Hip replacement and hip revision

Expert reviewer, Mr Damian McClelland, Clinical Director MSK and Orthopaedic Surgeon at Bupa UK
Next review due May 2022

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

Hip revision (a repeat hip replacement) surgery 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. The socket is lined with smooth cartilage.

If your cartilage gets worn away, the bone underneath is exposed and your joint can become sore and stiff. You may find it’s painful to walk or move around. An operation to give you a new hip joint should help to make you more mobile and ease any pain.

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

What is a hip replacement?

If you have a total hip replacement, your surgeon will take away the worn parts of your bones that are rubbing together. They’ll then put replacement pieces made from artificial materials in their place.

Hip replacements can be made of metal, ceramic, plastic or a combination of these. Your hip joint can be fixed into place with bone cement (cemented) or pressed into place without bone cement (uncemented). If your hip joint is uncemented, the metal surfaces are often given a special coating and roughened. This encourages your own bone to grow onto the artificial joint and secure it in place.

You’re most likely to be offered a hip replacement if you have very bad osteoarthritis. But you may also be recommended to have one if you have other hip problems, such as rheumatoid arthritis. Your surgeon will speak to you about the best type of hip replacement to suit your needs. After a while, artificial hip joints can wear out, but your new joint can last for up to 20 years.

What is a hip revision?

If your new hip replacement joint starts wearing out, you may need to have it replaced again. This is called a hip revision.

Hip revision surgery is often more complicated than the original hip replacement surgery. This is because your surgeon will first need to take out the existing artificial hip joint. Sometimes, your surgeon may also need to reconstruct some of the bone. This can make the operation longer.

A hip revision doesn’t always work as well as the original hip replacement.

Deciding on hip replacement

If your doctor suggests you have a hip replacement, it’s important to think about the advantages and disadvantages of this operation and if it’s right for you. Your doctor can help you to make a decision and discuss whether or not you have any other options. For more information on this, see our section: What are the alternatives to hip replacement? below.

Here are some of the things you might want to consider.

  • After a hip replacement, most people don’t have hip pain any more.
  • A hip replacement can help you move around more easily, though you may not be able to perform some activities (such as squatting) afterwards.
  • After your surgery, you may find it easier to do some everyday activities – you may even sleep better if pain has been keeping you awake at night.
  • If you were using a walking stick, you shouldn’t need it after you’ve recovered from the operation.
  • 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. For more information on this, see our section: Recovering from hip replacement below.
  • As with any surgery, there are some risks involved. For more information, see our section: Complications of hip replacement and hip revision below.
  • Your new hip joint may wear out eventually, and you may need to have another operation after 10 to 20 years.

Preparing for hip replacement

Your surgeon will explain how to get ready for your operation. If you smoke, you’ll need to stop. Smoking makes it more likely you’ll get a chest or wound infection after surgery. This can slow down your recovery.

If you’re overweight, it’s a good idea to try to lose weight. It may help to reduce the strain on your hip joint and reduce your risk of complications after surgery. Stay as active as you can and keep doing any exercises recommended by your doctor or physiotherapist.

Your surgeon will make sure you’re well enough to have the operation. You may need to have some blood and urine tests, X-ray images of your hip, and an electrocardiogram (ECG) to check your heart is healthy.

If you haven’t been to the dentist for a while, book a check-up. A dental infection may make you more likely to get an infection in your joint if bacteria from your teeth get into your bloodstream. If you take certain medicines, you may need to stop these about four weeks before your operation. Your surgeon will discuss this with you.

Your surgeon may recommend that you see an occupational therapist before your hip replacement. Buying some special equipment or making changes at home may mean you can move around more easily after surgery.

Your 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.

If you have a general anaesthetic, you’ll be asked to follow fasting instructions. This means not eating or drinking anything for a specific number of hours before your operation. It’s important to follow your anaesthetist’s advice.

Your surgeon will discuss with you what will happen before, during and after your surgery. If you’re unsure about anything, don’t be afraid to ask. No question is too small. It’s important that you feel fully informed so you feel happy to give your consent for the operation to go ahead. You’ll also be asked to sign a consent form.

