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The hip is a ball-and-socket joint that has a large range of movement. Total hip replacement (THR) surgery is undertaken when a patient’s native hip has been problematic due to a number of possible causes, including arthritis, trauma or collapse of the femoral head (the ball). Surgery is recommended when there is constant pain and stiffness that limits daily activities and reduces your quality of life. The surgery involves replacing the worn or damaged ball (femoral head) with a new prosthetic ball, as well as lining the socket (acetabulum) with a prosthesis to restore motion in the hip and eliminate pain.
Although hip replacement is an extremely successful procedure, there are possible risks associated with any surgery. The risks of complications are around 1-2%. The common ones in THR are:
Bleeding (intra-operative). This can be controlled in surgery using various techniques
Fracture of the femur or pelvis. These may be left to heal on their own or may need to stabilised during the surgery or soon thereafter
Blood clots. These can form in the leg veins during or after surgery and carry a risk of shooting to the lung or heart (embolization). Blood-thinning medication is used to reduce this risk.
Infections. This may be superficial, involving only the wound, which is treated with antibiotics, or deeper involving the joint, when further surgery may be needed to cure it. Our patients are all given antibiotics around the surgery to reduce this risk.
Other more rare complications include dislocation of the hip joint, loosening of the prostheses, leg length differences, and nerve damage, but these all occur very infrequently.
We aim to make the surgery as comfortable and pain-free as possible. The anaesthetist will decide with the patient on the pain management strategy best suited for them. This may include general or regional (spinal or epidural) anaesthesia, nerve blocks, local anaesthetic wound injections, patient-controlled pain medicine pumps, and intravenous and oral pain medication.
The best strategy is to follow the instructions given to you by your surgeon and physio- and occupational therapists. The wound is to be left undisturbed (clean and dry) until your first check-up, care should be taken when walking with crutches; certain movements need to be avoided (like crossing the legs or squatting) for the first 6 weeks; infections elsewhere need to be managed early.
Hip replacement surgery is usually very successful, second only to cataract surgery in the whole field of medicine. More than 95% of patients have relief from hip pain, and the success rate remains at 90 – 95% at 10 years post surgery.
Modern surgical techniques aim to get our patients back home and returning to function as soon as possible. The usual hospital stay is between two and four days. Patients are discharged once they are mobile and it is safe for them to return home.
Most patients will cope with crutches after their hip replacement, which they will use for between 4 and 6 weeks. A small number of patients may require a walking frame is they feel unsteady or are unable to use crutches.
Ideally, patients will have “pre-habilitation” where they do exercises to strengthen them prior to surgery. Rehabilitation will start very soon after surgery, mostly the next day, or in some circumstances even on the day of surgery.
