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Hip replacement and hip revision


Expert reviewer Roger M Tillman, Consultant Orthopaedic Surgeon
Next review due September 2019

Hip replacement surgery is a procedure to replace your hip joint with artificial parts (prosthesis) if it’s been damaged or worn away. This damage is usually caused by arthritis, or it can sometimes be from an injury.

Hip revision (another repeat hip replacement) involves replacing your artificial hip joint if it’s become loose, infected or worn out.

About your hip joint

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 that’s lined with smooth cartilage.

If your cartilage is worn away, the underlying bone is exposed and your joint can become painful and stiff. This can make walking and moving around painful. An operation to give you a new hip joint aims to help improve your mobility and reduce pain.

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

About hip replacement

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

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.

Speak to your surgeon if you have any questions about the type of replacement you’re having. You’ll meet them before your operation to discuss your care. It may be different from what’s described here as it will be designed to meet your individual needs.

About hip revision

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

Your surgeon will advise you on what type of hip replacement (metal or ceramic head, cemented or uncemented) is most suitable for you.

Hip revision is more complicated than the original operation. This is because your surgeon will first need to take out the existing artificial hip joint. 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.

Your new joint might not improve your life as much as your original hip operation. But even so, eight out of 10 people who have this operation are happy with the results for 10 years or more.

Deciding on hip replacement

It’s important to consider the advantages and disadvantages of hip replacement and how important each of these is to you. Your doctor can help you to make a decision that’s right for you. Here are some pros and cons that you should consider before deciding whether a hip replacement is right for you.

Pros

  • After a hip replacement most people don’t have hip pain any more so you don’t need to take painkillers.
  • Hip replacement can help you move around better.
  • Once you’ve recovered, you shouldn’t need a stick to walk any more.

Cons

  • You’ll need to stay in hospital for a few days after the operation and it will take time to recover.
  • Your movement may be a bit limited for around six weeks after the operation.
  • There are risks of having the operation.
  • You may need to have another operation after 10 to 20 years.

Preparing for hip replacement

Your surgeon will explain how to prepare for your operation. If you smoke, you’ll need to stop because it increases your risk of getting a chest and wound infection, which can slow your recovery.

If you’re overweight, it’s a good idea to try and lose weight. It may help to reduce the strain on your hip and lower your risk of complications of surgery.

If you take some types of medicines such as hormone replacement therapy, you might need to stop about four weeks before your operation. Tell your surgeon about any medicines you take so they can advise you.

The operation can be done under spinal or epidural anaesthesia. This completely blocks feeling from below your waist, but you’ll stay awake during the operation. Or you may be able to have the operation under general anaesthesia, which means you’ll be asleep during the operation. Your surgeon will let you know which type of anaesthesia is best for you.

An anaesthetic can make you sick so it's important that you don't eat or drink anything for six hours before a general anaesthetic. Follow your anaesthetist’s advice. If you have any questions, just ask.

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 exactly what will happen. You might find it helpful to prepare some questions to ask about the risks, benefits and alternatives to the procedure. This will help to inform you about the procedure so you can give your consent for it to go ahead. You may be asked to sign a consent form. Your surgeon may also ask you to give your consent to have your name on the National Joint Registry. This is used to follow up the safety, durability and effectiveness of joint replacements and implants.

You may need to wear compression stockings during the operation to help prevent blood clots forming in the veins in your legs (deep vein thrombosis). You may also need to have injections of a medicine (or tablets) to prevent DVT.

What are the alternatives to hip replacement?

Your surgeon will usually only recommend you have surgery if non-surgical treatments no longer help to reduce your pain or help you walk more easily. These include taking painkillers, having steroid injections in your hip joint, or using physical aids like a walking stick.

It’s possible you could 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. However, most surgeons now recommend a ceramic, or partly ceramic hip joint rather than a resurfacing.

What happens during hip replacement?

A hip replacement operation usually takes an hour or two. Hip revision surgery will take longer.

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

Your surgeon will remove the ball at the top end of your thigh bone and put a replacement ball on a stem into your thigh bone. They’ll then hollow out your hip socket to make a shallow cup and put an artificial socket into it. Your surgeon will then put your hip joint back together (they’ll put the ball into the socket).

Finally, your surgeon will close the cut in your skin with stitches or clips and cover it with a dressing.

