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Hip Replacement

This guide has been written to help patients understand why they need a hip replacement, what having a hip replacement involves and how they might be expected to recover.

Your individual care may need to be adapted to meet your needs and may differ from what is described below.

Why is my hip painful?

Most patients who need hip replacement surgery have osteoarthritis in their hip. This has worn away the smooth lining of the joint exposing bare bone, which becomes painful.

Other causes of a worn painful hip are seen after major trauma, inflammatory arthritis such as rheumatoid arthritis, or more rarely from infection or childhood hip diseases.

When do I need a hip replacement?

Hip replacement surgery is needed when patients’ level of pain and lack of mobility significantly impacts upon their life.

Before your surgeon will consider surgery all conservative treatments such as painkillers, a walking stick and loosing weight if necessary, must have been exhausted.

Individual thresholds for surgery will vary, but most patients reaching the stage of surgery have pain at night and significant difficulty mobilising.  On occasions stiffness can be more of a problem then pain.

What are my options?

Once patients’ pain and stiffness is no longer manageable with conservative measures, most patients are suitable for hip replacement surgery. Some younger patients with good bone quality may be suitable for a hip resurfacing procedure.

Am I too old?

No, a patient's age alone is not a barrier to surgery.

What are the benefits of having my hip replaced?

Most patients do extremely well following hip surgery.  Over 95% of hip replacements are still working well 10 years after surgery.  Recovery from surgery is normally rapid and patients by six weeks following surgery are usually walking with little or no discomfort greater distances than before their operation.

Getting ready for surgery

Having seen your surgeon in clinic and being consented for surgery you will be put on a waiting list.  This is a good time to think about trying to loose some weight and stopping smoking.  Both of these measures will aid your recovery considerably.

You will shortly be sent a date for your operation and will be asked to come to a pre assessment clinic a week or two before surgery.  At this clinic routine tests including blood tests, urine tests and MRSA screening swabs will be arranged and any patients who are felt to be of higher risk due to other medical problems may be asked to see an anaesthetist.

Coming into hospital

Nowadays nearly all of our patients come to hospital on the day of their operation.  Having arrived you will be allocated a bed and in due course taken to theatre.  You will be seen by your anaesthetist and have a chance to have a final chat to your surgeon.  Your leg will be marked appropriately and you will be asked to wear some compression stockings which will be in place for the next six weeks.  These stockings will help reduce the risk of you getting a blood clot.

As all our patients are brought in on the day of surgery and some operating lists run all day, you may have several hours waiting to go to theatre.  Please bring a book or a paper and try and bear with us.

The operation

You will be taken to theatre dressed in a surgical gown.  In the anaesthetic room most of our patients have a spinal or epidural anaesthetic, an injection in your back, making your legs numb and completely pain free.

Often patients want sedation also and you must discuss this with your anaesthetist. 
The operation lasts between one to two hours. Following surgery you will spend a short time in recovery. You will have a small pipe or drain coming from your hip which will be removed the following day.  Any blood loss through this drain is usually re transfused or given back to you during the night following your operation.  The day after surgery, most of our patients will be helped out of bed and begin to start walking.  Very occasionally patients are ready for home on day one!

Your hospital stay

We anticipate younger and fitter patients being able to go home within about three days.
Other patients may stay for five or perhaps more days.

Before going home your wound will be inspected and must be clean and dry and the physiotherapist must be happy that you can manage to walk with appropriate aids and can manage stairs.  More elderly and less fit patients may require some time in community care, but this will have been organised well in advance.

How soon will I recover?

Patients vary enormously. At six weeks most patients are considerably more comfortable and walking greater distances than prior to the operation.  Many patients will have returned to work by this stage. 

Your recovery will continue until four to six months after your operation.  All patients are brought back to be assessed in a clinic at six weeks.

Younger patients will be kept under review for a number of years, but most patients over the age of sixty will be discharged with the expectation their hip is likely to last them for as long as they will need it.

What about work?

Most patients return to work about six weeks after their operation.  Some more physically demanding jobs may require a week or two longer off work.  Often patients return well before six weeks.

What about driving?

Most surgeons advise their patients not to drive for six weeks after hip replacement surgery.  It is important that in an emergency you are able to stop the car safely.

What about sports?

Most patients are able to return to a high level of activity following hip replacement surgery.  Repetitive loading such as running, may be possible but is more likely to wear your joint more rapidly.  Activities that involve deep bending of your hip, such as certain yoga movements are best avoided.  After three months riding, golf etc. should be fine.

What about day to day activities?

Whilst on the ward your physiotherapist will teach you how to safely get in and out of bed, give you advice on dressing, toileting etc.  In particular, you will be told how to get in and out of bed, in and out of a car and in and out of a bath.

Do not be frightened to resume normal sexual relations, being careful not to force your hip into an uncomfortable position.  Initially it may be safer lying upon your operated side or back.

You will be shown how to get in and out of bed on the ward. It is advisable to sleep on your back, though you may sleep on your operated side with a pillow between your knees to prevent your leg from turning in.

For the first six weeks you can only have a walk-in shower or strip wash sitting on a high stool. You should not attempt to have a bath until after your first outpatient appointment. Should you then require any aids to enable you to get in and out of the bath contact Occupational Health.

What about the garden?

Patients are often keen to get back to gardening.  The most important point is to remember to take care picking things up off the ground and your physiotherapist will advise you how to avoid putting your hip at risk.  Even heavy digging should be possible by three months.

Movements to avoid following surgery

You should avoid bending at the hip, twisting your waist and crossing your legs.

What are the risks of surgery?

Total hip replacement is a major operation and even in the best of hands is associated with some risk. 

Your surgeon will discuss these risks with you in clinic before you sign a consent form. 

Risks that need to be discussed include infection (1%), dislocation 1% to 4%), blood clots, leg length change, nerve injury and loosening.