Consultant Specialist Orthopaedic Surgeon
HIP REPLACEMENT
Hip replacement surgery is a procedure which involves replacing your hip joint with artificial parts (prostheses) if it’s been damaged or worn away. This damage may be caused by arthritis, but it can sometimes be from an injury.
INTRODUCTION
What is a Hip Replacement
If you have a total hip replacement, your surgeon will take away the worn parts of your bones that are rubbing together. They’ll then put replacement pieces made from artificial materials in their place.
Hip replacements can be made of metal, ceramic, plastic or a combination of these. Your hip joint can be fixed into place with bone cement (cemented) or pressed into place without bone cement (uncemented). If your hip joint is uncemented, the metal surfaces are often given a special coating and roughened. This encourages your own bone to grow onto the artificial joint and secure it in place.
You’re most likely to be offered a hip replacement if you have very bad osteoarthritis. But you may also be recommended to have one if you have other hip problems, such as rheumatoid arthritis. Your surgeon will speak to you about the best type of hip replacement to suit your needs. After a while, artificial hip joints can wear out, but your new joint can last for up to 20 years.
PREPARATION
Preparing for Hip Replacement
Your surgeon will explain how to get ready for your operation. If you smoke, you’ll need to stop. Smoking makes it more likely you’ll get a chest or wound infection after surgery. This can slow down your recovery.
If you’re overweight, it’s a good idea to try to lose weight. It may help to reduce the strain on your hip joint and reduce your risk of complications after surgery. Stay as active as you can and keep doing any exercises recommended by your doctor or physiotherapist.
Your surgeon will make sure you’re well enough to have the operation. You may need to have some blood and urine tests, X-ray images of your hip, and an electrocardiogram (ECG) to check your heart is healthy.
If you haven’t been to the dentist for a while, book a check-up. A dental infection may make you more likely to get an infection in your joint if bacteria from your teeth get into your bloodstream. If you take certain medicines, you may need to stop these about four weeks before your operation. Your surgeon will discuss this with you.
Your surgeon may recommend that you see an occupational therapist before your hip replacement. Buying some special equipment or making changes at home may mean you can move around more easily after surgery.
Your operation can be done under spinal or epidural anaesthesia. This completely blocks feeling from below your waist, but you’ll stay awake during the operation. Or you may be able to have the operation under general anaesthesia, which means you’ll be asleep during the operation. Your surgeon will let you know which type of anaesthesia is best for you.
If you have a general anaesthetic, you’ll be asked to follow fasting instructions. This means not eating or drinking anything for a specific number of hours before your operation. It’s important to follow your anaesthetist’s advice.
Your surgeon will discuss with you what will happen before, during and after your surgery. If you’re unsure about anything, don’t be afraid to ask. No question is too small. It’s important that you feel fully informed so you feel happy to give your consent for the operation to go ahead. You’ll also be asked to sign a consent form.
PROCEDURE
What happens during Hip Replacement
A hip replacement operation usually takes about an hour or so. Hip revision surgery takes longer.
During the operation, your surgeon will make a cut (20 to 30 cm long) over your hip and thigh. They’ll then divide your hip muscles and separate (dislocate) your ball-and-socket joint.
Your surgeon will remove the ball at the top of your thigh bone and put a replacement ball on a stem into your thigh bone. They’ll hollow out your hip socket to make a shallow cup and put an artificial socket into it. Your surgeon will then put your hip joint back together (they’ll fit the ball into the socket).
Finally, your surgeon will close the cut in your skin with stitches or clips and cover it with a dressing.
Keyhole surgery
Sometimes a surgeon recommends having keyhole surgery (minimally invasive surgery). This involves making one or two smaller cuts (about 10 cm) over your hip and thigh. This should reduce the damage to your hip muscles and tendons and may mean you have less pain after surgery. But a minimally invasive hip replacement isn't suitable for everyone. Ask your surgeon if it’s an option for you.
AFTERCARE
What to expect afterwards
After surgery, you may feel some discomfort or pain as the anaesthetic wears off. You'll be offered pain relief if and when you need it. You may not be able to feel or move your legs for several hours after a spinal or epidural anaesthetic.
A nurse may have to put a pad or pillow between your legs to hold your legs apart and keep your hip joint in one position. This will stop your hip from dislocating (moving out of position).
A physiotherapist will usually visit you after your operation and will see you regularly afterwards. They’ll give you some exercises to do. It’s important to do these as often as they tell you to. The exercises are designed to help you get moving again and strengthen your hip.
You may feel a bit constipated after surgery. Some people don’t pass stools for two to four days after a hip replacement. To prevent constipation, eat plenty of fruits and vegetables and drink plenty of fluids (up to two litres a day). If your constipation doesn’t get better, your doctor may prescribe a short course of laxative medicines.
