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Hip replacement surgery

We offer hip replacement surgery to treat hip pain at our Bath Clinic

Hip replacement surgery, also called hip arthroplasty, is a common surgical procedure during which the damaged parts of your hip are removed and replaced with prosthetic components.

A hip replacement can help alleviate pain, restore mobility and function of the hip, and improve quality of life in people with severe hip pain and stiffness.

Most hip replacements are performed on people between the ages of 60 and 80, but adults of any age can have a hip replacement.

Hip replacement surgery is a common type of surgical procedure during which your damaged hip joint is replaced with an artificial one.

On this page, we look at the reasons why a person may need a hip replacement, what to expect during hip replacement surgery, and how long it takes to recover from the operation. We also provide an overview of hip replacement surgery at Circle Health Group’s Bath Clinic and what sets this clinic apart from other private healthcare clinics.

To understand how hip replacement works, we must first look at how your hip works.

Your hip joint is made of a ball and socket. The ball is the top of the thighbone (or the top of the femur), and the hip socket is located in your pelvis, also called the hip bone.

People with conditions such as arthritis may have inflammation, pain, and damage or degeneration of the hip joint.

In hip replacement surgery, your surgeon will replace either the ball, the hip socket, or both. This helps to relieve the pain, increase mobility, and improve the function of your hip.

Types of hip replacement

There are two types of hip replacements — partial or total.

In a partial hip replacement, also called half hip replacement or hip hemiarthroplasty, the surgeon replaces only the ball of the hip joint — also called the top of the femur or the femoral head.

In a total hip replacement, or total hip arthroplasty, the surgeon will replace both the ball and the socket joint.

Sometimes, a person may have damage in both hips, and the orthopaedic surgeon may recommend having both hips replaced. This is called a bilateral hip or double hip replacement.

Types of hip replacement techniques

Depending on the angle from which your surgeon approaches your hip, the hip replacement can also be broken down into the following types:

  • Anterior hip replacement, or direct anterior hip replacement
  • Anterolateral hip replacement, also called the Watson-Jones approach
  • Lateral hip replacement, or direct lateral, also called the Hardinge approach
  • Posterior hip replacement

Each approach comes with its own set of risks and advantages.

Some may be appropriate in certain cases, but not in others. Some techniques may increase or minimise the risk of dislocation, for example. Some are more invasive than others. The risk of complications may be lower with some methods, or the chances of restored mobility may be higher.

These factors are to be considered on a case-by-case basis, and your surgeon will consider the best approach based on your personal circumstances.

People may need hip replacements when they have one of the following conditions:

  • Osteoarthritis
  • Rheumatoid arthritis
  • Osteonecrosis (also called avascular necrosis)
  • Hip fracture
  • Septic arthritis
  • Tumour in the hip joint

The most common reason for having a hip replacement is osteoarthritis.

How do you know if you need a hip replacement?

Dr. Harvey Sandhu, who is a Consultant Orthopaedic Surgeon at Circle Health Group’s Bath Clinic, says there are three main things to consider when deciding whether it is time for hip replacement:

  • Pain
  • Function
  • Mental wellbeing

“If you’ve got pain that is mild or moderate, and you can still continue to do everything, and it doesn’t really limit you, and you’re comfortable at rest, then you don’t really need a hip replacement.”

“If, however, you have pain that’s significant, and it's impairing your general, everyday life — you’re finding walking difficult, you’re uncomfortable when you’re sitting, particularly if you're uncomfortable at night, and it’s disrupting your sleep — then obviously the pain is moderate to severe, and it warrants consideration of [hip replacement] intervention.”

“In terms of function, if your hip pain limits your ability to work, and you might literally be made unemployed, or if it’s significantly impairing your ability to function at home with your family and friends, or doing the activities that are important to you,” then that might be another reason to consider hip replacement.

“The last one, which is not talked about so much,” says Dr. Sandhu, “is mental mood. If you're in constant pain [and] your mood is down, and you’re just feeling constantly worn out, and it’s starting to affect your mental health, that's another indication [that you might need a hip replacement].”

These are some broad general guidelines, and they should be considered on a case-by-case basis. The decision to have a hip replacement will vary from patient to patient.

The time it takes to undergo hip replacement surgery depends on the type of hip replacement.

Total hip replacement may take up to about two hours. Double hip replacement may take longer than that, while partial hip replacement may take less.

