Hip Replacement Surgery
Learn everything about your treatment
A hip replacement, also known as a total hip arthroplasty, is an operation to replace a damaged hip with an artificial joint. It involves the removal of the existing hip joint and the use of an artificial joint in its place. This can provide great relief to people who suffer from chronic hip pain, have injured their hip or have a condition such as osteoarthritis or hip dysplasia.
What can a hip replacement achieve?
The main aim of a hip replacement is to improve your quality of life by reducing pain and allowing you to remain active. If your hip replacement is successful, your hip should function much better than before and your mobility should increase. This can therefore help you continue to live life to the fullest and take part in the activities that you enjoy. You may also find that you rely less heavily on painkillers after surgery. All of these factors can help to improve other areas of your life such as your mood and quality of sleep.
Of course, this is not an easy decision to make as it involves having major surgery. Therefore, hip surgery is often suitable for patients who have found no benefit from other methods to control their hip pain such as:
- Steroid injections
If the above methods have failed, a hip replacement may be a viable option to help manage your hip pain.
Hip replacement technique
Your surgeon will discuss all of the treatment options with you. The operation often takes one to two hours to perform. It involves your surgeon making a cut into the hip and removing the damaged hip joint. The surgeon then replaces it with an artificial joint known as a prosthesis. This is often made up of metal or plastic.
Who are BOA?
BOA stands for The British Orthopaedic Association. It is the leading orthopaedic organisation in the UK. Surgeons who are members of the society regularly attend training to keep their skills and knowledge up to date. This means that they are amongst the most highly qualified and experienced orthopaedic surgeons in the UK. At Medbelle, we aim to recruit surgeons who are members of BOA. This ensures that all our patients receive only the highest quality of care.
Hip replacement candidates
Who are the ideal hip replacement candidates?
A hip replacement may be suitable for you if you 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
- Can no longer carry out their normal daily routine
- Have pain that has negatively impacted their mental health and social life.
If you are considering having a hip replacement, you should try to optimise your health so that you are fit for surgery. As this is a major operation it is important to consider your fitness and recovery before you decide to have the procedure. In order to do this, you should try and ensure that you 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 performed once it has been cured.
Your surgeon will speak to you about your suitability for surgery and what the best type of treatment is for you.
Hip replacement procedure
How is a hip replacement performed?
There are a number of different techniques that your surgeon can use to perform a hip replacement. You can either have a total hip replacement, or a partial one. This page mainly focuses on how a total hip replacement procedure is performed.
You will have met with your surgeon for a consultation prior to the surgery to discuss the different options, and what technique would be most suitable for you. A hip replacement usually takes 1 to 2 hours to perform. However, this also depends on the nature of the problem with your hip and whether you have had previous hip surgery. Below is an overview on what will happen on the day of your procedure.
You will need to give your consent for the operation in the form of writing. You will do this before the surgery. This ensures that you have had enough time to obtain information about the hip replacement procedure, including the benefits and risks involved. Before you sign the consent form, you should also make sure that you have asked your surgeon any questions you have regarding the surgery.
Before the surgery can begin, you will be taken to the anaesthetic room to meet your anaesthetist. This is the doctor who will be responsible for giving you your anaesthetic. Your surgeon will have discussed with you what type of anaesthetic you will have during your operation. This will either be a general or a spinal/epidural anaesthetic. A general anaesthetic will put you to sleep throughout the procedure. A spinal or epidural anaesthetic will numb your legs and hips, and the anaesthetist will also give you a sedative at the same time. This will help to keep you relaxed throughout the operation.
In the operating theatre, your surgeon will prepare you for the operation by cleaning the treatment area and creating a sterile field. Your surgeon will then make the incisions. The incisions vary in size and location according to the technique used. In general, they are located around the affected hip joint. The general technique consists of the surgeon making an incision into the hip, removing the damaged hip joint and replacing it with an artificial joint.
