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Hip replacement and hip revision

A hip replacement operation involves replacing your hip joint if it’s been damaged or worn away. This is usually caused by arthritis, but is sometimes the result of an injury. Hip revision (or repeat hip replacement) involves replacing your artificial hip joint if it’s become loose, infected or worn out.

Your hip is a ball and socket joint. Usually the ‘ball’ at the top of your thigh bone (femur) moves smoothly in the ‘socket’ of your pelvis, which has a lining of low friction cartilage. The cartilage stops your bones from rubbing together and has no feeling (like fingernails). If your cartilage is worn away, the underlying bone is exposed and your joint becomes painful and stiff, which makes walking and moving around painful. A new hip joint aims to help improve your mobility and reduce pain.

You will meet the surgeon carrying out your procedure to discuss your care. It may be different from what’s described here as it will be designed to meet your individual needs.

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Hip replacement
How the procedure is carried out
An image showing a hip with arthritis and a hip with a replaced joint

Details

  • About hip replacement About hip replacement

    If you have a total hip replacement, the parts of your bones that are rubbing together will be removed. Replacement pieces made from artificial materials will then be put in their place.

    An image showing a hip with arthritis and a hip with a replaced joint 

    Hip replacements can be made of metal, ceramic or plastic. The most common combination is a metal head and a plastic cup. Hip joints can be fixed  (‘cemented’) or pressed into place (‘uncemented’). If the hip is uncemented, the metal surfaces are often treated with a substance and roughened. This encourages your own bone to grow into the artificial joint and fix it in place. You may also have a hybrid replacement where only one piece is cemented in place.

    Metal and ceramic parts tend to be more hard-wearing, but they may have other disadvantages. Metal-on-metal hip replacements, where both pieces are made from metal, are no longer routinely used for total hip replacement operations. Research shows that more metal-on-metal implants need a revision operation than metal-on-plastic total hip replacements. There’s also some evidence to suggest that particles of metal may get into your blood. This type of replacement joint may increase the risk of inflammation or cancer and not be suitable for women of childbearing age. However, more research is needed to confirm this. Speak to your surgeon if you have any questions about the type of replacement you’re having.

    If you have a metal-on-metal hip implant and are having any pain or difficulty moving the joint, see your GP for a check-up. You may need to have a blood test to check the level of metal in your blood and X-rays to check for damage to the implant.

    Bupa On Demand: Hip replacement surgery

    Want to talk to a Bupa consultant about hip surgery? We’ll aim to get you seen the next day. Prices from £250.

  • About hip revision About hip revision

    If you have had a hip replacement, it will usually last from 10 to 20 years, after which you may need to have it replaced. This is called a hip revision.

    Research suggests you’re less likely to need a hip revision operation during the first 10 years if you have a cemented implant rather than an uncemented implant.

    Renewing an artificial hip joint is more complicated than the original operation because you will first need to have the existing artificial hip joint taken out. If your artificial hip has worn loose, this may not be too difficult. But sometimes your surgeon may need to reconstruct some of the bone and the operation will take longer.

    You may find that your new joint may not improve your life as much as your original hip operation. This may be because your muscles take longer to recover from the build-up of scar tissue and repeat surgery. See our FAQs for more information.

    Bupa On Demand: Hip replacement surgery

    Want to talk to a Bupa consultant about hip surgery? We’ll aim to get you seen the next day. Prices from £250.

  • Pros and cons Pros and cons of hip replacement

    This information is intended to help you understand the advantages and disadvantages of hip replacement. Think about how important each particular issue is to you. You and your doctor can work together to make a decision that’s right for you. Your decision will be based on your doctor’s expert opinion and your personal values and preferences.

    Pros

    • After a hip replacement most people don’t have hip pain any more.
    • Hip replacement can improve your ability to move around.
    • You can reduce or stop taking painkillers you have been taking for your hip pain.
    • You should be able to walk without aids when you have recovered.

    Cons

    • You will need to stay in hospital for a few days after this operation.
    • Your movement may be limited after the operation to prevent hip dislocation.
    • There are risks linked to major surgery, including the risk of dying as a result of the operation.
    • You may need a repeat operation after 10 to 20 years.
  • Preparation Preparing for hip replacement

    If you smoke, you will be asked to stop. This is because smoking increases your risk of getting a chest and wound infection, which can slow your recovery. If you’re overweight, your surgeon will discuss the benefits of losing excess weight. This will help reduce the strain on your hip and may mean you’re less at risk from complications of surgery.

    The operation may be done under spinal or epidural anaesthesia. This completely blocks feeling from below your waist but you will stay awake during the operation. Alternatively, you may have surgery under general anaesthesia. This means you will be asleep during the operation. Your surgeon will advise you which type of anaesthesia is most suitable for you.

