Total Hip Replacement Surgery
What is the aim of this surgery?
Painful arthritis is a debilitating condition that can severely affect our lives, both physically and mentally. When other non-operative measures have been exhausted, such as lifestyle alterations, physiotherapy and painkillers then hip replacement is an excellent pain relieving option. The aim of this surgery is to replace the worn areas of the hip joint. This relieves pain, restores function and aims to return you to an active lifestyle.
Who might benefit from this procedure?
Surgery is considered once non-operative measures for hip osteoarthritis have been tried and your symptoms continue to affect your everyday activities and often your sleep. Because of the inherent risks of surgery* (see section below) it is often a question of when the benefits of surgery outweigh these risks.
What does the procedure involve?
You will come into hospital on the morning of surgery and be admitted by the ward staff. Please remember to bring with you the BOA consent form which will have been provided by our Invicta office team – these can also be downloaded here. Both the anaesthetist and your surgeon will meet with you and go over any questions or concerns you have.
The operation itself takes approximately 1 hour. You will have approximately a 10cm incision over your hip in the region of your buttock. After the operation is completed you will go to recovery before arriving back on the ward. The legs will feel numb and weak for few hours until the spinal anaesthesia wears off. It is usually safe to fully weight-bear on your new hip straightaway. This should only be done with the physiotherapy or nursing team at first.
How long will my recovery be?
It is common to be in hospital for one to three nights following surgery. During this time your analgesia will be tailored specifically to your needs and you will be taught to mobilise safely using crutches. It is common to use crutches for 2 to 6 weeks after surgery. Simple analgesics (Paracetamol and Naproxen) will be prescribed if tolerated and should be taken regularly. You will be given a stronger painkiller for breakthrough pain (Oxynorm or Zomorph). We try to avoid Codeine, Tramadol and Morphine after discharge as they can have significant side effects. Other measures like icing around the hip region can be considered to reduce pain.
You will receive a tailored rehabilitation programme which our physiotherapists will lead you through. These start as gentle exercises to help improve your range of movement, strength and stamina. Access to hydrotherapy and use of an exercise bicycle or elliptical trainer (cross-trainer) is very helpful in the first 4 weeks after surgery.
What are the risks of surgery?
Complications following hip replacement surgery are thankfully rare. More information is available via the specific BOA consent form here.
Infection: The chance of infection is between 0.25% – 0.50%. Infections that only involve the skin usually respond quickly to antibiotics. Should an infection involve the hip replacement itself then further surgery may be necessary, followed by a longer course of antibiotics given intravenously. It is very rarely necessary to remove the hip replacement completely to allow the bacterial infection to be treated. A spacer is commonly put in its place which is loaded with strong antibiotics to treat the infection very aggressively. A new hip replacement would then be implanted once blood tests confirm that the infection has been treated fully.
Deep vein thrombosis (DVT): The risk of a blood clot is less than 1%. We take this seriously because once a clot forms there is a small chance that this could travel to the lung, known as a Pulmonary Embolism (PE) – Although extremely rare a PE can be fatal (1:10,000). To minimize this risk we routinely give you blood thinners for 5 weeks after surgery. Compression stockings should be worn for 2 weeks and you should also aim to be as active as possible. Symptoms of a DVT include worsening pain, swelling and redness of the calf. Please contact us if you are concerned.
Swelling, Bruising and Stiffness: Swelling, bruising and pain around the operative and hip joint are common but will settle. Because swelling tends to follow gravity you may will see swelling and bruising in the thigh and knee. Stiffness is normal after a joint replacement. Your exercise programme from the physiotherapy team will help with this – it is very important to do your exercises religiously. Please contact us if you are concerned.
Nerve and Vasular damage: Damage to the skin nerves that supply sensation to the area around the wound is unavoidable leaving you with numbness of the scar and surrounding area. Thankfully serious injury to major nerves and blood vessels is very rare (less than 0.1%).
Leg Length Discrepancy: Surgeons at the The Invicta Clinic use precise pre-operative digital templating using a system called TraumaCad. This software allows us to accurately analyse your hip and leg anatomy before your surgery in order to place the perfect sized implants in an optimum position. It is always our aim to restore normal leg lengths. Leg length inequality is rare.
