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Total Hip Replacement
This leaflet will briefly outline what a hip replacement will involve for you as a patient and mention some risks and complications of this type of surgery.
What is a total hip replacement?
The operation replaces a diseased hip with a new artificial hip joint. The femoral head (ball) and acetabulum (socket) are replaced with new parts (called a prosthesis). The hip replacement may be fixed with or without cement or by a combination of these (hybrid).
The aim of the operation is to replace a hip joint that is painful and stiff with one that is not painful, moves more easily and allows you to sit, walk and lie more comfortably.
What can you do to help?
Prior to surgery there are certain things you can to to help:-
Visit your dentist for a check up
Try and lose weight
Take good care of your skin
Take as much exercise as your hip allows
You may be seen in an assessment clinic shortly before your surgery where your fitness for surgery will be assessed. You may have blood tests at this stage.
You should have no solid food or drink for six hours before your operation. When you arrive in theatre you will be given an anaesthetic (a spinal or general anaesthetic). The surgery takes approximately 1 to 2 hours.
How long do you stay in hospital?
Postoperative regimens vary between surgeons and the type of hip replacement. A physiotherapist will usually get you walking a couple of days after surgery. Once you are walking safely and there are no wound complications you may be discharged (usually at 5 to 10 days) with arrangements to have any stitches or clips removed and an outpatient appointment.
What can go wrong?
Generally a total hip replacement is an effective procedure that can dramatically improve your quality of life. All operations carry some risk and the most frequent and important are outlined below:-
Surgical mortality – A hip replacement is a major operation and a very small number of patients may not survive their surgery.
Anaesthetic – You will have an anaesthetic that carries a very small risk, depending on your level of health. The anaesthetist (a doctor) will explain the risks to you.
Dislocation – The risk of dislocation (joint coming out) is highest in the first few weeks following your operation. It is vital to adhere strictly to the advice given to you by staff on movements and positions to avoid. The risk is approximately 5 in 100 after a first hip replacement and increases to over 10-20 per 100 for repeat (revision) operations.
Infection – The risk of developing an infection around a hip replacement is around 1 in 100 in an osteoarthritic hip and 2-4 per 100 in rheumatoid arthritis. The following measures are used to reduce this risk: a) antibiotics at the time of surgery; b) surgery is performed in a laminar flow theatre used only for orthopaedic operations.
If an infection does become established and does not respond to antibiotics the hip replacement may be removed. It is usually possible to reinsert another joint when the infection has cleared but if not you would be left without a hip joint (Girdlestone procedure). This results in a shortened leg and although it is possible to walk on the leg, you would need a stick or crutch.
Thromboembolism – Blood clots may develop in the veins of your leg during or after surgery. Part of a clot may break off and travel to your heart. This can be fatal but is extremely uncommon and occurs in 1 in 1000 cases. This risk is increased if you are female, overweight, have varicose veins, high blood pressure, diabetes or heart disease. Recognised ways to reduce blood clots are exercise, foot pumps and blood thinning agents, all of which are used at the Hospital. Elastic (TED) stockings may also help.
Loosening, wear and fractures – The overall rate of loosening of the Charnley and Exeter type hip replacements are approximately 4 to 8 in 100 at 10 years. These rates are higher in younger, or more active people and in patients under 50 years old. For this reason some surgeons may use different types of prostheses in younger patients.
Patients with osteoporosis, rheumatoid arthritis and neurological disorders may suffer fractures in the bones around the prosthesis which may require further surgery.
Injury to nerves and blood vessels – The risk of a nerve or vessel injury is less than 1 in 100 cases after a first replacement but increases in revision operations. Injury may result in paralysis, weakness, numbness or pain in the leg and foot which is usually temporary but may be permanent.
Unequal leg length – Every effort is made to ensure the legs remain equal length but following surgery there may be a difference in length up to 1.5cm which usually causes no problems with walking. Around 10-15 per 100 patients may be aware of leg length difference after surgery. If this is bothersome a shoe raise may be required.
Knee swelling and pain – It is necessary to manipulate the leg during the operation and this may cause some swelling, stiffness and pain in the knee. This usually settles over a few weeks.
We hope this information sheet has answered any questions you might have. If you have any further queries please feel free to discuss them with any of the medical or nursing staff either in the Clinic or on your arrival in Hospital.