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Hip replacement and hip revision

This section contains answers to frequently asked questions about this topic. Questions have been suggested by health professionals, website feedback and requests via email.

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 approximately one in 50 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. The risk of dislocation varies depending on the surgical technique used and your general health. For example, if the muscles in your hip area are weak, the joint may become loose. Hip dislocation is more common if you have a repeat hip replacement (an artificial hip joint replaced). Your hip is most likely to dislocate soon after your operation – more than half of dislocations occur within four to 12 weeks. This is because the muscles have not fully healed and are therefore weaker.

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 and lean forward, or if you lie down and lift your waist.

Dislocation is more common after hip replacement surgery 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 fully 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, you may be advised 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 puts 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) and 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, co-ordination 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're having a hip replacement, it's a good idea to try and be as fit and healthy as possible before your operation to speed up your recovery.

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 infection, wound infection or blood clot (deep vein thrombosis, DVT), which can slow your recovery.

If you're overweight, your doctor may recommend a weight-loss programme. 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 placing items that you use often at arm level so you don't have to reach for them. 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 is 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

Currently the artificial joints used in hip replacement last about 10 to 20 years, after which your artificial joint may become loose and need to be replaced. 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 enough 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. So, you may find that your new joint, although a big improvement on your old 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. Reasons why your mobility may be affected 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. This may limit how much you can exercise straight after surgery, thus slowing down your recovery. If antibiotics don't help to clear an infection, the implant may need to be removed.
  • Scarring. During a repeat operation cuts are made over the original scars, so the tissue may not heal as well as before. Any infection may delay healing and cause scar tissue to form. 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, such as getting dressed, climbing the stairs, getting in and out of the bath and walking short distances. For more information and advice about the operation, ask your doctor or surgeon.

 

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

For our main content on this topic, see Information.

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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