    If you're having a general anaesthetic, you will be asked to follow fasting instructions for about six hours beforehand. It's important to follow your anaesthetist's advice.

    Your surgeon will discuss with you what will happen before, during and after your procedure. This is your chance to make sure you understand what will happen. You may find it useful to prepare some questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to give your informed consent for the procedure to go ahead.

    You may also be asked to give your consent to have your name on the National Joint Register. This is used to follow up the safety, durability and effectiveness of joint replacements and implants.

    To help prevent blood clots forming in the veins in your legs (deep vein thrombosis, DVT), you may be asked to wear compression stockings.

    Bupa On Demand: Hip replacement surgery

    Want to talk to a Bupa consultant about hip surgery? We’ll aim to get you seen the next day. Prices from £250.

  • Alternatives What are the alternatives to hip replacement?

    You will usually only be recommended surgery if non-surgical treatments no longer help to reduce your pain or improve your mobility. For example, taking over-the-counter painkillers or using physical aids like a walking stick.

    It’s possible that you may be able to have a hip resurfacing operation rather than a conventional hip replacement. This involves removing the damaged bone and covering the surfaces of the ball and socket with metal caps. This surgery may be an option if you’re 65 or younger with strong bones.

  • The procedure What happens during hip replacement?

    A hip replacement operation usually takes around one and half to two hours, and a hip revision about twice as long.

    Your surgeon will make a cut (20 to 30cm long) over your hip and thigh. They will then divide the hip muscles and separate (dislocate) your ball and socket joint.

    The ball at the top end of your thigh bone will be removed and a replacement ball on a stem will be inserted into your thigh bone. Your hip socket will be hollowed out to make a shallow cup and an artificial socket placed into it. The hip joint is then put back together (the ball is put into the socket).

    Your surgeon will close the cut in your skin with stitches and cover it with a dressing.

    Alternatively, it may be possible for you to have the operation done making one or two smaller cuts (about 10cm) over your hip and thigh. This means that there may be less damage to your hip muscles. This type of operation (minimally invasive hip replacement) is carried out using specially designed surgical instruments. It isn't suitable for everyone.

  • Hip replacement on demand

    You can access a range of our health and wellbeing services on a pay-as-you-go basis, including hip replacements.

  • Aftercare What to expect afterwards

    You will need to rest until the effects of the anaesthetic have passed. You may not be able to feel or move your legs for several hours after a spinal or epidural anaesthetic. You may need pain relief to help with any discomfort as the anaesthetic wears off.

    A special pillow may be placed between your legs to hold your hip joint still and stop it from dislocating.

    You may be given medicine as injections or tablets to prevent DVT. You will be given this shortly after your surgery and you may need to carry on taking it for a few weeks.

    A physiotherapist will usually visit you after your operation and at regular intervals afterwards. They will give you exercises to do and it’s important that you do these as often as your physiotherapist tells you. Normally three times a day. These are designed to help your recovery by restoring movement and strength in your hip.

    You will stay in hospital until you're able to walk safely with the aid of walking sticks or crutches. This is usually between three and five days after your operation. But it can be anything from one to eight days depending on your recovery. When you're ready to go home, you will need to arrange for someone to drive you. Your nurse will give you some advice about caring for your hip and a date for a follow-up appointment.

    Your stitches may need to be removed after 12 to 14 days. Dissolvable stitches don't need to be removed.

  • Recovery Recovering from hip replacement

    You will probably be prescribed painkillers to take home when you leave hospital. If you need further pain relief, you can take over-the-counter painkillers (eg paracetamol). Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.

    The exercises recommended by your physiotherapist are a crucial part of your recovery, so it's essential that you continue to do them when you’re home.

    There are certain movements that you shouldn't do in the first six weeks. For example, don't cross your legs or twist your hip inwards and outwards. This is to reduce strain on your scar and also the risk of a dislocation.

    You should be able to move around your home and manage stairs. However, you may find some routine activities, such as shopping, difficult for a few weeks. You will need to use sticks or crutches for about four to six weeks.

    You can usually return to light work after about six weeks. If your work involves a lot of standing or lifting, you may need to stay off for longer.

    Follow your surgeon's advice about driving. The length of time before you're fit to drive will depend on several factors. These include which leg has been operated on and whether your car is manual or automatic.

    See our FAQs for more information about your recovery.

  • Risks What are the risks?

    As with every procedure, there are some risks associated with hip replacement or hip revision surgery. We have not included the chance of these happening as they are specific to you and differ for every person. Ask your surgeon to explain how these risks apply to you.