Keyhole surgery

Rather than have open surgery that’s described above, it may be possible to have keyhole (minimally invasive surgery) instead. In this operation, your surgeon will make one or two smaller cuts (about 10cm) over your hip and thigh. It aims to lessen the damage to your hip muscles and tendons. This type of operation isn't suitable for everyone. Ask your surgeon if it’s an option for you.

What to expect afterwards

You might have some discomfort as the anaesthetic wears off. But you'll be offered pain relief as you need it. You might not be able to feel or move your legs for several hours after a spinal or epidural anaesthetic.

A nurse may have to put a pillow between your legs to hold your hip joint still and stop it from dislocating (moving out of position).

A physiotherapist will usually visit you after your operation and will pop back regularly afterwards. They’ll give you some exercises to do. It’s important to do these as often as they tell you to. They’re designed to help your recovery by bringing back movement and strength in your hip.

You’ll need to stay in hospital until you're able to cope on your own at home. This is usually for between four and eight days but it might be sooner if you’re recovering well. When you're ready to go home, ask a friend or your family to drive you. Your nurse will give you some advice about caring for your hip and a date for a follow-up appointment. This is usually about eight weeks after your operation. See our advice about Caring for surgical wounds.

A district nurse will need to remove your stitches after 10 days. If you have dissolvable stitches, they won’t need to be removed.

Recovering from hip replacement

How long it takes to recover from a hip replacement varies from person to person. It may depend on several different things, including, for example, the type of surgery you have and if you have any complications. When you leave hospital, your recovery will continue at home. By around six weeks, you may be able to return to work, but will depend on what it is you do.

Short -term recovery

You’ll probably feel the benefits of the operation almost immediately after your operation but you might feel some pain initially. You’ll usually be prescribed painkillers to take home when you leave hospital. If you need further pain relief, you can take over-the-counter painkillers, such as paracetamol. Always read the patient information leaflet that comes with your medicine and, if you have any questions, ask your pharmacist for advice.

After the operation, your body uses up extra energy to help your wound heal. For a couple of weeks after your operation you may feel more tired than usual, so remember to rest when you need to. You won’t be able to return to work or drive for a while after your operation.

Getting up and moving after your operation is important. At first you’ll need support and supervision, but it’ll gradually get easier and you can build up over time.

Long-term recovery

The exercises your physiotherapist gives you are a crucial part of your recovery, so it's really important to keep going with them when you’re home.

There are some movements you should avoid doing during the first six weeks to protect your hip. For example, don't cross your legs or twist your hip inwards and outwards. This will reduce strain on your scar and also reduce the risk of dislocating your hip.

You should be able to move around your home and manage stairs, but you might find things like shopping difficult for a few weeks. Ask friends and family to help out, or order your shopping online.

After a couple of weeks, you should be able to walk for longer distances and periods of time with less support. However, some people need to use sticks or crutches for around four to six weeks.

Try and sleep on your back for the first six weeks. If this is uncomfortable, sleep on your side but put a pillow between your knees to keep your hip in the right place.

If you work, you can usually go back after about six weeks. But if your work involves a lot of standing or lifting, you may need to stay off for longer.

You should be able to drive again after about six weeks but check with your surgeon as this can vary. It’s best to hold off on any travel that takes three hours of more (including flying) for a month after your operation. This is to prevent getting deep vein thrombosis (DVT). You can take a long-haul flight after 12 weeks, but check with your travel insurer before you go.

For more information about recovering from hip surgery, see FAQ: What sports can I do? and FAQ: Recovering from hip surgery.

Side-effects of hip replacement and hip revision

As with every procedure, there are some risks associated with hip replacement or hip revision surgery. We haven’t 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 are the unwanted, but mostly temporary effects you may get after having the procedure. Side-effects of hip surgery include:

  • a sore hip and leg for a few weeks
  • swelling in your leg – this might last for several weeks

Complications of hip replacement and hip revision

Complications are when problems occur during or after the operation. Complications of hip replacement can include the following.

