What is a hip replacement?
The hip joint is a 'ball and socket' joint - the ball is the rounded top part of the thigh bone (femur). The socket is a cup-shaped depression in the side of the hip bone. The ball fits inside the socket, and moves easily in many different directions.
Hip replacements can be made from a number of different materials, including metal, plastic or ceramic, and are used to replace the ball and socket joint.
Why would a hip replacement be needed?
Rarely, these are performed for reasons such as trauma (eg car accidents) or bone cancer. Usually, though, hip replacements are performed because of wear and tear caused by osteoarthritis. This may arise from trauma caused many years ago, although often no cause can be found. Rheumatoid arthritis can also cause inflammation and damage to the hip joint. The damage to the joint leads to pain, stiffness, and reduced mobility. A successful hip replacement should reduce the pain and increase mobility.
Are there any alternatives to hip replacement surgery?
Generally, your specialist will only perform a hip replacement when all other options have been used and surgery is really necessary.
Such options include painkillers, using a walking stick, physiotherapy, and steroid injections into the joint. As the arthritis worsens, these become less effective and surgery may eventually be needed.
How is a hip replacement performed?
The surgery may be performed under general anaesthesia or spinal anaesthesia (an injection in the spine area makes the body go numb from the waist downward).
A cut is made on the side of the hip, and the damaged ball and socket are removed. The artificial joint is then inserted; a new cup is placed into the hip, and a stem, with a ball on the top, is inserted snugly into the femur. The parts are held firmly in place with special cement or adhesives. The wound is then stitched closed.
What happens after a hip replacement operation?
You will be encouraged to walk soon after the operation, often the next day. Your physiotherapist will help you to mobilise and strengthen the hip, using crutches or a frame at first.
You will usually be able to go home after about 4 to 7 days. Your specialist and physiotherapist will be able to guide you as to how much exercise you can do with the new hip. You should check with your specialist and insurance company before starting to drive again.
A hip replacement lasts for about 15 years; your hip will last longest if you follow the advice of the physiotherapist, maintain regular activity and have a healthy body weight.
What are the risks of hip replacement surgery?
Dislocation of the hip replacement - this may need a small procedure to put the replacement back into place. If the hip keeps dislocating, further surgery may be needed.
Infection - this can lead to loosening of the replacement, which may need antibiotics or even further surgery.
Split of the femur - when the stem of the 'ball' joint is inserted into the femur, a split can occur in the bone. This may need wires to fix the bone or a different replacement being used.
Damage to nerves - this is quite uncommon, but can lead to numbness or weakness in the leg or foot.
Bone forming in the muscle - the hip lays down new bone to mend the surgical area, and in doing so can accidentally put new bone into the surrounding muscles. This can lead to reduced hip movement and may need further surgery.
Leg length difference - your specialist will aim to make both legs the same length, but occasionally this is not possible and a shoe-raise may be needed. This is more likely if the legs were different lengths before the operation.
Blood clots in the legs - clots in the calf (deep vein thrombosis / DVT) occurs in about 1 in 40 hip replacements. These can usually be treated with medication, but a DVT can (rarely) move to the lungs. This can cause breathing difficulty, or even be life threatening.
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Any procedure involving skin incision can also result in unfavourable scarring, wound infection, or bleeding. This list of risks is not exhaustive, and you should discuss possible complications with your specialist. Whilst these risks will seem very worrysome, and indeed can be serious, it should also be borne in mind that many people have no postoperative problems whatsoever.
The information provided is as a guide only and you should discuss matters fully with your specialist before deciding if this is the right procedure for you. Please also read our disclaimer