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Hip replacement and hip revision

A hip replacement operation involves replacing your hip joint if it has 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 has become loose, infected or worn out.

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

How a hip replacement is carried out

About hip replacement

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 shiny 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 can help to improve your mobility and reduce pain.

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

Illustration showing a hip with arthritis and a hip with a replaced joint

Artificial hip parts can be made of metal, ceramic or plastic – the most common combination is a metal head and a plastic cup. Metal and ceramic parts tend to be more hard-wearing, but they may have other disadvantages. 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 that will encourage 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 on metal hip replacements, where both artificial pieces are made from metal, are no longer being routinely used. This type of joint was mainly used for younger, more active people because it was thought that it would be more hard-wearing and last longer. However, there is now some evidence that when the metal parts move against each other, very small particles of metal may rub off, and some of these may get into your blood. Over time, these particles may also damage the surrounding tissues, leading to pain and the replacement joint becoming loose. There is also some evidence to suggest that this type of replacement joint may increase your risk of cancer – some scientists dispute this however, and more research is needed to confirm it.

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.

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 if it’s still bonded to your bone, the operation will almost certainly take longer.

You may find that your new joint, although a big improvement on your old one, 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 frequently asked questions for more information.

What are the alternatives to hip replacement?

You will usually only be recommended surgery if non-surgical treatments, such as taking over-the-counter painkillers (eg paracetamol) or anti-inflammatory medicines (eg ibuprofen), or using physical aids like a walking stick, no longer help to reduce your pain or improve mobility.

It’s possible that you may be able to have a hip resurfacing operation rather than a full hip replacement. This involves removing the damaged bone and covering the surfaces of the ball and socket with metal caps. This surgery is only suitable for a small number of people – whether or not you’re able to have it will depend on a number of factors, including your age and how strong your bones are.

Preparing for hip replacement

Your surgeon will explain how to prepare for your operation. For example, if you smoke you will be asked to stop, as smoking increases your risk of getting a chest and wound infection, which can slow your recovery. If you’re overweight, your surgeon may recommend you try to lose excess weight. This will help to reduce the strain on your new hip and may also mean you’re less at risk from the possible complications of any surgery.

The operation is usually done under general anaesthesia. This means you will be asleep during the operation. Alternatively, you may have the surgery under spinal or epidural anaesthesia. This completely blocks feeling from below your waist and you will stay awake 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. This means not eating or drinking, typically for about six hours beforehand. However, it's important to follow your anaesthetist's advice.

Your surgeon will discuss with you what will happen before, during and after your procedure, and any pain you might have. This is your opportunity to understand what will happen, and you can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to be informed, so you can give your consent for the procedure to go ahead, which you may be asked to do by signing a consent form.

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

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

What happens during hip replacement?

A hip replacement operation usually takes around two hours.

Your surgeon will make a cut (20 to 30cm long) over your hip and thigh. He or she 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 is 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 or clips 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 and you may be at a higher risk of complications.

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 to prevent DVT, such as rivaroxaban or dabigatran. You will be given this shortly after your surgery and you may need to carry on taking it for a few weeks.

A physiotherapist (a health professional who specialises in movement and mobility) will usually visit you the day after your operation and at regular intervals afterwards. He or she will give you physiotherapy exercises to do and it’s important that you do these as often as your physiotherapist tells you, probably at least once 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 about five days after your operation. 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.

Most skin stitches or clips will need to be removed after 12 to 14 days. Dissolvable stitches don't need to be removed.

Recovering from hip replacement

If you need 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.

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. See our frequently asked questions for more information.

You should be able to move around your home and manage stairs. You may find some routine activities, such as shopping, difficult for a few weeks and need to ask for help. You will need to use 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 as the length of time before you're fit to drive will depend on several factors, including which leg has been operated on and whether your car is manual or automatic.

See our frequently asked questions for more information about your recovery.

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, both 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 frequently asked questions 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.
  • Unstable 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, but rarely the sciatic nerve may be stretched and this can lead to loss of movement and sensation in your foot (this is usually temporary).

 

Produced by Polly Kerr, Bupa Health Information Team, July 2012.

For answers to frequently asked questions on this topic, see FAQs.

For sources and links to further information, see Resources.

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  • This information was published by Bupa's Health Information Team and is based on reputable sources of medical evidence. It has been reviewed by appropriate medical or clinical professionals. Photos are only for illustrative purposes and do not reflect every presentation of a condition. The content is intended only for general information and does not replace the need for personal advice from a qualified health professional. For more details on how we produce our content and its sources, visit the about our health information page.

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