    Side-effects

    Side-effects are the unwanted but mostly temporary effects you may get after having the procedure. Your hip will feel sore for several weeks and you may have some temporary pain and swelling in your thigh and also in your ankle. This is normal and may last for several months.

    Complications

    Complications are when problems occur during or after the operation. The possible complications of any operation include an unexpected reaction to the anaesthetic, excessive bleeding or DVT. Specific complications of hip replacement are uncommon, but can include the following.

    • Infection. You will be given antibiotics during and after surgery to help prevent this.
    • Joint dislocation. This is most likely to happen in the early weeks and months after your surgery and you may need another operation to treat it. See our FAQs for more information. 
    • Difference in leg length. Your leg may be slightly shorter or longer and you may need to wear a raised shoe to correct your balance.
    • Hip fracture. Tiny cracks can occur in your bone while fitting the new joint. These usually heal, but sometimes your bone can fracture and require further surgery.
    • Loosening of the joint. The hip joint may become loose and you may need further surgery to correct this.
    • Nerve damage. This can result in numbness around your scar. Rarely the sciatic nerve may be stretched and this can lead to loss of movement and sensation in your foot (this is usually temporary).
  • FAQs FAQs

    What is the most common complication of hip replacement surgery and why?

    Answer

    A common complication of hip replacement surgery is dislocation of your joint (the ball part comes out of the socket). This happens to between one and 10 in 100 people who have a hip replacement. It's important to take care of your new hip to reduce the risk of it happening.

    Explanation

    Dislocation is a possible complication following a total hip replacement. Your hip is most likely to dislocate soon after your operation. Up to seven in 10 dislocations happen within the first six weeks. This is because the muscles have not fully healed.

    The risk of dislocation varies depending on the surgical technique used, your age and your general health. For example, if the muscles in your hip area are weak, the joint may become unstable. Hip dislocation is more common if you have a repeat hip replacement (an artificial hip joint replaced or hip revision).

    You can dislocate your hip if you bend your hip further than a right angle. For example, if you sit in a low chair. You can also dislocate your joint if you cross your legs, or if you turn your feet inwards or outwards too much.

    Dislocation can happen after hip replacement surgery. This is because during the operation your surgeon moves surrounding muscles and tissue out of the way to get to your hip. Your hip joint is then dislocated and some bone is removed to fit the new parts. This results in the normal stability of your hip joint being affected.

    Your surgeon will repair any damage to muscles and tissues that surround your joint, but your joint will only become stable when your muscles around it have healed.

    The exercises recommended by your physiotherapist are a crucial part of your recovery, so it's essential that you continue to do them.

    If your hip dislocates often, you may need further surgery. Alternatively, your surgeon may advise you to wear a brace (a fitted support) to stabilise your joint and allow the surrounding tissue to heal.

    Are there any sports or activities I shouldn't do after my hip replacement?

    Answer

    It's important to stay active after you have fully recovered from your operation. However, don't do any high-impact sports that put a lot of pressure on your hips, such as running, squash or tennis.

    Explanation

    During your recovery your physiotherapist will recommend exercises for you that will improve your strength and range of motion.

    As you recover, you can start swimming but don't do breaststroke as the sideways kicking can cause a dislocation. Also do more walking to strengthen your muscles around the joint.

    When you have made a full recovery, you can have a more active lifestyle. However, try not to run on hard surfaces or take part in sports that could cause injury, such as football or rugby. Or activities that put a lot of pressure on your hip such as squash or tennis. It's best not to do any sports with a high risk of falling such as skiing or snowboarding.

    Regular exercise will help to improve and maintain your mobility. When returning to any sport, it's important to take your time to rebuild your strength, coordination and reflexes. For example, if you play golf, work on chipping and putting before attempting longer distance shots.

    Your doctor, surgeon or physiotherapist will be able to give you more information about what activities are suitable for you.

    What can I do to make my recovery easier?

    Answer

    It’s important that you try to be as fit and healthy as possible before your operation. You can also prepare your home for when you return from hospital.

    Explanation

    If you smoke, your surgeon will talk to you about the benefits of giving up. Smoking increases your risk of complications after a hip replacement, including infection, loosening of the implant and the need for another operation.

    Obesity (a BMI over 30) also increases your risk of complications after a hip replacement. Your doctor may recommend a weight-loss programme before your operation.

    You can also exercise to strengthen your upper body. This will help you to get around after the surgery when using walking aids, such as crutches. If it's possible, try to strengthen your leg muscles. Strengthening the muscles in your legs will speed your recovery and make it easier to do the post-operative exercises. Your surgeon or physiotherapist will recommend exercises for you.