Implant Failure: We will only use implants with class-leading long term data when available from our National Joint Registry (NJR) and Orthopaedic Data Evaluation Panel (ODEP). These hip replacements have excellent long-term survival and we would expect them to last at least 20 years. There is always a small risk of the implants loosening earlier than this either from wear or infection. If this occurs then further surgery, known as a Revision Hip Replacement, may be needed.
Hip Implant Dislocation: This is rare occurring in around 1% of cases. Should it become a recurring issue then further surgery or a revision procedure may be necessary.
What are the chances of an improvement in my symptoms?
Hip Replacement surgery is an excellent pain relieving operation for the vast majority of patients. Over 95% of patients report a significant improvement to their pain, mobility and function.
Time off work
Desk-based: Commonly 0-3 weeks (4-6 weeks if your commute is arduous)
Manual Jobs: Commonly 6 weeks
Heavy Manual: Commonly 10-12 weeks
Everyone has a different speed of recovery, however, so these times are just a guide.
Driving after Hip Replacement
From a safety point of view the DVLA state that you should be in control of your vehicle – this means you must be able to safely get in and out and safely perform an emergency stop. A guide is that you should be fully weightbearing without any walking aids and this usually equates to 2-6 weeks after surgery.
Your insurance company may have their own guidelines so please always check with them before returning to driving.
Returning to Sport & Exercise
Your ability to return to your chosen sporting goals will be specifically tailored to you by your surgeon and treating physiotherapist.
In general terms you should allow the hip to fully heal before increasing your level of activity or loading the joint dynamically. There are certain sports that may put extra stress on your new joint and your surgeon may therefore advise you to avoid these. It’s important to discuss any concerns you may have with your specialist prior to surgery and set clear goals with realistic expectations. Contact sports should be avoided as a rule but there are exeptions. Walking can be increased gradually within the pain limits from day one. Water based gentle exercises can be started as soon as able with waterproof dressings for the wound. Swimming can start once you feel safe in the water. Once confident breast stroke is also fine. Water based exercises help to recover immensely and helps to feel the hip near normal or normal soon. Sports that are safer and do not put excess stress on the joint such as Golf, Tennis, Swimmming, Cycling, Skiing, most Gym Classes and Exercise Machines (Exercise Bike, Elliptical Trainer and Rowing Machine)
Hard work with the physiotherapy exercises will be rewarded. Your hip replacement will commonly improve for up to a eighteen months after surgery.
Our In-Hospital physiotherapy team will usually visit you on the day of surgery. If your surgery finishes late in the day then they will visit first thing the following morning. You will be shown the how to mobilise with crutches and be led through the initial exercise programme. It is advisable to take short frequent walks every day, starting with short distances and increasing as your strength and stamina allow.
Once you have left hospital your rehabilitation programme will be managed with visits to the physiotherapy outpatient department as and when required. If you would like to have this closer to home then arrangements can be made – a list of physiotherapists, all of whom we have visited personally, is available here. You will be able to weight-bear immediately and can usually discard your crutches by week 6. Physiotherapy sessions will continue for 10-12 sessions usually. You should persist with your exercise and rehabilitation programme long term if you want to achieve the best outcome.
Going on Holiday around the time of hip replacement
Because of the risks of developing blood clots in the legs (DVT) or lung (PE) it is important that you do not plan for long haul travel (5 hours flight time or longer) either side of your surgery as follows:-Before Surgery – 4 weeks. After Surgery – 12 weeks. Short haul flights should be avoided for 2 weeks before and 6 weeks after surgery.
Hip replacements are made of metal alloys and are likely to set off airport detectors. You should tell the security staff who are well-used to patients following joint replacement surgery. A letter should not be necessary but we are happy to provide one upon request.
Will I need revision surgery?
Newer technology and implant design means that hip replacement now last a long time on average. You can certainly look after your new joint by keeping active and maintaining muscle strength and stamina.
Infections can occur by “seeding” from other sources. An example is a dental procedure. Please inform your dentist before any procedures so that appropriate antibiotics can be given if necessary.