Hip replacement and hip revision

Published by Bupa's Health Information Team, August 2010.

This factsheet is for people who are planning to have a hip replacement operation or hip revision surgery, or who would like information about it.

Hip replacement operation involves replacing a hip joint that has been damaged or worn away, usually by arthritis or injury. Hip revision (or repeat hip replacement) involves replacing an artificial hip joint that 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

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About hip replacement

Your hip is a ball and socket joint. Normally, the ball at the top of your thigh bone (femur) moves smoothly in the socket of your pelvis (hip) on a lining of cartilage. The cartilage stops the bones from rubbing together. If the cartilage is worn away, the underlying bone is exposed and your joint becomes painful and stiff. As a result walking and moving around becomes painful.

A new hip joint can help to improve your mobility and reduce pain.

Types of artificial hip

Artificial hip parts can be made of metal, ceramic or plastic. Hip joints can be fixed in place using a special substance called 'bone cement'. Alternatively, they may be designed so that your own bone grows onto the metal. These 'uncemented' hips can be coated with a type of bone mineral (hydroxyapatite) or can be made from a material that has lots of tiny holes (porous coating). This encourages your bone to grow into the artificial joint and fix it in place.

Hip revision surgery

During your original hip replacement, your hip joint was replaced with artificial hip parts. These usually last from 10 to 20 years, after which they need replacing.

Renewing an artificial hip joint is more complicated than the original operation because the existing artificial hip joint will need to be taken out before the new one is fitted. If the hip has worn loose then this may not be too difficult for your surgeon, but if it is still bonded to your bone then removing the old components can be a challenge.

You may find that your new joint, although a big improvement on your old joint, may not improve your life as much as your original hip operation. This may be because the muscles can take a long time to recover from the build-up of scar tissue and repeat surgery.

What are the alternatives to hip replacement?

Surgery is usually recommended only if non-surgical treatments, such as taking painkillers (eg paracetamol) or anti-inflammatories (eg ibuprofen), or using physical aids like a walking stick, no longer help to reduce your pain or improve mobility.

Hip resurfacing may be a better option for people with stronger bones. In this operation the surfaces of the ball and socket are covered with metal caps.

Preparing for your operation

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.

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 stay awake during the operation. Your surgeon will advise you which type of anaesthesia is most suitable for you. Often people have a combination so that they are asleep, but the spinal/epidural anaesthetic will ease any pain immediately after surgery.

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, by signing a consent form, for the procedure to go ahead.

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).

About the operation

A hip replacement 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 separate the ball and socket (hip joint).

The ball at the top end of your thigh bone (the femoral head) 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 will be placed into it. The two halves of the hip joint are then put back together (the ball is put into the socket).

Your surgeon will close the skin cut with stitches or clips and cover it with a dressing.

It may be possible for your surgeon to make a smaller cut over your hip and thigh. This type of operation (minimally invasive hip replacement) is carried out using specially designed surgical instruments. It isn't suitable for everyone - ask your surgeon if it's an option for you.

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 (injection or tablets) to prevent DVT, such as rivaroxaban or dabigatran. You will be given this shortly after your surgery and then you may need to take it for a few weeks.

A physiotherapist (a health professional who specialises in movement and mobility) will usually visit you each day to guide you through exercises that are designed to help your recovery.

You will stay in hospital until you're able to walk safely with the aid of sticks or crutches. This is usually about five days. However, if you're generally fit and well, your surgeon may suggest you do an accelerated rehabilitation programme, where you start walking on the day of the operation and are discharged within one to three days.

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 before you go home.

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

Recovering from hip replacement surgery

If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. 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 to reduce the risk of a dislocation. Your physiotherapist will give you further advice and tips to protect your hip.

You should be able to move around your home and manage stairs. You will find some routine daily activities, such as shopping, difficult for a few weeks and will 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. But 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 automatic.

What are the risks?

Hip replacement is commonly performed and generally safe. However, in order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications.

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 the thigh and also in the ankle.

Complications

Complications are when problems occur during or after the operation. Most people having hip surgery aren't affected. The possible complications of any operation include an unexpected reaction to the anaesthetic, excessive bleeding or developing a blood clot, usually in a vein in the leg (deep vein thrombosis, 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 immediately after your surgery and you may need another operation to treat this.
• Difference in leg length - your leg may be slightly shorter or longer and you may need to wear a raised shoe on the shorter side 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 require further surgery to correct this.
• Nerve damage - this can quite often result in numbness around your scar, but rarely the sciatic nerve may be stretched and this can leave weakness in the foot (usually temporary).

The artificial hip joint usually lasts between 10 and 20 years, after which you may need to have it replaced.

The exact risks are specific to you and differ for every person, so we haven't included statistics here. Ask your surgeon to explain how these risks apply to you.

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

For sources and links to further information, see Resources.