Hip Replacement. Department of Orthopaedic Surgery Tel:

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1 Information for Patients Hip Replacement Department of Orthopaedic Surgery Tel: DMI ref: indd(RP) Issue 3: February 2008 The Ipswich Hospital NHS Trust, All rights reserved. Not to be reproduced in whole, or in part, without the permission of the copyright owner.

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3 Why are hip replacements performed? The main reason is to relieve the pain that is caused by arthritis. The commonest form of arthritis is osteoarthritis, which is due to gradual wear and tear of the joint over the years. When the joint surfaces become worn they no longer glide smoothly against each other. This can cause pain on activity, which may be felt in the groin or buttock and can also be felt in the thigh, knee or lower leg. The pain may also be felt at rest and can cause a disturbed night s sleep. Stiffness of hip movements can cause difficulties with putting on shoes and socks, getting in and out of a car and sitting in a low chair. The affected leg may also become shorter. An Arthritic Hip Pelvis Worn head of femur Acetabulum (socket) Head of femur (ball) Osteophyte (extra bone) Femur (thigh bone)

4 What is a hip replacement? A hip replacement is an artificial joint that replaces an arthritic hip joint. The worn joint surfaces are removed and replaced by a metal and plastic replacement, which forms a new ball-and-socket joint. The two main components are an acetabular cup, which forms the new socket, and a femoral stem, on top of which is added a head (the new ball). Each component can either be fixed with bone cement or can have a surface that allows the bone to grow into the component. A total hip replacement

5 What are the alternatives to a hip replacement? Non-operative treatment: such as taking pain relievers, using a walking stick, losing weight, modifying your activities and taking regular gentle exercise. What are the benefits of having a hip replacement? 1 Less pain. The main aim is to relieve the pain of arthritis. 2 Improved mobility. You should be able to walk more easily and so become more active. A hip replacement is a very successful operation about 95% of patients (19 out of 20) are pleased with their new hip. What are the risks of a having a hip replacement? Some of the risks are listed below. Although there seem to be a large number of possible risks, on the whole the results of hip replacement surgery are very good the chance of a complication is less than 5% (1 patient in 20). Medical problems The risk of developing an illness, such as a heart attack or a stroke, is increased by having major surgery. A hip replacement is a major operation but modern anaesthetic techniques and medical treatments have resulted in the operation becoming safer and safer. Infection Hip replacement surgery is carried out under strict sterile conditions and you will also be given a strong antibiotic at the beginning of the operation. Despite this, infection is still a potential problem.

6 Deep infections involving the artificial joint occur in about 1% (1 in 100) or less of all hip replacements. This usually needs further surgery to clean out the infection and often the artificial joint needs to be removed to clear all the infection. A new replacement may be inserted after a few weeks of antibiotic treatment but the end result is generally not as good as if there had not been an infection. Blood clots (DVT and PE) Following surgery to the legs blood clots can form in the deep veins of the calf or thigh (deep vein thrombosis or DVT). This usually causes pain and swelling in the calf or thigh. Occasionally part of the blood clot can break free and travel in the bloodstream to the lungs (a pulmonary embolism or PE). A PE can be life threatening. The overall mortality from a PE after hip replacement surgery is about 0.1% (1 in 1000 hip replacements). Regular exercises, wearing elastic compression stockings and either receiving an injection of a blood-thinning agent or taking a daily aspirin tablet will help reduce the risk of a DVT or PE. Bleeding Some bleeding occurs after any major operation such as a hip replacement. The bleeding normally settles down within the first few hours after surgery. Some patients may require a blood transfusion to replace the blood lost. Occasionally a deep collection of blood (called a haematoma) may persist. This usually responds to ice and physiotherapy. Nerve injury A major nerve injury can occur in about 1 in 200 operations. This may happen when one of the nerves that pass across the hip becomes stretched, leading to numbness and weakness of the lower leg and foot. Usually the nerve will recover but this can take several weeks.

7 Leg length discrepancy In some cases the legs cannot be made equal in length. A noticeable difference can be corrected by wearing a shoe raise on the shorter side. Dislocation An artificial hip may dislocate when the ball pops out of the socket. This happens in 1-5 in every 100 hip replacements. Relocation (putting the ball back in the socket) usually requires sedation or anaesthesia. If there are repeated dislocations then further hip surgery may be needed. Failure of the replacement Over the years hip replacements have improved dramatically and most modern hip replacements can now be expected to last at least years. However, some hip replacements can fail earlier, either because one of the components loosens from the bone or because the artificial joint surface wears down. If a hip replacement fails it may be possible to perform a further operation to remove the failed replacement and implant a new replacement (known as a revision hip replacement). However, a revision hip replacement is often more complicated than the original hip replacement and overall the results are not as satisfactory. What does a hip replacement involve? Before the operation 1 Try to keep your weight as low as possible. Nearly all the risks of surgery are greater if you are overweight. 2 Exercise regularly gentle walking, static cycling (on an exercise bike) and swimming are recommended. Hip exercises will also be useful and an exercise sheet is available.

8 3 You will be invited to attend a pre-operative education group, which will give you more information about your operation. 4 You will be given an appointment to see a specialist nurse who will carry out a number of medical checks, including testing for a urine infection and screening for the MRSA bug. You may also be assessed by a physiotherapist. The operation Usually you will be admitted to hospital on the day before your operation. The operation may be performed under general anaesthesia (when you are fully asleep ) or spinal anaesthesia may be used (an injection of local anaesthetic into the back leads to numbness of the legs). Your anaesthetist will discuss the exact type of anaesthetic with you when you are admitted to hospital. The operation itself lasts about 1½-2 hours. Including preparation and recovery, you will be away from the ward for at least three hours. Recovery in hospital After the operation you will be given oxygen and you will have an intravenous drip. A drainage tube may be used to collect any bleeding from the hip. On the first day after the operation physiotherapy will start and you will be allowed to stand out of bed with the help of a zimmer frame. Over the next few days it is important to work hard with the physiotherapist so that you can get the best result out of your new hip. Your physiotherapist will advise you on the precautions you need to take during the first six weeks to prevent a dislocation. These include avoiding bending too much at the hip and not crossing your legs.

9 The total time in hospital is usually 5-7 days. Most patients go home with support as needed, but some may go to a rehabilitation facility for a short period. Usually you will be walking with a pair of sticks and you will be able to walk up and down stairs. After leaving hospital The discomfort of the operation settles steadily but you may need to continue with pain relief medication for a few weeks. The wound may be closed with surgical clips or stitched with an absorbable or non-absorbable stitch. The ward nurses will give you advice about your wound before you go home. After a hip replacement mild swelling of the whole leg may be present for several months this is normal. Rest with your leg up to allow the swelling to drain away (your foot should be higher than your hip). It is important to go for regular short walks and to continue with daily home exercises so that your hip movement continues to get better and better. After six weeks you may be able to walk outdoors without your stick. After three months many patients can return to playing golf and even gentle tennis. You can expect your hip to improve for up to a year after the surgery. Driving If you have a hip replacement you should not drive for at least six weeks after the operation. If you have had a right hip replacement you should only drive after six weeks if you can stamp on the brake pedal comfortably you must be able to perform an emergency stop effectively.

10 X-ray showing a hip with arthritis (arrowed). X-ray showing a successful total hip replacement. If you have any concerns during your recovery, please contact your consultant s secretary or the ward on which you stayed. They may be contacted via the hospital switchboard on

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