If there are complications during surgery, this may prolong the procedure.

At Bath Clinic, says Dr. Sandhu, the actual hip replacement surgery takes anywhere between 40 minutes and an hour and a quarter, on average.

However, the patient is down for the operation for a few hours in total. This includes the time it takes to perform health checks, have anaesthesia, recover from the surgery in the operating theatre, and so on.

Hip replacement is a common procedure. In England and Wales, about 160,000 total hip and knee replacement operations are performed every year. At Bath Clinic, Dr. Sandhu himself is doing 15 hip replacements in a given week.

However, hip replacement is still major surgery. As with any major surgery, it comes with risks.

The possible risks of hip replacement surgery are:

  • Infection (this affects about 1 in 100 patients)
  • Venous thrombosis (VTE) occurs when a blood clot forms in a deep vein, such as a vein in your lower leg, thigh, or pelvis
  • Pulmonary embolism (PE) occurs when a blood clot formed elsewhere ‘breaks loose’ and travels through the bloodstream into the lungs
  • Fracture — older people may be at a higher risk of fractures
  • Excessive bleeding
  • Damage to nerves
  • Leg length discrepancy after the surgery
  • Hip dislocation
  • Risk of persisting pain or stiffness
  • Risk of the hip wearing out, or failure of the prosthesis
  • Risk of acute kidney injury (this may affect 10% of the patients)
  • Risk of cardiovascular complications

It is worth noting that the risk of serious hip replacement complications is low.

If you are considering hip replacement surgery, your doctor or consultant will go through all the possible risks with you in more detail.

Different categories of risk

Dr. Sandhu explains that hip replacement risks can be grouped into three main categories:

  • 90-day mortality risk — a younger, 45-year-old patient, might have a risk of mortality of 1 in 1,000 or 1 in 2,000; on the other end of the spectrum, for a person who is 90 years old and has a history of illness, the risk can be 1 in 100 or even higher
  • The risk of serious complications usually affects 2 in 100 patients
  • The risk of ongoing pain after surgery may affect 1 in 10 people who undergo a hip replacement

These risks should be considered on a case-by-case basis, with age being a particularly decisive factor.

There are certain things you can do to prepare for the surgery and ensure that your recovery will be as speedy as possible.

Not smoking, cutting back on alcohol, eating healthily, and trying to stay fit will all improve a person’s recovery.

“If you build muscular strength in your leg, then you will have a much better outcome from surgery,” explains Dr. Sandhu.

If you are overweight or obese, you can also reduce the risk of complications such as infection, pulmonary embolism, and venous thrombosis by losing weight.

“If you have good strong muscles before the operation, and then you have an artificial joint, [you will] do much better,” says Dr. Sandhu.

“What makes the joint work are the muscles and tissues around the joint. So, if these muscles are weak, poor outcomes such as continued limping may occur even after a successful hip replacement.”

You may be asked to come in early in the morning for your surgery. Your consultant will perform quite a few health checks and then start the anaesthetic process.

You may be administered a spinal anaesthetic, a general anaesthetic, or both. During the spinal anaesthetic, a needle is placed around the nerves in your lower back, which will numb your legs and allow the operation to take place. During general anaesthesia, you will be given some medications that will put you in a controlled state of sleep.

After the surgery, you will be taken to a recovery room in the operating theatre, where you will receive one-on-one nursing care.

After a while in the recovery room, you will be taken back up to the hospital ward.

Most patients come to the hospital on the day of the surgery and are expected to go home two days later. Some patients go home the next day after the surgery and, very rarely, some patients may go home even on the same day.

Recovery time varies and depends on the patient. However, there are a few general ‘milestones’ that inform the recovery process.

Pain after surgery: what is ‘normal’?

“The first day or two can be quite difficult,” says Dr. Sandhu, and pain in these first two days is common. However, the hospital will provide you with painkillers. These painkillers should help you feel ‘moderately comfortable’ and help you return home.

For one or two weeks after the surgery, you will need crutches. By two weeks, you may need only one walking stick, and from three to four weeks onwards, patients will hopefully not need to use a walking stick at all.

“By six weeks, hopefully, you will be walking [unaided] really well,” says Dr. Sandhu.

How long before you can bend down to tie your shoelaces?

