socket that performs the function of the natural joint, which may reduce pain and help with walking and sleeping.

If you hold any x-rays, please bring them with you when you come into hospital.

Your surgeon will visit you before the operation, which is a good time to ask any questions, and will mark your leg with a felt pen to make sure the correct side is operated on. An anaesthetic is given in theatre. This may be a general anaesthetic, where you are asleep, and/or a regional block such as an injection into the spine, where you are awake but the area is completely numbed. Discuss this and its risks with the anaesthetist, and tell them about any allergies.

You will lie on the side opposite the one being operated on. Your skin is cleaned with antiseptic and sterile drapes are placed around the hip. The surgeon makes an incision, the exact position and length of which depends on the surgeon’s technique and on your leg, then works through the fat and muscle overlying the hip bones. The top of the thigh bone (femur), which forms the neck and ball, is cut away and a replacement stem and ball are placed in the remaining thigh bone. The socket is drilled smooth, removing as much arthritic bone as possible to create a clean base for the new cup. In some cases special bone cement holds the stem and/or cup in position. Implants are made from a range of materials including different metals, polyethylene and very tough ceramic. When satisfied with the position, the surgeon closes the wound and then the skin, using either stitches or metal clips — both are equally successful and the choice comes down to surgeon preference.

When you wake you will feel sore around the hip, which is normal, and you will be encouraged to start walking as soon as possible with the help of the physiotherapists. An x-ray and blood tests may be taken within 48 hours.

Mr Chauhan participates in the National Joint Registry, and every joint inserted requires assessment with a questionnaire. Before and after surgery you will be asked to complete forms on your progress, which are used to assess your outcome and are sent to the Registry.

Hip replacement is a major procedure and recovery can take several weeks to several months. Clear communication with your surgeon and careful attention to the post-operative instructions matter a great deal.

Alternatives to hip replacement

• Losing weight
• Stopping strenuous exercise or work
• Physiotherapy and gentle exercises
• Medicines, painkillers or anti-inflammatories such as ibuprofen or steroids
• Using a stick or a crutch
• Arthroscopy
• Injections into the hip joint
• Hip fusion (arthrodesis)

Some of these are not appropriate if you want to regain as much physical activity as possible, but you should discuss all the possibilities with your surgeon.

Risks of hip replacement

Common

• Pain: the surgical site will be quite sore afterwards. Tell the staff if you are in pain so that medicines can be given. Pain improves with time. Rarely it becomes a chronic problem, which may be due to one of the complications below or to no obvious cause.
• Bleeding: a blood transfusion or iron tablets may occasionally be required. Rarely, bleeding forms a blood clot or large bruise which may become painful and require an operation to remove it.
• Deep vein thrombosis: a blood clot in a vein. The risk is greater after any surgery, and especially bone surgery. A DVT can travel in the bloodstream and lodge in the lungs as a pulmonary embolism, a very serious condition affecting your breathing. Medication may be given to limit the risk, and some centres use stockings or foot pumps. Walking and moving early is one of the best ways to prevent clots forming.
• Hip stiffness: may occur after the operation, especially if the joint was stiff beforehand. Manipulation of the joint under general anaesthetic may be necessary.
• Prosthesis wear: modern techniques and implants mean most hip replacements last over 15 years, though in some cases significantly less, often for reasons that are unknown. Implants can wear from overuse and there is still debate about which material is strongest. Loosening is sometimes caused by secondary infection, which may require removal of the implant and revision surgery.
• Joint dislocation: usually the joint can be put back into place without surgery. Sometimes an operation is required, followed by a hip brace, or rarely a revision operation if the hip keeps dislocating.
• Altered leg length: the operated leg may appear shorter or longer than the other. This rarely requires a further operation or shoe implants to correct.

Less common

• Infection: antibiotics are given at the time of the operation and the procedure is performed in sterile theatre conditions with ultraclean airflow, but infections still occur in 1 to 2% of cases. The wound may become red, hot and painful, sometimes with a discharge of fluid or pus. This is usually treated with antibiotics, and an operation to wash out the joint may be necessary. In rare cases the prosthesis is removed and replaced at a later date. Infection can sometimes lead to sepsis, requiring strong antibiotics.

Rare

• Altered wound healing: the wound may become red, thickened and painful (a keloid scar), especially in Afro-Caribbean patients.
• Nerve damage: efforts are made to prevent this, but damage to the nerves around the hip is a risk and may cause temporary or permanent altered sensation along the leg. In particular the sciatic nerve may be damaged, which can cause temporary or permanent weakness or altered sensation.
• Bone damage: bone may be broken when the prosthesis is inserted, which may require fixation either at the time or at a later operation.
• Blood vessel damage: nearby vessels may rarely be damaged and may require further surgery by a vascular surgeon.
• Pulmonary embolism: the spread of a blood clot to the lungs, which can affect your breathing and can be fatal.
• Death: this very rare complication may occur after any major surgery and from any of the above.