Hip Replacement FAQS

What are the symptoms of hip arthritis?

Pain is the major symptom of hip arthritis.  Typically, the pain is felt in the buttock, the groin and around the hip joint.  The pain sometimes radiates down the leg towards the knee but rarely below the knee into the foot.  Some patients often complain of pain in their back and down the back of the leg to the foot.  This may be related to sciatica.

What is hip arthritis?

Arthritis is the wear and tear of the cartilage that covers the ball and socket. Healthy cartilage normally allows the joint to run smoothly.  However, as arthritis develops from mild to severe, the cartilage becomes thinner and develops cracks within it until bone is exposed so that severe arthritis ends with bone rubbing against bone.

healthyhip

What can be done about my hip pain?

Treatment will always start will simple measures. This includes pain killers, such as paracetamol, ibuprofen and occasionally stronger medication that will need to be supplied by your General Practitioner (GP). Some people find some over the counter rubs and gels may help as well as Glucosamine tablets that can be bought from chemists and health food stores.

Another measure, although not straightforward, is to be honest about your weight and aim to achieve a Body Mass Index (BMI) of under 35. Hips and knees are weight bearing joints so the more weight you can lose, the less stress goes through your joint which should improve your pain.
Injections are occasionally possible but these are normally reserved for painful knees.

There are no ‘quick fixes’, such as cartilage implants or washouts of a hip

You will always be expected to have exhausted all these measures before a discussion can be had regarding surgery to relieve your pain.

Small Steps Leads To Great Leaps

What About Surgery?

The assessment of whether to proceed down this route will be made between a Consultant Orthopaedic surgeon and the patient. The last resort is surgery. There are various types of hip replacements that are aimed at alleviating your pain.
A hip replacement is an operation that replaces the worn out surfaces with an artificial bearing surface which runs smoothly. Essentially, both the ball and socket surfaces are replaced.

How am I prepared for theatre?

You will need a pre-operative assessment to assess your suitability to undergo the stresses of surgery. This will either be performed by a nurse or occasionally an anaesthetist.

What I can Expect From the Operation

The aim of the surgery is to improve your pain, improve your mobility and hence improve your quality of life. You will find that everyday activities such as walking, sitting and driving will be more comfortable. The arthritic pain disappears straight after your operation and you will be mobilised the day of surgery and usually discharged 2-3 days later. The pain from the operation subsides over the next few weeks, so that by 6 weeks you should be able to drive again. You will be expected to adhere to strict precautions in the first 6 weeks, which includes not crossing your legs or bending down too far.

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The Day Of Your Surgery

You will receive directions from the hospital as to where to proceed. You should normally have nothing to eat or drink from 2 in the morning on the day of your operation as the anaesthetist will need you to have an empty stomach prior to any planned anaesthetic.

You will be placed into a hospital gown and will be prepared by the nurse for theatre. Mr Nasr will see you prior to your surgery to check the consent form and mark the joint we are operating on.

The anaesthetist will also come to talk to you on the day of surgery to discuss the options for anaesthetic and your pain relief afterwards.

What happens during the operation?

You may have either a general anaesthetic, where you are put to sleep or a spinal anaesthetic where you are numb from the waist down. You may have sedation with the spinal anaesthetic in order that you can go into a sleep and wake up 60-90 minutes later.
The wound will be about 8-10 inches long depending on your size. The ball is removed and replaced with an artificial ball with a stem that may be secured into the thigh bone with or without medical bone cement. The new hip socket has the remnants of articular cartilage removed and a new socket can be inserted with or without the use of bone cement. There are various options for the bearing surface between the new ball and socket components. This is normally metal on very hard plastic. Some patients are deemed suitable for a ceramic ball.

What happens after the operation?

Patients will spend some time in the recovery room before being transferred to the ward. There will be some discomfort in your hip if you have woken from a general anaesthetic but no pain if you have had a spinal anaesthetic (this takes 4-6 hours to wear off). You will be attached to some monitors to check your heart rate and breathing and will be have a wedge pillow between your legs. You will have adequate pain relief that will include pain killers given through a drip in your arm. It is also possible to use a morphine pump. You will be mobilised within a few hours of your surgery. After 24 hours you should be taking tablets by mouth and walking around the ward and to the toilet. You will be cared for by the ward nurses and your rehabilitation supervised by the on site physiotherapists. You will have a blood test after your surgery to check your blood count is satisfactory. An X-ray is normally taken soon afterward to check the position of the implants.

ballandsocket xray

Total Hip Replacement Video

After Your Operation

What precautions must I take after my operation?

1. Do not bend the hip too far. Your knee should not be above your hip as this may risk a dislocation.

a. You should avoid low chairs and toilet seats

b. You should not bend down to pick objects from the floor

2. You should not cross your legs, especially in bed. You will have to sleep on your back for the first 6 weeks after the operation

3. If you are undergoing any other surgery, especially dental work, you need to prevent infection of your hip replacement by taking antibiotics

What are the risks with surgery?

Hip replacement surgery is a very successful surgical procedure. However, as with any form of surgery, there are risks and complications that need to be taken into account before you decide to proceed.
•    Anaesthetic risks – you will have the opportunity to discuss these in detail with your anaesthetist prior to the operation
•    Bleeding – you may need a blood transfusion if your blood count drops below a pre-determined level
•    Infection – this is the biggest concern for an orthopaedic surgeon and we take very careful precautions in order minimise this risk.  We operate in very strict conditions in theatre and you will given 3 doses of antibiotics.
•    Nerve injury – this is extremely rare but may involve some numbness or hypersensitivity around the scar
•    Blood clots – these can develop in the veins in the calf (a deep vein thrombosis) and dislodge to travel to the lungs (pulmonary embolus)
•    Dislocation – this risk is higher in the first 6 weeks so you must adhere to the hip precautions that will be taught to you by the physiotherapists
•    Leg length discrepancy – occasionally you may notice that the operated leg is longer or shorter than your other side.  You would not normally notice this unless the difference is more than an inch and the best way to decide on this is by assessing the X-ray
•    Other very rare risks – kidney problems, heart attacks, stroke, urine and chest infections

What happens after I’m discharged?

You will be reviewed at 2 weeks for a wound check and to ensure you have not developed a deep vein thrombosis.
You will then be reviewed at 6 weeks to assess your pain, mobility and function and also your suitability to resume activities such as sleeping on your side and driving.
You will normally be followed up for 12 months and if all is well be discharged at this point