4. Replacing the hip joint
The artificial joints (or prostheses) are made of several different materials, including metal and ceramic. You and your surgeon will discuss the exact type of replacement joint they plan to use before the day of your surgery. In order to replace the hip joint, your surgeon will first remove the existing joint. Once removed, the surgeon prepares the space for the new joint by reshaping the area and placing a cup shaped insert into the joint. Your surgeon will then line this insert with either plastic or ceramic. They will then attach the other part of the joint to the bone of your leg (femur). The surgeon checks that the new joint has a good range of movement before finishing the operation.
5. Closing of incisions
The surgeon will stitch the cut muscles and soft tissues back together. The surgeon then closes the skin incisions, usually with absorbable stitches. Afterwards, they will apply a dressing over the incisions to help minimise bruising and swelling. Your surgical team will either remove or change these dressings after a couple of days.
5. Return to the ward
At the end of the surgery, the nurses will move you to a recovery room. Here, you will gradually recover from your anaesthetic. Patients often spend 1 to 5 nights in hospital after this operation before they go home to continue their recovery.
- Your consultation
Hip replacement consultation
What should I expect from my hip replacement consultation?
Your hip replacement consultation is an opportunity for you to meet with your surgeon to discuss the procedure and what you would like to achieve from it. This will last between 15 minutes to an hour. You will talk with your surgeon about your concerns, and they will assess your hip and general mobility. They can then discuss with you the best surgical approach to solve the problems that you have identified.
Your surgeon will also discuss with you the potential risks and complications that come with a hip replacement procedure. It is important to be aware of these so that you can make a fully informed decision on whether or not you wish to go ahead with the operation.
To assess your suitability for surgery, your surgeon may ask you about the following:
- Any current medical conditions you have
- Your past medical history
- Any previous surgeries you have had
- What medications you are currently taking (including over-the-counter and herbal remedies)
- Your intake of alcohol
- Your smoking history
- Whether or not you have any allergies
During your consultation, we recommend that you are as open as possible with your surgeon. Be honest about your expectations and everything you have tried so far. Your surgeon is there to listen carefully to you, to help to restore your quality of life and mobility and to lessen the hip pain that you are suffering from.
What questions should you ask during your hip replacement consultation?
You can ask your surgeon any questions you have about the procedure during your consultation. We want you to be confident with your decision to have a hip replacement, so make sure you express any queries you might have. There is no such thing as a silly question! The following are some examples of questions that you may consider asking:
- Will a hip replacement correct the concerns that I have expressed?
- How long is the recovery period?
- What scars will I be left with?
- How long does a hip replacement last?
- What other options are available for me?
- Will I be in pain after the surgery?
- How soon after a hip replacement can I return to work?
- Will I be able to take part in sports and exercise after my hip replacement?
- Risks & complications
Hip replacement risks and complications
What are the main hip replacement risks and complications?
As with any surgery, there are risks and complications that can occur with a hip replacement. It is very important that you are aware of these and are able to weigh up these risks with the benefits before you choose to go ahead with the treatment. This page outlines the main hip replacement risks and complications. You should read these carefully and take a while to think about them when deciding if a this procedure is suitable for you.
Bruising & bleeding
Some bruising is common after surgery. This should resolve over the first couple of weeks. You may also experience some minor bleeding from the incision site. This often occurs right after surgery but may occur a few weeks later. However, if you notice significant bruising, pain, or swelling, please inform your surgeon straight away. It is possible that you may have a haematoma, which is a solid collection of blood under the skin. These often develop within 24 hours of surgery and require medical attention. You may be more at risk if you are male, have high blood pressure, or take certain medications.
Although every effort is made to reduce the risk of infection, it is still possible for one to develop. An infected artificial joint must be treated quickly and may require surgical removal if it becomes severe. You must therefore be aware of the signs of infection. Contact your surgeon right away if you notice any of the following signs:
- Feeling feverish with a temperature over 38° C.
- Redness at the incision site that is spreading after the first 48 hours.
