A hip replacement involves removing the worn end of both the thigh bone (femur) and hollowing out the socket (acetabulum). A metal cup is then inserted in to the socket and a metal stem with a smooth ball on top is inserted in to the hollow of the femur bone.
Both the stem and cup can be either cemented in place or pressed tightly in to the bone so that new bone grows on to the surface of the implants. Which is better for you depends on your age and bone quality and can be discussed with you prior to surgery.
The metal cup has a liner inside and this can be made from a strong plastic or ceramic. The ball on top of the stem is either metal or ceramic. A metal head with plastic liner is the safest option for most patients but young patients may wish to discuss the pros and cons of ceramic surfaces.
The most common reason for a hip replacement is pain that has failed to respond to non-operative measures such as simple analgesia & activity modification. It will usually be limiting your normal daily activities and may be keeping you awake at night.
Stiffness may play a role but usually in association with pain. This may present as difficulty with your shoes and socks or getting into or out of the car.
Patients often have a significant limp and this can take a long time to resolve after surgery.
Most hip replacements are performed under a spinal anaesthetic, where the legs are numbed from an injection of local anaesthetic into the back. This can be combined with sedation if you prefer not to be aware of the surgery. Occasionally a general anaesthetic is used for various medical reasons, but ultimately this is the decision of the Anaesthetist looking after you and can be discussed with them prior to surgery.
A scar will run down along the side of the hip. This is closed with a dissolvable suture under the skin with additional paper stitches (like pieces of tape) on top. It is normal to have an area of numbness but this should diminish over 12 - 18 months. The scar itself is quite red and raised initially and matures over 6 - 12 months when it will be flat and slightly lighter than the surrounding skin.
The dressing can remain in place for several days & only if it leaks blood will the nurse change it. As a general rule, the less the wound is interfered with, the better. It is fine to shower but avoid getting too much water directly on the dressing. The paper stitches can remain in place for 2 weeks. At this point, you can shower without the dressing on & the paper stitches will peel off easily when wet.
At the end of the procedure, some local anaesthetic is injected around the hip joint. This will usually ensure minimal pain following the surgery. As the local anaesthetic begins to wear off (usually after 12 - 24 hours), discomfort can return. This can be minimised with a combination of simple analgesia such as paracetamol, an anti-inflammatory & a stronger morphine-like tablet or injection (depending on patient tolerances / allergies). If you are in significant pain, call the nursing staff to help get some more analgesia.
🏊🏼 Swimming is not recommended for the first 3 weeks after surgery until the wounds have healed. You can go for short walks 1 - 2 days after surgery & begin to build this up over the next week.
🚴🏻 After approximately 2 weeks, you can begin to use a stationary bike with the seat raised. This can be slowly lowered over the next few weeks as the hip movement improves. It is best to leave a road bike for approximately 3 months after surgery.
During surgery bleeding can occur and you may require a blood transfusion. There is a small risk of fracture or damage to the main nerve in the leg. This could manifest itself as an inability to bring up your foot after the operation. A clot (deep vein thrombosis) can occur in your calf and can travel to your lungs (pulmonary embolism) and this could result in death. To minimise this risk, you will receive injections to thin your blood and stockings/foot pumps to maintain circulation. Every effort is made to ensure that leg lengths are equalised but occasionally the operated leg can be slightly longer. Infection can also occur and can require further surgery and a prolonged stay in hospital. Ongoing pain and stiffness can both occur. In addition, you will notice a patch of numbness over the area. The implants can loosen with time and may require further surgery in the future. Finally a hip replacement can dislocate whereby the head pops out of the socket and this can also require further surgery to put it back or change the components.
You will usually be reviewed 4 weeks following surgery. This allows us to ensure that the incisions are healing and check the motion. It is often the best time to have a talk about the procedure and ask any questions regarding returning to normal activities.
It must be stressed that recovery from a hip replacement is not easy. Beginning to move a swollen, bruised leg involves a degree of discomfort and determination. Your physiotherapist will be there to supervise and encourage you & rapidly you will start to notice improvements. Exercises should be performed regularly and diligently as directed by the physiotherapist. It is often useful to take some simple analgesia 30 minutes before your exercises.
When patients return home, they often sit for prolonged periods allowing the operated leg to swell. Sitting is fine but you should try to get up for a few steps every few minutes to help improve the circulation. Alternate this with sitting on the couch with your legs elevated on a couple of pillows.
You can lie on the operated side as soon as you find it comfortable. You can lie on the normal side after 3 weeks with a pillow between your legs. Dislocation is the main risk and you should avoid bending the hip up towards your chest whilst simultaneously bringing your knee toward the midline.
Roughly 6 weeks following surgery is reasonable. If you have an automatic car and it is your left leg, then perhaps you can start earlier. Bear in mind that sitting in a car involves a significant knee bend and anything longer than a few minutes can be very uncomfortable.
This is obviously dependent on the nature of the work. Office based workers may be able to return after 6 weeks but for manual workers, 3 months is a more realistic goal. Don’t forget to think about how you normally get to & from work when contemplating returning.
You should seek advice if the pain dramatically worsens after discharge. Any symptoms such as calf swelling or tenderness or simply feeling unwell or shortness of breath should also be assessed.
Compiled October 2015
Review date: March 2016
Review date: March 2016