What are the alternatives to hip replacement?

Your surgeon will usually only recommend you have a hip replacement if non-surgical treatments aren’t easing your pain or helping you walk more easily. Non-surgical treatments include taking painkillers, having steroid injections in your hip joint or using physical aids such as 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 of your joint with metal caps. This surgery may be an option if you’re young and active with strong bones. Hip resurfacing isn’t usually recommended for older people, women or smaller men because of potential problems. Your surgeon can discuss this option with you in more detail if you are suitable for this type of surgery.

What happens during hip replacement?

A hip replacement operation usually takes about an hour or so. Hip revision surgery takes longer.

During the operation, your surgeon will make a cut (20 to 30 cm 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 of your thigh bone and put a replacement ball on a stem into your thigh bone. They’ll 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 fit 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

Sometimes a surgeon recommends having keyhole surgery (minimally invasive surgery). This involves making one or two smaller cuts (about 10 cm) over your hip and thigh. This should reduce the damage to your hip muscles and tendons and may mean you have less pain after surgery. But a minimally invasive hip replacement isn't suitable for everyone. Ask your surgeon if it’s an option for you.

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What to expect afterwards

After surgery, you may feel some discomfort or pain as the anaesthetic wears off. You'll be offered pain relief if and when you need it. You may 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 pad or pillow between your legs to hold your legs apart and keep your hip joint in one position. This will stop your hip from dislocating (moving out of position).

A physiotherapist will usually visit you after your operation and will see you regularly afterwards. They’ll give you some exercises to do. It’s important to do these as often as they tell you to. The exercises are designed to help you get moving again and strengthen your hip.

You may feel a bit constipated after surgery. Some people don’t pass stools for two to four days after a hip replacement. To prevent constipation, eat plenty of fruits and vegetables and drink plenty of fluids (up to two litres a day). If your constipation doesn’t get better, your doctor may prescribe a short course of laxative medicines.

You may need to wear compression stockings during and after the operation. This will help to prevent blood clots forming in the veins in your legs (deep vein thrombosis). You may need to have an injection of an anti-clotting medicine (or tablets) as well as or instead of wearing compression stockings.

You’ll need to stay in hospital until you're able to cope on your own at home. This is usually for four to eight days but it may be sooner if you’re recovering well. When you're ready to go home, ask a someone you know 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.

You’ll have a scar on your hip and thigh. If your surgeon used staples or stitches, you’ll usually need to keep your wound covered until these are removed. A district nurse will help you change your bandages and remove your stitches after 10 days. If you have dissolvable stitches, they won’t need to be removed. Ask your surgical team for advice on keeping your wound covered and when you can have a shower or bath.

Recovering from hip replacement

Everyone recovers differently from hip replacement surgery. How quickly you recover may depend on your age, your general health, the type of surgery you have and if you have any complications. When you leave hospital, your recovery will carry on at home. It’s important to build up slowly, doing a little bit more exercise each day. By around six weeks, you may be able to return to work but this will depend on what sort of job you do.

Short-term recovery

You’ll probably feel the benefits of the operation almost straight away, but you may feel some pain for a few weeks. You’ll usually be prescribed painkillers to take home when you leave hospital. If you need more pain relief, you may be able to take over-the-counter painkillers, such as paracetamol. But ask your doctor or nurse for advice first. Always read the patient information leaflet that comes with your medicine and, if you have any questions about your medicines, ask your pharmacist.

After your operation, your body uses up extra energy to help your wound heal. For the first couple of weeks, you may feel more tired than usual, so remember to rest when you need to. If you lost a lot of blood during surgery, you may be recommended to take iron supplements. You won’t be able to return to work or drive for a while after your operation – usually for around six weeks, sometimes longer.

Your leg may be a bit swollen and ache at first. But getting up and moving after your operation is important. Ideally, you shouldn’t sit down for long periods of time. At first, you’ll need support and supervision, but it’ll gradually get easier. However, if the pain and swelling in your hip or leg gets worse, seek medical help as this may be a sign of a blood clot in your leg.