- Yellow pus-like or foul-smelling fluid seeping from the incision.
- Increased pain or discomfort that your pain medication does not resolve.
Unfortunately, it is not always possible to avoid scarring where the surgeon has made incisions. The size and location of the scars will vary slightly according to the technique your surgeon uses. Usually, you will have one or two scars around your hip. Make sure you ask your surgeon to explain where your final scars will be. Remember that scars will also fade with time. How much they fade will depend on the healing ability of your skin. Your surgeon can also give you some tips on how to care for your wounds and to reduce the scarring that you are left with.
Sometimes the skin where the surgeon has operated on can change colour slightly after the surgery. This should settle over a few months as the area heals.
If, during your surgery, the nerves in your hip or pelvis are injured, you may lose some feeling or movement in your leg. This is rare and in most cases, temporary. However, even more rarely, more long-term loss of sensation or movement can occur. At Medbelle, we only work with highly skilled and qualified surgeons. This means that you will be at less risk of this occurring.
It is possible for the artificial joint to become dislocated. Although uncommon, this may affect the result of the surgery. When it does occur, displacement of the implant tends to happen 6 to 8 weeks after the surgery. It often only happens once. If it happens more than once, surgery may be needed to re-stabilise the joint. To lower the risk of hip dislocation, avoid crossing your legs or fully bending your hip. For example, avoid sitting cross-legged and bending forwards when in a seated position.
Difference in leg length
After a joint replacement of any type, there is always the possibility that there may be some mismatch between your natural joint and the prosthetic one. In the case of hip replacement procedures, this appears as slightly different leg lengths after the surgery. To ensure that you are happy with the final results, you should talk openly with your surgeon during your consultation to make sure that they understand your expectations. Your surgeon will consider this when planning their approach to minimise any difference in leg length. Even if this is a problem, it is correctable with special shoes or an insole that fits inside your existing shoes to even out your legs.
General surgical complications
All surgeries carry some common risks. These include the development of blood clots, nausea and vomiting, and postoperative pain. As the surgery involves the use of an anaesthetic agent, it is also possible that you may develop complications relating to the anaesthetic itself.
It is vital that you follow your surgeon’s specific aftercare instructions to reduce the risk of these complications occurring.
- Preparing for your treatment
Hip replacement preparation
How can I prepare for my hip replacement?
Preparation is key for a smooth and speedy recovery. Doing some household chores and planning ahead will make your life easier after you come home from surgery. During this time, you will need to take things slowly to allow your wounds to heal. Below are some simple hip replacement preparation tips that can help you make a smooth recovery:
You might want to do certain tasks like cleaning the house, taking the bins out or doing the laundry before the operation. This way, you won’t have to do these chores when you come back home. Coming home to a clean and tidy house is sure to make you feel more comfortable whilst you recover. As you will take some time to regain strength and mobility, it is useful to have someone who can do these chores for you.
It’s good to stock up on some key food items that can be kept in your cupboard or your fridge. You won’t be able to leave the house for a few days after you leave hospital, so this will save you from having to go to the supermarket. Preparing some meals in advance may also be a useful way of minimising stress when you return home. You can keep pre-prepared meals in the freezer. You can then easily defrost these on days you don’t feel like cooking or can’t get to a supermarket.
Children and pets
Looking after pets and young children can often be a handful! After a surgical procedure such as a hip replacement, it is understandable to be tired and lack your usual energy. In particular, you won’t be able to take dogs for a walk or run after small children until you have had a chance to recover. Asking friends or family to mind your children or pets can, therefore, help to make your recovery less stressful. As another option, you might wish to get a babysitter or nanny to help you with your little ones as you recover.
After the surgery, you will not be able to drive for around 6 weeks. Therefore, make sure you have organised for someone to pick you up and drive you home. We recommend asking a friend or family member, rather than a taxi, as you will feel more at ease having someone familiar collect you from the hospital. Also, think ahead about any transport you may need during this first 6 weeks and try to arrange it in advance.
