What is a hip replacement?
Hip replacement – also called hip arthroplasty – is a surgical procedure to replace damaged sections of the hip joint with artificial implants, which are normally made from metal, ceramic or hard plastic. Depending on the extent of the damage or disease in your joint you may be given a total or a partial hip replacement.
With a total hip replacement, your entire hip joint is removed and replaced with a prosthetic implant whereas with a partial hip replacement, only the damaged section of your hip joint is removed and replaced with a prosthetic implant.
Modern prosthetic implants last at least twenty to thirty years in most cases. After this time you may need a revision hip replacement, which means replacing the worn-out implant with a new one. Revision hip replacement surgery generally takes longer than a first time hip replacement and there is a greater risk of complications.
What does hip replacement involve?
Prior to surgery you will undergo a detailed examination with your orthopaedic consultant. This will involve taking your medical history, examining your hip to assess the range of motion in your joint and arranging any scans. You may be given an X-ray or an MRI scan to assess the level of damage in your joint. You may also be given a diagnostic injection of anaesthetic to confirm the precise location of the pain.
On the day of your procedure you will be given a general anaesthetic or epidural, which numbs the lower half of your body. In conventional hip replacement surgery, the surgeon makes an incision along the front or side of your hip. Diseased and damaged bone and cartilage is cut away, leaving healthy bone and tissue. A prosthetic implant is inserted into your pelvic bone and fixed in place. The round ball at the top of your femur is replaced with an artificial ball, which is attached to a stem that fits inside your thighbone.
Once the procedure is completed, the incision is closed and you are moved to the recovery room while the anaesthetic wears off.
Hip replacement surgery is normally offered to people who have significant pain and loss of mobility due to hip pain. Conditions that lead to the need for hip replacement surgery include:
- Hip arthritis – there are several types of hip arthritis. The two most common are:
- Osteoarthritis, which is caused by the cartilage that covers the ends of bones becoming worn and uneven. This cartilage normally helps the joints to move smoothly
- Rheumatoid arthritis, which is an autoimmune disease that results when the body attacks cartilage and sometimes underlying bone, causing damage and deformity in the joints.
- Hip fracture : if the fracture is severe and there is extensive damage to the hip joint, you may be offered a partial or total hip replacement.
- Hip impingement: a problem inside the joint interferes with its normally smooth motion, preventing the ball from gliding smoothly inside the socket. Over time this may cause damage to the cartilage leading to hip impingement. In turn this can result in osteoarthritis, which may require hip replacement surgery.
- Hip dysplasia: this is a congenital problem, which means some people are born with it. It occurs when the hip socket doesn’t fully cover the ball of the femur, leading to cartilage damage and labral tears. In severe cases, a hip replacement may become necessary.
- Hip cartilage injuries: a number of different injuries can occur to the cartilage that covers the surface of the hip joint owing to trauma, wear and tear or damage due to the joint being immobilised. In the most severe cases a hip replacement may be an option.
- Osteonecrosis: this is a disease that restricts the blood supply to the ball part of the femur, causing the bone to become deformed.
Revision hip replacement surgery is offered to people who have previously had hip replacement or partial hip replacement surgery and whose implant is starting to wear out or has failed due to injury, infection or wear and tear.
Recovery from hip replacement surgery and revision hip replacement surgery varies depending on your age and overall health. Staff will help you to get up on your feet within 24 hours of your operation.
Initially you may experience some discomfort when walking and exercising. You may be given an injection to prevent blood clots forming in your legs and a short course of antibiotics to help prevent infection.
A physiotherapist may be able to show you some exercises to help strengthen your hip and prevent damage to your new implant. Most people are able to go home within days of their operation. You will normally return for a follow-up appointment after six to twelve weeks so your consultant can check on your progress.
Depending on the type of work you do and your overall level of fitness you may be able to return to work within six weeks. You can normally drive after six weeks, subject to advice from your consultant.
Revision hip replacement surgery is generally more complicated and time-consuming than a first hip replacement, with a higher risk of complications and longer recovery times. Your consultant will discuss this with you.
Hip replacement and partial hip replacement surgery is extremely common and the results are generally good, with patients reporting relief from pain and increased mobility. You will be given detailed advice on looking after your new hip, such as avoiding bending your hip more than 90 degrees during any activity and avoiding swivelling on the ball of your foot.
Additional care should be taken following revision hip replacement surgery to avoid the risk of complications.