You may need to wear compression stockings during and after the operation. This will help to prevent blood clots forming in the veins in your legs (deep vein thrombosis). You may need to have an injection of an anti-clotting medicine (or tablets) as well as or instead of wearing compression stockings.
You’ll need to stay in hospital until you're able to cope on your own at home. This is usually for four to eight days but it may be sooner if you’re recovering well. When you're ready to go home, ask a someone you know to drive you. Your nurse will give you some advice about caring for your hip and a date for a follow-up appointment. This is usually about eight weeks after your operation.
You’ll have a scar on your hip and thigh. If your surgeon used staples or stitches, you’ll usually need to keep your wound covered until these are removed. A district nurse will help you change your bandages and remove your stitches after 10 days. If you have dissolvable stitches, they won’t need to be removed. Ask your surgical team for advice on keeping your wound covered and when you can have a shower or bath.
RECOVERY
Recovery from Hip Replacement Surgery
Everyone recovers differently from hip replacement surgery. How quickly you recover may depend on your age, your general health, the type of surgery you have and if you have any complications. When you leave the hospital, your recovery will carry on at home. It’s important to build up slowly, doing a little bit more exercise each day. By around six weeks, you may be able to return to work but this will depend on what sort of job you do.
Short-term recovery
You’ll probably feel the benefits of the operation almost straight away, but you may feel some pain for a few weeks. You’ll usually be prescribed painkillers to take home when you leave the hospital. If you need more pain relief, you may be able to take over-the-counter painkillers, such as paracetamol. But ask your doctor or nurse for advice first. Always read the patient information leaflet that comes with your medicine and, if you have any questions about your medicines, ask your pharmacist.
After your operation, your body uses up extra energy to help your wound heal. For the first couple of weeks, you may feel more tired than usual, so remember to rest when you need to. If you lost a lot of blood during surgery, you may be recommended to take iron supplements. You won’t be able to return to work or drive for a while after your operation – usually for around six weeks, sometimes longer.
Your leg may be a bit swollen and ache at first. But getting up and moving after your operation is important. Ideally, you shouldn’t sit down for long periods of time. At first, you’ll need support and supervision, but it’ll gradually get easier. However, if the pain and swelling in your hip or leg gets worse, seek medical help as this may be a sign of a blood clot in your leg.
Long-term recovery
The exercises recommended by your physiotherapist are a crucial part of your recovery, so it's important to keep doing them once you’re back at home.
Your surgeon or physiotherapist may also give you advice on what you should and shouldn’t do in the first six weeks to protect your hip. For example, try to avoid:
crossing your legs
twisting your hip inwards and outwards
bending your hips past 90 degrees (a right angle)
sitting on very low chairs or toilet seats – raise them where possible
bending over from your hips to reach objects on the floor or tie shoelaces
cutting or painting your toenails
lying on your side for the first six weeks after your surgery – if you do, put a pillow between your legs.
You should be able to move around your home and manage stairs, but you may find things like shopping difficult for a few weeks. Ask friends and family to help out or order your shopping online. Don’t be afraid or embarrassed to ask for help. Make sure you can move around safely at home – watch out for rugs and trailing wires.
After a couple of weeks, you should be able to walk longer distances and for longer periods of time with less support. But some people need to use walking sticks or crutches for around four to six weeks.
Try to sleep on your back for the first six weeks. Put a pillow between your knees to keep your hip in the right position. Most people can have sex after six to eight weeks but avoid any positions that put too much pressure on your hip joint.
If you work, you can usually go back after about six weeks. But if your work involves a lot of walking, standing or lifting, you may need to stay off for longer – sometimes for up to three months. Speak to your occupational health advisor, as you may be able to change the type of work you do until you’ve fully recovered.
You should be able to drive again after about six weeks but check with your surgeon and car insurer. You shouldn’t drive if you’re in a lot of pain or you’re still taking any medicines (including painkillers) that can make you drowsy. Even getting in and out of a car as a passenger for the first three weeks may put too much strain on your hip. Try to avoid travelling in a car unless it is essential.
By six to eight weeks, you should be able to take a short flight (internal or European). It’s best to hold off on any long-haul travel until around 12 weeks, and always check with your doctor and travel insurer before you go.
By around six to eight weeks, you should be able to walk and swim. But it will take you longer to get back to sports such as tennis or golf. For more information on recovering from hip surgery, see our FAQs: Are there any sports I shouldn’t do? and How can I make my recovery easier? below.
Possible side effects of Hip Replacement surgery
After hip replacement surgery, you may have some temporary side-effects. These include:
a sore hip and leg for a few weeks
swelling in your leg – this might last for several weeks
constipation
However, If the pain and swelling in your hip or leg gets worse, seek medical help as this may be a sign of a blood clot in your leg. For more information, see our section: Recovering from hip replacement above.