A healthy diet is an important factor in helping you to heal and recover after a hip replacement. Eat lots of healthy green vegetables, fresh fruit, and high-protein foods such as chicken, fish and legumes. Drink plenty of fluids – water is best. Tea and coffee are high in caffeine, so we advise you to keep those to a minimum and avoid alcohol. Also, try to avoid foods that are high in sugar and salt as much as you can.
Make sure you have loose and comfortable clothing at home. We recommend wearing loose clothing such as skirts, shorts and jogging bottoms during your recovery so you feel as comfortable as possible.
It is important that you lie and sleep on your back after a hip replacement. Your surgeon may suggest putting a pillow between your legs to keep the replaced hip in the correct position. After 3-4 weeks you may be able to start to sleep on the side that was not operated on, also with a pillow between your legs for support. Your surgeon will explain this to you in detail and give further suggestions on sleeping comfortably after the procedure.
It is vital that you follow your surgeon’s specific hip replacement preparation tips and aftercare advice. You must follow their instructions to achieve the best results from surgery and reduce the risk of complications occurring.
Hip replacement aftercare
What can I expect after a hip replacement?
Knowing what sort of things to expect after your hip replacement can help to make you feel more comfortable and at ease in the lead up to your operation. Your surgeon will discuss the details of your hip replacement aftercare process with you during your consultation. They will provide you with information on how best to take care of yourself during your recovery. This includes advising you on:
- When you can go back to work
- How long you must wait before resuming exercise
- How you should wash and care for your wounds
- When and how to start physiotherapy
A key element of your hip replacement aftercare is regular follow up appointments which your surgeon will also arrange for you. During these appointments, they will check your wounds to see how they are healing, assess your hip’s function, and check to see if you are in any pain. They will also address any complications and make an assessment of the results of the procedure at each point in your recovery.
How will I feel after surgery?
If you were put to sleep with a general anaesthetic, you will gradually wake up following surgery under close supervision. You will have dressings around your hip and you may have some soreness in this area. The dressings will normally stay in place for up to a week before they are removed. If a spinal or epidural anaesthetic was used, you may feel a change in sensation of your hips and legs, but this will gradually wear off. Your hip may also feel tender, and moving around will be difficult. Your surgeon or the nurses in the recovery room will offer you painkillers which you can take if you need to.
Is there anything I need to do in the first 24 hours?
You will usually be in hospital for a few days after the surgery. During this time, the nurses will check on you regularly to see how you are doing. After a general anaesthetic you will feel tired and groggy and the anaesthetic can also affect your memory and concentration. This can last from anywhere between a few hours and up to 2 days. In the first 24 hours, just concentrate on recovering. The physiotherapist will visit you and encourage you to sit on the end of the bed and begin to gently move your hip.
How much time do I need to take off work?
The recovery period may depend on several factors relating to your health but in general, you will need to take around 6 weeks off work. You may need longer if your job is more active or if you do not feel comfortable returning to work. You should therefore listen to the exact time frames that your surgeon provides you with. Whether you have an office job or a physical job, make sure that you do not lift anything heavy for at least 8 to 10 weeks.
When can I return to exercise and sport?
You should avoid any strenuous activity and contact sports for at least 8 weeks after your hip replacement. However, you should be fine to resume some light physical activity after 2-6 weeks depending on how you are recovering. Start off gently, with light aerobic activity such as walking on a treadmill or a short walk outside. You can start to take short walks after around a week and slowly build these up to improve the strength of your hip. Low impact sports such as swimming, cycling and walking are the best type of exercise for your new hip. You should avoid high impact, dangerous and contact sports even after you fully recover.
What other points should I consider?
