FAQs

Here you’ll find some of the most commonly asked questions about hip replacement surgery. If you have a question that’s not covered here, please get in touch.

Q   What is a total hip replacement?

A   In a total hip replacement, the ball at the top of the upper thigh bone is removed, together with damaged cartilage from the hip socket. An artificial ball is fixed into the thigh bone, and an artificial lining in the socket.

Q   When should I have a hip replacement?

A   It depends on how much your quality of life is being affected by pain and reduced mobility. This, together with your medical history, an examination, and X-rays will be the basis on which a recommendation for surgery is given.

Q  Are there any age limits for hip replacement surgery?

A  There are no upper or lower age limits, but the majority of hip replacements are carried out in older people because arthritis increases with age. Artificial hips should last many years, but the younger you are, the more likely it is that you will need subsequent replacements.

Q  What are the different types of artificial hip joints?

A  The different materials used for the ball and socket are:

  • Metal-on-polyethylene (a high-density plastic) – a metal ball and plastic socket is the most commonly used combination.
  • Ceramic-on-polyethylene – a ceramic ball and plastic socket.
  • Ceramic-on-ceramic – both components are ceramic.

The fixation of the hip replacement into the body can be cemented or uncemented. The Exeter hip that I use has a cemented femoral stem for the ball and the socket can be either cemented or uncemented. If you choose to have a hip replacement I will discuss all these options with you before the operation.

Q  How long does the operation take?

A  Usually between 60 and 90 minutes.

Q  What are the anesthesia options?

A  We tend to use a spinal anaesthetic to numb the legs, with sedation to give a gentle sleep during the operation. This allows us to avoid the deep general anaesthetics that used to be given and the side effects that went with them. The anaesthetist will talk you through the options before your surgery and you can decide what is best for you.

Q  How long will my new hip last?

A  It varies from person to person depending on things like your age, lifestyle and how active you are, but today’s artificial hips can last more than 20 years.

Q  What is an ODEP rated hip replacement?

A  The Orthopaedic Data Evaluation Panel (ODEP) was set up in 2002 to monitor guidance on hip replacements issued by the National Institute of Health and Care Excellence (NICE). NICE have stated that a successful hip replacement should have a failure rate of less than 10% at 10 years and prostheses with good evidence of meeting this standard are given a 10A rating. The NICE guidance was updated in February 2014 and a stricter benchmark was introduced, proposing that a successful hip replacement should work well in 95% cases over a 10-year period. Components that possess good evidence that they meet this benchmark, such as the Exeter stem that I use, are awarded a 10A* rating.

Q  What are the complications of hip replacement surgery?

A  Thousands of hip replacement operations are carried out every year with no complications whatsoever. But any surgery carries the risk of complications and, although with hip surgery these are rare, it’s important to understand them so that you can decide whether or not to have the operation, and so that any necessary corrective action can be undertaken quickly.

  • Bleeding – in the few days immediately following surgery, a small amount of bleeding is entirely normal. But occasionally a wound hematoma can form – blood collecting under the skin, causing swelling. Although this will often resolve itself, a minor operation may be needed to remove it.
  • Infection – very occasionally, infection at the site of the operation can occur. Usually this will mean removing the artificial hip until the infection has cleared up, followed by surgery to put in a new joint several weeks later. We take the risk of infection very seriously and use multiple strategies to reduce it.
  • Blood clots – after surgery, blood clots can form in the deep veins of the legs – deep vein thrombosis (DVT). Ways to prevent this happening include using a spinal anaesthetic, maintaining hydration and early mobilisation after the operation, using calf compression devices to promote circulation and taking anticoagulant drugs for a short time. The risk for each person is assessed and the prevention measures tailored to the individual’s needs.
  • Pulmonary embolism – in very rare instances a blood clot can travel to the lungs leading to respiratory problems and, in extreme cases, death. The causes and prevention processes are very similar to those for DVT. Pulmonary embolism can be treated with anticoagulant drugs and oxygen therapy.
  • Hip dislocation – occasionally a new hip can dislocate in which case it needs putting back under anaesthetic. The risk of it happening is greatest in the few weeks immediately following surgery and it may be reduced by following the advice given by the physiotherapists after the operation. Very occasionally, new hips can dislocate repeatedly, in which case further surgery may be needed to stabilise the joint.
  • Leg length difference – it is possible for the leg to be either lengthened or shortened during a hip replacement. We make every effort to balance the leg length to the other side, including the use of a computer programme to plan the operation. Nevertheless in some instances it is not possible to match the leg lengths exactly and sometimes a small heel raise may be needed to account for the difference.
  • Injury to nerves and blood vessels – there is a very small risk that nerves or blood vessels may be injured during hip replacement.
  • Medical complications – sometimes people develop complications such as chest infections, urinary tract infections and heart attacks after an operation. Checking general health at pre-admission clinic before the operation helps to reduce the risk of such an event.
  • Heterotopic ossification – this is an unusual condition in which bone forms within the muscles surrounding the hip. In extreme cases the new bone formation can severely restrict the range of movement of the hip joint. It is less common when the operation is done through the posterior approach to the hip, which is the way I do a hip replacement. Some people are more likely to develop the condition because of their medical history or pattern of arthritis and in high-risk individuals I take special precautions against its development.
  • Periprosthetic fracture – whether we have had a hip replacement or not, a heavy fall can sometimes break our femur (thigh bone). If this happens after a hip replacement the presence of the prosthesis can make treatment of the fracture more difficult and complex. Although these fractures are rare they are best avoided, which is why I advise against certain activities after hip replacement, such as contact sports and off-piste skiing.
  • Wear and loosening – these are the most common causes of failure in hip replacements over the long-term. The performance of different hip replacement designs are monitored by the National Joint Registry and by ODEP and the risk of failure can be reduced by having a hip replacement with good evidence of long-term success. If a hip replacement does wear out or come loose then revision surgery may be needed.

