HIP replacement
Hip replacements are one of our most common and successful operations. Replacement surgery relieves pain and restores mobility for patients with many types of arthritis.
Hip arthritis
Many patients suffer from hip arthritis. This may be from wear and tear in older age, congenital abnormality, as a result of joint infection, or even various causes of inflammatory arthritis such as rheumatoid arthritis.
Common symptoms that patients experience include: groin pain, pain in the hip or thigh, sharp pains with movement; difficulty standing up; stiffness; pain when sleeping. Not all hip pain is the same - hip arthritis will worsen lower back problems, and may be felt as low as the knee as well.
Before considering hip replacement surgery you should exhaust all non-operative treatment options. hip surgery is frequently very successful, however all prosthesis have a lifespan and all surgery carries some risks.
Hip arthroplasty
Total hip replacement surgery replaces the worn arthritic cartilage and bone of the joint surfaces between the pelvis and femur. The term "arthroplasty" roughly means to form a new joint.
The worn cartilage articulation is replaced by a new ball and socket joint. The new joint is also smooth so it doesn't catch or give way. As part of the surgery the hip will normally regain motion and you can stand straighter and back pain may be improved.
The femoral stem is implanted inside of the femur and the socket is fixed within the pelvis. This will normally allow immediate full weight bearing on the leg.
Hip prosthesis
There are many differing hip replacements. Most have a metal femoral stem and this may be cemented to the bone using a polymer known as PMMA (polymethylmethacrylate) which hardens in 10 minutes. The acetabulum socket is commonly made of a roughened surface which allows bone ingrowth. 3D printed porous titanium is increasingly used for this.
There are also differing bearing surfaces. The most common bearing is a highly cross-linked polyethylene insert and a metal head. Ceramic heads and well as acetabular liners are also available. These are all very mature technologies that have been used in clinical practice for decades now. Metal-on-metal articulations are rarely used currently due to problems with this kind of bearing.
With mot hip replacements replacement the joint is immediately strong and stable. This means it can take your full body weight as soon you recover from anaesthetic and are able to walk.
The bearing components can wear over time like all mechanical devices. Current data suggests that 95% of hip replacements will last at least 10 years, and almost 90% for 20 years. Ask your surgeon for more detail regarding your particular situation.
Should I have hip replacement surgery?
Hip replacement is elective surgery. This means you may want it to improve your quality of life, but nothing terrible will happen if you don't. If you have exhausted all other treatments however it may be the best long term solution for pain relief and regaining your mobility.
There are at least 3 questions your surgeon will consider:
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Is the hip pain caused by arthritis?
If not hip replacement is usually not be the right option for you. Your surgeon will examine your hipand x-rays and advise you about this. -
How old are you?
Sometimes patient think they are too old. Your surgeon however only wants to know how fit you are. In some respects older patient will do better as they wear their prosthesis slower. Younger patients have a greater concern as they might need to have revision surgery in the future. -
Is your pain worth going through surgery?
This is a personal question. You need to talk in detail with your surgeon about the risks and benefits. Even if your hip x-rays look worn, if you are functioning well without frequent pain then you don't need surgery.
What to expect?
A normal well functioning hip replacement should give you years of comfortable mobility. The hip should feel stable and allow you to walk, sit and sleep comfortably.
You can run if you need to, but regular distance running will probably make the components wear out faster and not really what the replacement is intended for. Hiking, cycling and swimming are all perfectly fine however. Hip replacements do have precautions though to prevent hip dislocation.
There will be post-surgery pain but you will have medications to help with this. Many patients hip pain is improved immediately however if their arthritis is severe. You will have some leg swelling, and your leg may initially fell longer or shorter depending on your previous hip position.
Most patients are in hospital a few days, and a wound check appointment is scheduled at 10-14 days after surgery to ensure the skin healed and no signs of infection. You will have x-rays before and after surgery.
You will initially walk with assistance and a rolling frame. Then you will progress to a small walker, crutches or stick. Before you leave hospital you need to be able to care for yourself and get around safely.
More details are available in our information for patients section.
Risks of hip surgery
All surgery has risks and this is moderately large surgery. There are general risks of all surgery/anaethetic of this magnitude which include: risks of surgery and anesthetic including stroke, heart attack and even death. You will be assessed first and all measures to ensure these are minimal.
With all joint replacement surgery infection is a concern and may affect 1 or 2%. This can require further operations or antibiotics. You will be given antibiotics before the surgery starts and meticulous sterile care in taken in operating theatre.
Dislocation of the hip replacement is another concern. All ball and socket joints can dislocation if pushed too far. You will be shown what positions are not safe. Generally however these restrictions are less than the stiffness most patients had from their arthritis in the first place however.
A small change in leg length is also possible. Particularly when your surgeon is trying to ensure your hip has a minimum tension and clearance to avoid dislocation. You may also feel slightly longer as the hip replacement may aim to restore the length caused by bone collapse and loss of cartilage.
More information is available in our information for patients section.