A damaged or worn hip joint can cause a great deal of pain and discomfort. It can happen when the cartilage that lines the ball and socket hip joint gets worn away which leaves the bone exposed and rather than the usual fluid movement of the joint, the joint becomes stiff and painful. Without the protective layer of cartilage, it can lead to the wearing of the joint. If no other pain relief or alternative treatment works, then a doctor or surgeon may recommend hip replacement surgery.
What Is Hip Replacement Surgery?
Hip replacement surgery is a procedure that removes the bones in the hip joint that are rubbing together and replaces the joint with a new artificial joint, also known as a prosthesis. Depending on the level of wear, as well as other factors dependent on your circumstances, the artificial joint may be made of metal, plastic or ceramic.
The procedure is considered a major operation and will only be recommended if all other forms of hip pain relief have been exhausted. Instead of a hip replacement, a surgeon may recommend steroid injections, painkillers, mobility aids and potentially hip resurfacing, which covers the joints with a metal cap.
Why Might You Need a Hip Replacement?
Hip replacement surgery will be offered to those experiencing pain or mobility issues because of their hip joint. If the pain is so severe that it reduces the quality of life or impacts sleep, mood and movement then a hip replacement may be required. Usually, this pain will come from conditions such as arthritis (septic and rheumatoid), bone dysplasia, osteoarthritis and hip fractures.
Any adult may be recommended for hip replacement surgery, however, it is more common for those above 60 years old.
The prosthesis used in hip replacements are expected to last around 15 years when it is looked after properly. After this time, or sooner if there is an issue, you may need to have the prosthesis replaced with a new artificial joint, this procedure is called hip revision surgery.
Is a Hip Replacement Right for You?
Hip replacement surgery is a major operation and can be a great solution to hip pain, but must be carefully considered to make sure it's the right procedure for you.
For most people, hip replacement surgery will be successful which gives the patient greater mobility, and they will be free from hip pain so that they are less reliant on painkillers. After the patient has recovered from surgery, the hip replacement should reduce the reliance on mobility aids such as walking sticks.
One of the biggest drawbacks for hip replacement surgery is that the prosthesis only lasts for 10-15 years and may need replacing at a later date through hip revision surgery. The procedure needs several days' recovery in hospital; then it will take around six weeks to recover fully, during this time mobility may be slightly limited.
As with any procedure, there is a risk of complications with hip replacement surgery, and you will only be offered the surgery if you are deemed fit and healthy enough to cope with the operation and the rehabilitation.
Preparing for a Hip Replacement
Preparing for a hip replacement will often mean general preparation for your body to cope with the surgery. Smokers will be advised to quit smoking to reduce the risk of a chest infection, while those who are overweight will be advised to lose weight, so there is less pressure on the joint and to lower the risk of complications. Depending on the medication you use, your surgeon may advise you to stop taking certain medications before the procedure.
On the day of the procedure, your doctor will explain the procedure and the associated risks; you may be provided compression socks to wear during surgery to reduce the possibility of blood clots. To prepare for the anaesthesia, you may be asked not to eat or drink anything for several hours beforehand.
You will then be given anaesthesia. Depending on your needs this may be a general anaesthetic where you are asleep throughout the surgery or an epidural anaesthetic, where you have no feeling from the waist down. You will be advised on the most appropriate anaesthetic for your needs.
Once the anaesthetic is working, the surgeon will make an incision at the hip to remove the damaged hip bone. This may be a large incision, around 20cm in length, or keyhole surgery with several smaller incisions, depending on your needs.
Once the damaged bones are safely removed, they will then be replaced with an artificial ball and socket joint. Once the joint is back together, the surgeon will then close the incision with stitches or clips and cover it with a dressing.
The procedure will last around 90 minutes, but because of the surgery and the impact on the joint and muscles, it can be a slow rehabilitation period.
When the anaesthetic wears off, you may feel pain and discomfort, but you will be provided with painkillers if you need them. You will be given pillows to keep your hip joint still and stop it dislocating for several hours after surgery.
A physiotherapist will then visit you when you are ready and provide you with some useful exercises to aid your recovery. You will be allowed to leave the hospital and return home as soon as you are deemed able to cope on your own at home. This can take around four days but maybe sooner or later depending on your recovery.
If you are given stitches, these will have to be removed after around ten days by a nurse. After two months, you will be offered a follow-up to check your progress.
Risks and Complications
As with any surgery, hip replacements come with a level of risk. Some of the most common complications of surgery include blood clots, such as deep vein thrombosis and dislocation, which is where the joint pops out because the muscles haven't healed.
You may notice a difference in leg length after surgery, which may mean you need to wear an insole in your shoe to help with your alignment. Nerve damage and hip fractures may also occur as well as a loosening of the hip joint which may need to be resolved with further surgery.