A hip replacement may be suitable for patients if they have persistent and troubling hip pain which has not responded to medical treatment or physiotherapy. The ideal hip replacement candidates, therefore, include patients who:
- Have a damaged hip due to a condition like arthritis
- Are in constant, severe pain
- Have reduced mobility because of their hip
- Found pain medication and physiotherapy to be unhelpful
- They can no longer carry out their normal daily routine
- Have pain that has negatively impacted their mental health and social life.
If patients are considering having a hip replacement, they should try to optimise their health so that they are fit for surgery. As this is a major operation, it is important to consider fitness and recovery before deciding to have the procedure. To do this, patients should try and ensure that they are:
- At a stable weight with a BMI of less than 30
- Stopping smoking and using nicotine products for at least 6 weeks before surgery
- Doing regular exercise
- Eating a healthy diet
- Reducing your alcohol intake
- Stopping the use of any recreational drugs.
Who is not suitable for a hip replacement?
A small number of patients are not good hip replacement candidates. Patients who may fall into this category include:
- Those with a current serious illness or infection
- People with severe osteoporosis (brittle bones)
- People who cannot fully understand or follow the pre and post-operative instructions.
These patients may therefore wish to consider other options. However, this is not to say that if you fall into one of these categories, you will never be able to have a hip replacement. For example, an infection can be treated, and the surgery is performed once it has been cured. The surgeon will speak to you about your suitability for surgery and what the best type of treatment is for you.
Although rheumatoid arthritis (RA) usually affects the hands, feet, and wrists, it can also affect other parts of the body, including the hips. It is an autoimmune condition which means that the body’s immune system attacks its own healthy tissue.
It is not fully understood what causes RA, although it has been linked to a combination of genetic and environmental factors. RA in the hips causes inflammation in the hip joints, which leads to pain, stiffness, warmth and swelling. The joint inflammation, in particular, comes from a thin layer called the synovial membrane, which coats many joints in the body, including the hip joints. The membrane contains joint fluid that provides lubrication and cushioning for the joints, helping the bones glide over each other.
The inflammation can lead to the hip joints swelling, breaking down cartilage, and as RA advances, it can lead to deformity and destruction of the joints and bones.
For many patients, medication for RA will slow down or prevent further disease progression, but if the damage to the joint is too advanced, then a total hip replacement or a smaller surgery called synovectomy, usually via arthroscopy (removal of the synovial membrane via small incisions) might be performed.
Post-traumatic arthritis is a form of osteoarthritis that occurs after an injury, usually a direct trauma to the joint. For example, if a broken bone or a fracture extends to a joint, this leads to early inflammation.
Although not fully understood, research indicates that post-traumatic arthritis is due to long-acting inflammation in the joint. Approximately 12% of osteoarthritis cases are suspected to be caused by this.
Post-traumatic arthritis can come on years after the injury with the characteristic osteoarthritis symptoms, such as pain, stiffness and tenderness. Patients following an osteoarthritis diagnosis may recall trauma to the area years before.
Treatment for patients depends on the disease progression; for more advanced osteoarthritis and damaged cartilage, an orthopaedic surgeon may recommend a total hip replacement or a hip arthroscopy.
Ankylosing Spondylitis (AK) is an inflammatory disease usually diagnosed in younger patients between 20 and 40 years old but sometimes earlier.
It primarily affects the spine, but, commonly, some patients will also have symptoms in large joints such as the hips. If the disease progresses, it can fuse the spine, and the AK associated hip arthritis known as spondyloarthritis can damage the bones and cartilage in the joint.
Many patients that suffer from this do not necessarily need hip surgery, but if the damage to the joint is severe, an orthopaedic surgeon may recommend a total hip replacement to restore function and help alleviate pain, stiffness and other symptoms typical of arthritis in the hip.