Q  Should I exercise before having surgery?

A  Yes, it’s a good idea to exercise before your operation and to avoid weight gain as much as possible – the fitter you are, the faster you will recover. You may find it helpful to get professional medical advice on which forms of exercise to do, as some may exacerbate the problems you already have.

Q  How soon will I be able to get out of bed after the operation?

A  As soon as the day of your surgery itself, and certainly the next morning, when you’ll be encouraged to walk with a walking aid and help from hospital staff.

Q  Will I be in pain after surgery?

A  Yes, there is likely to be some pain from the operation site, but you will be given medication to relieve it. Typically, the pain you’ve been experiencing as a result of damage to your hip will disappear, and any post-operative pain will be short-lived.

Q  How long will I be in hospital?

A  Most people stay in hospital just two or three nights.

Q  Will I need help when I return home after the operation?

A  Yes, it’s important that you have someone at home who can help you in the first couple of weeks after your operation. You will be more tired than normal and you’re likely to need help with everyday tasks such as cooking and cleaning.

Q  Will I need a walking aid after surgery?

A  In general, the hip replacement will be able to take your full weight from the moment it’s done but most people feel more confident using some form of walking aid for a while. While you’re in hospital a physiotherapist will assess which aid is best for you. You can do without the walking aid as soon as you feel confident enough in your strength and balance.

Q  Will I need any other equipment at home after surgery?

A  Yes, in the first few days and weeks after surgery a ‘grabber’ – to pick things up off the floor – is very useful and prevents you from having to bend down. For around six weeks after your operation you will need a special raised toilet seat. This will all be explained and arranged at your pre-operative assessment.

Q  Will I need physiotherapy after surgery?

A  While you’re in hospital a physiotherapist will take you through a series of exercises that will help build strength and flexibility in your new hip. When you return home it’s very important to keep up these daily exercises. We’ll assess whether or not you need any additional post-operative physiotherapy, but most people don’t need it.

Q  How soon before I can drive after surgery?

A  You should be able to return to driving six weeks after your operation.

Q  How soon after surgery can I take a shower or bath?

A  We advise you keep the wound dry for the first week or so after the operation. At about that time you’ll be visited at home by a district nurse, who will remove the dressing and inspect your wound. As long as it’s healing well, you should then be able to have a shower, but I advise against sitting in a bath until six weeks after the operation.

Q  Will my movements be restricted after surgery?

A  Yes, there are some precautions we advise you take to minimise the risk of dislocation. For example, you must not cross your legs, bend down or twist from the hip after surgery and the physiotherapists will advise you on the movements to avoid.

Q  Are there any physical activities I should avoid with my new hip?

A  While you’re having a hip replacement to relieve pain and restore your function, there are some activities that are best avoided. High-impact activities like contact sports, running, off-piste skiing and singles tennis are not recommended, but once you’ve gained stability in your new joint, activities such as walking, swimming, cycling, golf, doubles tennis and gardening are actively encouraged. If you’re already a good skier, you can aim to get back to piste skiing and you’ll be able to use gym facilities, perhaps with some initial advice from the gym staff when you first go back. You will have a post-operative appointment with me around six weeks after your hip replacement and this is a useful opportunity for us to discuss how we get you back to your favourite pastimes.

Q  How long before I’m completely back to normal?

A  This varies from person to person, but as a guide you should be able to resume all normal activities within around 12 weeks. The hip replacement continues to heal and improve for more than a year after the operation.

Q  When I’ve had my hip replacement will I set off the alarm in the airports?

A  Lots of people ask me this and the answer is yes, it is very likely the alarm will go off. Most of the time you just need to tell the airport staff that you’ve had a hip replacement, but sometimes they will ask you to go through a body scanner to confirm that everything is OK.

Q  How do I make arrangements for hip surgery?

A  If you have decided you’d like some advice about your hip, you simply need to make an appointment with your GP and ask to be referred to me.

 

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