Dressings and Stitches
You may need to keep your wound covered initially. If your surgeon has used staples or stitches then the wound should be kept covered until these are removed. If your stitches are deeper, then they only need to be covered for the first few days. You will be able to shower or bathe once your surgeon says you can do so. Your surgeon will also tell you when they will be able to remove your stitches. If you notice anything leaking from the wound, you should inform your surgeon straight away.
During your hospital stay, the physiotherapist will come and assess you and help to get you up and about. Once you have left hospital, you may need further physiotherapy sessions. This is not always the case however, and your surgeon will create an individual plan for you. You should continue to do the exercises that the physiotherapist showed you whilst you were in hospital. You will find that your new hip improves slowly over time. As soon as you are able to, it is a great idea to start walking regularly every day.
There may not be a noticeable difference to your hip pain immediately after surgery, but it is important to remember that this pain is temporary and caused by the surgery. You should be able to appreciate the final results between 6 and 12 months after surgery. This is because it may take a while for the hip joint to settle and for you to regain your confidence, strength and mobility. As long as you follow your surgeon’s hip replacement aftercare advice, you will gradually feel more and more like your usual self and be able to appreciate your new hip.
It is vital that you follow your surgeon’s specific hip replacement aftercare advice to ensure that you get the best results possible and reduce the risk of complications.
Hip Replacement FAQs
What are some common hip replacement FAQs?
We have put together some commonly asked hip replacement FAQs below. It is useful to read them through as there may be some questions that you had not thought of asking. If you still have further questions, don’t worry! Your surgeon will be happy to answer them during your consultation.
Do I need a GP referral for a hip replacement?
You do not always need a referral letter as some private surgeons may agree to see you initially without this. However, if possible it is preferred that you have a GP referral. If you decide you want to go ahead with the procedure, your surgeon will require more information on your medical history. In this case, they usually contact your GP for this information, with your permission.
When can I shower after hip replacement surgery?
Your surgeon will give you specific advice on how to wash and bathe after the surgery. In general, you may not shower or bathe as normal for the first 2 weeks in order to keep the wound dry and to protect you from falling whilst you are still improving your mobility. During this time, we suggest strip washing one area at a time instead. After this time, you will be able to shower normally (assuming there is step free access), but will not be able to sit in a bath for around 8 weeks. You must follow your surgeon’s specific aftercare advice to ensure the best results possible.
When will I feel completely recovered after hip replacement surgery?
It is normal for your recovery to take between 3 to 6 months. After this time, you should feel like your usual self again and be able to partake in hobbies and sports as you did before the surgery. We, therefore, advise that you plan ahead. Please ensure to discuss any specific sports or hobbies with your surgeon prior to your surgery. If you have a major event coming up such as a wedding, plan your surgery at least 6 months before it if possible.
How long will my hip replacement last for?
A hip replacement operation is permanent. The artificial hip joint often lasts for between 15 and 20 years. This means that most patients only undergo one hip replacement in their lifetime, with the exception of those patients who suffer from surgical complications such as an infected prosthesis, or those who have their hip replaced at a young age. These repeat operations are often more complicated and less successful, but in most cases they still improve hip function and reduce pain. You should follow general health advice to get the best long term results from your operation. This includes maintaining a healthy weight, exercising regularly and staying hydrated.
What are the effects of smoking, drugs and alcohol on hip replacement surgery?
Smoking and drinking too much alcohol can increase your risk to a number of surgical complications. This is why we advise you to cut back on alcohol and stop smoking well in advance of the operation. Most surgeons ask that you are smoke and nicotine free for at least 6 weeks before and after surgery.
Are there any alternatives to hip replacement surgery?
Pain relief and physiotherapy are the usual first line treatments for hip pain and problems with mobility. However, sometimes further treatment is needed. If you have a condition such as osteoarthritis, your doctor will often offer you a steroid injection into the hip to control your discomfort before thinking about surgery, although this is not a permanent solution. It is possible to carry out a partial hip replacement where only the part of the joint where your leg joins the hip is replaced. Your doctor and surgeon will be able to tell you which treatment plan is most suitable for you.