Long-term recovery

The exercises recommended by your physiotherapist are a crucial part of your recovery, so it's important to keep doing them once you’re back at home.

Your surgeon or physiotherapist may also give you advice on what you should and shouldn’t do in the first six weeks to protect your hip. For example, try to avoid:

  • crossing your legs
  • twisting your hip inwards and outwards
  • bending your hips past 90 degrees (a right angle)
  • sitting on very low chairs or toilet seats – raise them where possible
  • bending over from your hips to reach objects on the floor or tie shoelaces
  • cutting or painting your toenails
  • lying on your side for the first six weeks after your surgery – if you do, put a pillow between your legs.

You should be able to move around your home and manage stairs, but you may find things like shopping difficult for a few weeks. Ask friends and family to help out or order your shopping online. Don’t be afraid or embarrassed to ask for help. Make sure you can move around safely at home – watch out for rugs and trailing wires.

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

Try to sleep on your back for the first six weeks. Put a pillow between your knees to keep your hip in the right position. Most people can have sex after six to eight weeks but avoid any positions that put too much pressure on your hip joint.

If you work, you can usually go back after about six weeks. But if your work involves a lot of walking, standing or lifting, you may need to stay off for longer – sometimes for up to three months. Speak to your occupational health advisor, as you may be able to change the type of work you do until you’ve fully recovered.

You should be able to drive again after about six weeks but check with your surgeon and car insurer. You shouldn’t drive if you’re in a lot of pain or you’re still taking any medicines (including painkillers) that can make you drowsy. Even getting in and out of a car as a passenger for the first three weeks may put too much strain on your hip. Try to avoid travelling in a car unless it is essential.

By six to eight weeks, you should be able to take a short flight (internal or European). It’s best to hold off on any long-haul travel until around 12 weeks, and always check with your doctor and travel insurer before you go.

By around six to eight weeks, you should be able to walk and swim. But it will take you longer to get back to sports such as tennis or golf. For more information on recovering from hip surgery, see our FAQs: Are there any sports I shouldn’t do? and How can I make my recovery easier? below.

Side-effects of hip replacement and hip revision

After hip replacement surgery, you may have some temporary side-effects. These include:

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

However, If the pain and swelling in your hip or leg gets worse, seek medical help as this may be a sign of a blood clot in your leg. For more information, see our section: Recovering from hip replacement above.

Complications of hip replacement and hip revision

Most people don’t get serious complications after hip replacement surgery. But possible complications 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’s usually in the first three months after your surgery and you may need another operation to treat it.
  • A blood clot. This is usually in a vein in your leg (deep vein thrombosis).
  • An infection. Your surgeon may prescribe antibiotics during and after surgery to help prevent this.
  • Difference in leg length. One leg may be slightly longer than the other after surgery – you can correct this by wearing a shoe insert on the shorter side.
  • Hip fracture. You can get tiny cracks in your bone while your surgeon’s fitting the new joint. These may 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.
  • Bleeding under your skin, causing a swelling called a haematoma. This may clear up on its own or you may need a smaller operation to remove the blood.
  • Nerve damage. It’s possible that nerves in your leg and bottom can be damaged during the operation.
  • Urine (wee) infections or difficulty weeing.
  • Particles of metal getting into your bloodstream from the metal parts. For more information, see our FAQ: Are metal-on-metal hip parts safe? below.

Frequently asked questions

  • It’s important that you’re as fit and healthy as possible before your hip replacement. If you’re overweight or obese, this can increase your risk of complications after surgery. So, losing some weight before your operation may help your recovery. Smoking makes you more likely to get infections after surgery. This can slow down your recovery, so it’s a good idea to give up beforehand.

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

    Try to get your home ready for when you come back from hospital. You may need to rearrange your furniture to make it easier to move around safely. You’ll need to make sure you’ll be able to wash and dress yourself, and to cook easily after your surgery. You may need to make your bed, chairs and toilet seats higher so you don’t strain your hip when you sit down. An occupational therapist will have lots of advice on getting your home ready, and on borrowing or buying the equipment you’ll need. 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.