"Patients are normally able to bend down and tie their shoelaces at six weeks after the operation", says Dr. Sandhu.

“Some patients are a bit stiff and some may need some rehab or physiotherapy to help them attain that movement. But generally, six weeks is a good figure [for the patient] to be reaching their to their feet.”

“Six weeks is a reasonable timeframe for driving as well,” adds Dr. Sandhu.

Returning to exercise after hip replacement

Six weeks is also a good timeframe for returning to mild-to-moderate activity. By this point you can be “working on an exercise bike, getting back to a good degree of activity, doing walks, slowly doing a moderate amount of exercise,” Dr. Sandhu says.

At 12 weeks, generally speaking, patients should be able to engage in more significant, or ‘hard,’ physical activity.

The guidance on when it is okay to return to physical activities after hip replacement is changing. “Patients are now increasingly allowed to do more activity than they were previously,” Dr. Sandhu say. Skiing, playing tennis, or swimming are activities he now recommends without hesitation.

“The boundaries of what we want patients to do and when we want them to return to these activities are significantly improving because we're finding the outcome for hip replacements is better now [compared to a few decades ago]. People are able to do more and they're able to do things quicker.”

He also gives the example of returning to swimming after hip replacement. “One of the things [...] we get asked about all the time is, ‘can I return to doing breaststroke after a hip replacement? And traditionally, we always said no. But now I say, ‘Fine!’ because in my experience, I've never heard of anybody ever dislocating a hip after doing breaststroke.”

Bathing and sleeping after hip replacement

Many people wonder if they should take a bath or a shower after hip replacement.

Taking a bath may require lowering yourself in the bathtub to get in and then getting back up — these can be difficult movements to do after hip replacement surgery.

So, patients should take showers rather than baths, “at least for the first couple of months” after the surgery, says Dr Sandhu.

Regarding sleep, experts still recommend that patients sleep on their backs for the first six weeks after hip replacement.

The consultants at Bath Clinic, including Dr. Sandhu, have received training and practised at various prestigious hospitals around the globe. Dr. Sandhu himself has practised at the world-renowned Sunnybrook Hospital in Toronto and the Harborview Medical Centre in Seattle.

He thinks that what makes the Bath Clinic special is its caring environment.

“The staff at Bath Clinic are like a family [...] which is unusual, in a way, for a private institution.  Everybody cares.”

In addition to its caring environment and internationally trained specialists, Bath Clinic also offers cutting-edge technology such as the Mako® robotic-arm assisted hip replacement and comprehensive aftercare plans.

At Circle Health Group, you can be sure of getting the highest quality, personalised care and fast access to treatment at affordable prices.

Bath Clinic has fixed price packages that include the cost of surgery, your initial consultation, your treatment, and aftercare.

We also offer flexible payment options and the opportunity to pay in instalments, should you prefer.

We will always confirm your treatment cost with you before you book any appointments or procedures with us. You always know the full price of your treatment plan upfront.

When you choose to go private with Circle Health Group, you can expect:

  • Flexible appointment times to fit your schedule
  • The freedom to choose your hospital and your consultant
  • Bespoke, consultant-led treatment plans tailored to your individual needs
  • Private en-suite rooms as standard
  • Tasty and nutritious meals cooked onsite to your dietary requirements
  • Support from the same compassionate clinical team from beginning to end
  • Affordable, fixed-price packages with aftercare included
  • Flexible payment options to help spread the cost of your care

If you want to know more about hip replacement surgery and find out if it's the right treatment for you, book your appointment online today or call a member of our team directly on 0141 300 5009.

Specialists offering Hip replacement surgery

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Mr Harvey Sandhu

Consultant Orthopaedic Surgeon

MA MBB Chir FRCS (Tr & Orth)

Bath Clinic

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Mr Julian Foote

Consultant Orthopaedic Surgeon

MB BCh, FRCS (Tr and Orth) Ed

Bath Clinic

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Mr Steve Pope

Consultant Orthopaedic Surgeon

BSc MBBS FRCS(Eng) FRCSI FRCS(Orth)

Bath Clinic

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Mr James Berstock

Consultant Orthopaedic Surgeon

MBChB, MRCS, FRCS, MD, PGCertMedEd

Bath Clinic

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Mr Alistair Charles Ross

Consultant Orthopaedic Surgeon

M.B., B.S., F.R.C.S.,

Bath Clinic

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