  • Joint dislocation. This is when the ball part comes out of the socket because your muscles haven’t fully healed. If this happens, it will most likely be in the early weeks and months after your surgery and you may need another operation to treat it.
  • Developing a blood clot, usually in a vein in your leg (deep vein thrombosis).
  • An infection. Your surgeon may prescribe you antibiotics during and after surgery to help prevent this.
  • Difference in leg length. Your leg may be slightly shorter or longer so you might need to wear a shoe insert on the shorter side to correct your balance.
  • Hip fracture. You can get tiny cracks in your bone while your surgeon’s fitting the new joint. These might heal, but it’s possible that you’ll need to have another operation.
  • Loosening of your hip joint. You may need another operation to fix this.
  • Nerve damage. It’s possible that nerves in your leg and bottom can be damaged during the operation.
  • Particles of metal getting into your bloodstream from the metal parts. See FAQ: Metal hip replacement parts for more information.

Frequently asked questions

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

    More information

    If you’re overweight or obese, it increases your risk of complications after a hip replacement. So your surgeon might advise you to lose some weight before your operation.

    It’s also a good idea to exercise to prepare your upper body for using crutches. And try to strengthen your leg muscles too, as it will help you recover. Ask your surgeon or physiotherapist for advice on the type of exercises to do.

    Try to prepare your home for when you return from hospital. You could rearrange your furniture to make it easier to move around safely. And place items that you use often at arm level, so you don't have to reach for them. An occupational therapist is a good source of advice on aids for your home. Stock up on frozen or tinned food too so you don't need to go shopping immediately after your surgery. Or do an online shop to be delivered when you get home.

    If possible, ask friends or family to stay with you for a couple of weeks after the operation to help you while you recover.

  • It's really important to stay active after hip replacement or revision surgery. But hold off on high-impact sports that put a lot of pressure on your hips like running and tennis, until you’ve fully healed.

    More information

    As you recover from your operation, you can start swimming. But stick to strokes other than breaststroke as the sideways kicking might dislocate your hip. It’s a good idea to go for extra walks to strengthen your muscles around the joint too.

    Once you’ve made a full recovery, you can have a more active lifestyle. But try not to run on hard surfaces or do sports that could injure you, such as football or rugby. It’s best not to do any activities that put a lot of pressure on your hip such as squash or tennis until after 12 weeks. Instead do some low-impact sports such as golf, hiking, biking, and dancing.

    See Related information for information on getting back into exercise.

  • 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.

    More information

    Over time, your artificial joint may become loose and need to be replaced. This repeat operation is called hip revision surgery.

    During a hip revision operation, your surgeon will need to remove the original implants and any cement used to hold them in place. They’ll then be able to put the new implants in. Your thigh bone might have grown into the implant, which will make it more difficult to remove. Your bones may have become thinner with age and be more likely to break (fracture). Your surgeon might need to use a hip replacement part with a longer stem to get a stronger fix.

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

  • Repeat hip operations take longer to do, are more complex and have a greater risk of complications compared with the original operation. And you may find that your new joint doesn’t improve your mobility as much as your original hip operation.

    More information

    Complications that can affect how well you can get around after hip revision surgery include the following.

    • Infection. An infection causes pain and swelling and can be quite debilitating. You’ll be given antibiotics but if these don't help, you might need to have the implant removed.
    • Scarring. Your surgeon may make cuts over your original scars, so the tissue might not heal as well as before. Scar tissue can make your leg muscles feel stiff and affect your walking.
    • Fragile bones. As we get older, our bones become thinner. So they’re more likely to break and with each revision, there’s less bone to hold the new implant in place. Your joint is more likely to become loose or dislocate with each revision.
    • 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’s every chance you’ll have a good quality of life afterwards. You may always have a limp or need to use a shoe insert, but you should be able to get back to your everyday activities.

  • Metal-on-metal hip replacements, where both pieces are made from metal, are generally not used any more.

    More information

    The Medicines and Healthcare products Regulatory Agency (MHRA) released guidelines that said certain types of metal-on-metal implants aren’t suitable. This is because research showed that you may be more likely to need a revision operation if you have one.

    There’s also some evidence to suggest that particles of metal may get into your blood. Some researchers suggested this type of replacement joint can increase the risk of cancer, but more research is needed to confirm this. Speak to your surgeon if you have any questions about the type of replacement you’re having.

    Some types of metal-on-metal implant need to be checked every year. 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 be referred to a surgeon to check for damage to the implant.


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Related information


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  • Reviewed by Rachael Mayfield-Blake, Freelance Health Editor, September 2016
    Expert reviewer Roger M Tillman, Consultant Orthopaedic Surgeon
    Next review due September 2019



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