  • Many people return to sporting activity after their hip replacement. But speak to your surgeon before your operation about the types of sports you do and the impact they will have on your new joint replacement.

    Hold off on high-impact sports that put a lot of pressure on your hips, such as cycling and tennis, until you’ve fully healed.

    As you recover from your operation, you can start swimming. But your surgeon may tell you to avoid doing breaststroke as the sideways kicking may dislocate your hip. It’s a good idea to go for extra walks to strengthen your muscles around the joint. You may be able to use an exercise bike, but check with your surgeon or physiotherapist first. Cycling may be difficult for the first 12 weeks because it may be difficult to get on and off the bike.

    Once you’ve made a full recovery, you can have a more active lifestyle. But try not to run on hard surfaces at first, so avoid sports such as squash and tennis. And don’t do sports with a high risk of falling, such as skiing.

  • You’ll need hip revision surgery to replace your artificial joint if this becomes loose, wears out or breaks. This can be a much more complicated operation than your original hip replacement. Your surgeon will need to remove the original implants and any cement used to hold them in place. Then they’ll be able to put the new implants in. Some implants can be more difficult to remove than others.

    If your thigh bone has grown onto the implant, this can make the implant difficult to remove. Your bones get thinner as you get older and are more likely to break (fracture). Your surgeon might need to use a hip replacement part with a longer stem to get a stronger fix into the bone.

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

  • Repeat hip operations take longer and are more complex than initial hip replacement surgery. They are also more likely to cause complications than the original operation. You may also find that your new joint doesn’t improve your mobility as much as the first operation did.

    Complications that can affect your mobility 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 may need to have the implant removed.
    • Scarring. Your surgeon may make cuts over your original scars, which means the tissue may 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. 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 length difference. During hip revision surgery, more bone is removed because your old implant has to be taken out before your new one is fitted. So, you're more likely to have a difference in leg length 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 most people should be able to return to their everyday activities. Speak to your surgeon who will be able to discuss your particular circumstances with you.

  • Most surgeons no longer do hip replacements where both pieces are made from metal. This is because metal-on-metal hip replacements can cause problems for some people. There’s also some evidence that small particles of metal (called debris) may get into your blood. In many people, the debris doesn’t cause any problems. But in some people, it can cause bone loss and loosen the implants.

    In 2017, the Medicines and Healthcare products Regulatory Agency (MHRA) recommended that people with certain types of metal-on-metal implants should have their implants checked every year. You may be checked for five years or you may be checked for life, depending on which implants were used.

    If you have a metal-on-metal implant but aren’t noticing any problems, you may just need to fill in a questionnaire every year. But if you’re in pain, have certain implants or an X-ray shows up potential problems, you may need an MRI or ultrasound scan. You may also have blood tests to measure the amount of metal in your blood at the same time. If there seems to be a problem with the scans or blood tests, your implant may need to be replaced (hip revision surgery).

    If you’re not sure which type of implant you have, try not to worry. Most hospitals will have contacted you already if you have a metal-on-metal implant. If your surgery was fairly recent, speak to your surgeon or contact the hospital. There will be a record of which implants were used during your operation. If your surgery wasn’t recent, speak to your GP, who should be able to refer you back to the surgeon who performed it. If you signed a consent form to register with the National Joint Registry, you can contact them directly for details of your implant.

    If you have a metal-on-metal hip implant and are having any pain or difficulty moving the joint, speak to your GP. You may need to be referred to a surgeon to check whether or not your implant is damaged.

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    • Personal communication, Mr Damian McClelland, Clinical Director MSK and Orthopaedic Surgeon at Bupa UK, January 2019

  • Reviewed by Michelle Harrison, Specialist Health Editor, Bupa Health Content Team, May 2019
    Expert reviewer, Mr Damian McClelland, Clinical Director MSK and Orthopaedic Surgeon at Bupa UK
    Next review due May 2022

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