    You may also want to prepare your home for when you return from hospital. This may involve rearranging furniture to make it easier for you to move around safely. And also placing items that you use often at arm level, so you don't have to reach for them. An occupational therapist can advise you on aids for your home. It also helps to stock up on non-perishable food, such as frozen or tinned items, so that you don't need to go shopping immediately after your surgery.

    You may need help after surgery. It's a good idea to arrange to have a friend or family member stay with you for a couple of weeks after the operation.

    Why is hip revision surgery more complicated than the original hip replacement operation?

    Answer

    Hip revision surgery is more complicated than the original operation because the existing implants and any cement need to be taken out before a new joint can be fitted. Your bones are more likely to fracture and there may be less bone to hold the new implant in place. As a result, repeat hip operations take longer to complete and have a greater risk of complications.

    Explanation

    Over time, your artificial joint may become loose and need to be replaced. Currently the artificial joints used in hip replacement last between 10 and 20 years. The repeat operation is called hip revision surgery.

    During a hip revision operation, the original implants and any cement used to hold them in place need to be removed before the new implants can be put in. Your thigh bone may have grown into the implant, making it more difficult to remove, and your bones will have become thinner with age. As a result, your bones are more likely to fracture and your new joint is more likely to become loose because there isn't as much bone to hold it in place. A hip replacement with a longer stem may need to be used to get a stronger fix.

    Your surgeon may have to rebuild the bone in your hip using bone taken from another part of your body or from your thigh bone. This is called a bone graft. If you have a bone graft, it may take longer to recover as it may restrict your movement and you might need to use crutches for longer.

    Why am I unlikely to walk completely normally after hip revision surgery?

    Answer

    Hip revision surgery is more complex and has a greater risk of complications than the original operation. You may find that your new joint may not improve your mobility as much as your original hip operation.

    Explanation

    Repeat hip operations take longer to complete, are more complex and have a greater risk of complications compared with the original operation. Complications that can affect mobility after hip revision surgery are listed here.

    • Infection. With age your immune system weakens and you're more vulnerable to infection. Infection causes pain and swelling, delays healing and affects your overall health. If antibiotics don't help to clear an infection, the implant may need to be removed.
    • Scarring. During a repeat operation cuts may be made over the original scars, so the tissue may not heal as well as before. Scar tissue can make your leg muscles feel stiff and affect your walking.
    • Fragile bones. With age your bones become thinner, so they are more likely to fracture and there is less bone to hold the new implant in place. As a result, your joint is more likely to become loose or dislocate and this can affect your mobility.
    • Leg difference. During hip revision surgery more bone is removed because the old implant has to be taken out before the new one is fitted. So you're more likely to have a shorter leg and a slight limp.

    Hip revision techniques are improving all the time and there is every chance that you will have a good quality of life afterwards. You may always have a limp, but you should be able to continue to do everyday activities. For more information and advice about the operation, speak to your doctor or surgeon.

  • Resources Resources

    Further information

    Sources

    • Map of Medicine. Elective hip surgery. International View. London: Map of Medicine; 2013 (Issue 2).
    • Hip replacement surgery. Arthritis Research UK. www.arthritisresearchuk.org, published November 2013
    • Hole JW and Koos KA. Human Anatomy. Mosby. 2nd Ed. Dubuque. 1994: 204
    • Anesthesia for hip and knee surgery. American Academy of Orthopedic Surgeons. www.orthoinfo.aaos.org, published March 2014
    • National Joint Registry. 10th Annual Report. 2013. www.njrcentre.org.uk, published 2013
    • Metal on metal hips. British Orthopaedic Association. www.boa.ac.uk, published 7 July 2012
    • Map of Medicine. Osteoarthritis. International View. London: Map of Medicine; 2014 (Issue 3).
    • Primary total hip replacement: a guide to good practice. British Orthopaedic Association. www.boa.ac.uk, published August 2006
    • Total hip replacement. American Academy of Orthopaedic Surgeons. www.orthoinfo.aaos.org, published December 2011
    • Minimally invasive total hip replacement. National Institute for Health and Care Excellence (NICE), published October 2010. www.nice.org.uk
    • Total hip replacement and resurfacing arthroplasty for end-stage arthritis of the hip (review of technology appraisal guidance 2 and 44). National Institute for Health and Care Excellence (NICE), published February 2014. www.nice.org.uk
    • Singh JA. Smoking and outcomes after knee and hip arthroplasty: a systematic review. The J Rheumatol 2011. 38(9): 1824-1834
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    Reviewed by Dylan Merkett, Bupa Health Content Team, November 2014.

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