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Hip replacement

Hip replacement is a very common surgery. Find out more below

Hip replacement is a very common surgery. You may know people who have had it. If you are experiencing hip pain yourself, you may be wondering whether you need a hip replacement.

If you are having hip pain and think you might need a hip replacement, the first step is to visit one of our specialist surgeons at Circle Reading Hospital.

They will diagnose the cause of your hip pain and discuss all your options with you.

If you do decide to go ahead with a hip replacement operation, the full facilities of our modern, safe and welcoming hospital will be available to get you back to health as soon as possible. 

Hip replacement surgery, also called hip arthroplasty, is a common surgical procedure.

The hip joint is a ‘ball and socket’ joint where the top of the thigh-bone (the head of the femur) sits within a cup-like socket (the acetabulum) in the pelvis. The surfaces where the bones meet are covered in cartilage to ensure smooth movement.

The joint is surrounded by a capsule and filled with a thin layer of lubricating fluid. The whole joint is held together with muscles, ligaments and tendons. Sometimes, this joint may become damaged.

Hip replacement surgery involves replacing your damaged hip joint with an artificial implant made of metal, plastic and ceramic.

The aim is to stop the pain of a damaged hip joint and allow you to continue to lead a normal, healthy life.

There are a number of symptoms that might suggest that you could benefit from a hip replacement. However, a discussion with a specialist hip surgeon will help you understand your condition better and help you decide what treatment is best for you.

Pain

Pain is the most common symptom that may lead to a hip replacement. The pain can be felt in many places, but most commonly inside the hip joint, on the overlying skin or in the groin.

Occasionally, pain can be ‘referred’ and is felt in the knee or back. Referred pain describes when the pain you feel in one part of your body is really caused by pain in another part of the body.

Reduced mobility

A combination of pain and reduced range of movement in the joint can be a sign of degeneration in the hip. If you find that your ability to move your hip through its full range of motion is decreasing, then you should seek specialist advice.

In some cases, leaving a long time before having joint replacement surgery can make recovery afterwards, particularly regaining flexibility in the hip, more difficult.

Pain even whilst resting

Commonly, the pain from joint degeneration, particularly in the early stages, comes on during activities. Over time, the level of exertion that brings on the pain may decrease until eventually there is pain in your hip even when you haven’t been undertaking exercise.

A reduction in activities

It is common to find that people with joint pain start to reduce the activities that they undertake to try and avoid aggravating the hip pain. If you find that you are not doing the regular and enjoyable activities in your day-to-day life, it may be a sign that you should seek specialist help.

When you meet your surgeon, they will ask you questions about your hip, your general health and other medical conditions. These are designed to get an idea of how long your problem has been going on for, how it has changed over time, what makes it better or worse and how it affects your daily life.

The surgeon will examine your hip to see what causes you pain and how the range of motion in your hip is affected.

Once this is done, the specialist will talk you through what they think is going on and if any further investigation is needed, and will work with you to come up with a management plan that meets your needs.

Investigations for hip replacement

Once your specialist has talked through all your symptoms and asked about how your hip pain affects your daily life, they may want to take some images of your hip.

The first is usually a simple x-ray, which will allow the expert to see any changes to the bones or the joint space in your hip. For some patients, this is the only imaging that is required.

You may have pictures of your hip taken using CT or MRI. These will allow the surgeon to get a better idea of how strong your bone is around the hip joint, and whether there are any other soft tissue problems which may contribute to your pain.

There are a number of hip problems that can lead to needing a hip replacement.

Osteoarthritis

This is often referred to as ‘wear and tear’. This usually results in damage to the cartilage layer inside the joint, which can get worn away, leading to pain. For some patients this will come about after a long life of being physically active.

For others, this can start when younger, which can be due to a combination of the shape of the bones in your hip, the activities that you do and biological and genetic factors.

Rheumatoid arthritis

Rheumatoid arthritis (RA) is a disease that causes inflammation in joints. If it occurs in the hip, it can lead to damage to the joint, increased pain and a reduction in function.

Post-traumatic arthritis

Damage to the hip in an accident or injury can lead to wear over time. This eventually will lead to increasing pain and a reduction in the activities that you can undertake.

Osteonecrosis/avascular necrosis (AVN)

This rare condition is caused by a loss of blood supply to the ‘ball’ of the hip joint. Without blood flow, the bone dies and will stop repairing and regrowing itself.

People from all walks of life and of all ages can have a hip replacement. There are three main groups that patients having joint replacements fall into:

  • The young hip replacement – these patients are usually in their forties, have led an active life and wish to keep doing so. They may have worries related to the cause of their hip problems, the surgical procedure, and how long any replacement would last.
  • The older hip replacement – these patients may be in their seventies and want to continue to remain active. They may want a joint replacement that will last them their whole lives, so they can continue to participate in their preferred day-to-day activities.
  • The elderly hip replacement – these patients may be in their eighties or older. Their hip can be extremely uncomfortable, and they want to avoid pain, immobility and a functional decline.

“The aim is to have a ‘forgotten hip’ where the patient does not even remember that they have had a hip replacement.”

Mr Tom Pollard, Consultant Orthopaedic Surgeon, Circle Reading Hospital

Before you have surgery on your hip, you will have a preoperative appointment. Here you will see one or more healthcare professionals that may include nurses, anaesthetists and physiotherapists. The aim of this appointment is to ensure that you are prepared for the procedure and that any questions are answered.

The procedure will be conducted under anaesthetic. The two kinds of anaesthetic used for a hip replacement are:

  • A general anaesthetic – this is where you are asleep for the duration of the procedure. Pain relief for the surgery will be given during the operation. Occasionally a pain-relieving nerve block is performed where local anaesthetic is injected around a nerve to reduce discomfort
  • A spinal anaesthetic – medication is injected into your back before the procedure starts. This will make your legs numb so that you cannot feel the operation being performed. This can be combined with sedation to make the procedure more pleasant

The operation itself is performed by making a cut in the skin overlying the hip. The ball at the top of the thigh-bone, the head of the femur, is removed. An implant, consisting of a stem which sits inside the thigh-bone and a head which replaces the original top of the thigh-bone, is inserted.

A cup is fitted into the socket in the pelvis. This is for the new head to move within.

Once the surgeon is happy that the new hip works well, the muscles and skin are closed. 

The time that hip replacement surgery takes depends on the type of hip replacement.

The whole procedure usually takes one to two hours.

After your procedure, you will be taken to a recovery area to let you get over any residual anaesthetic and to ensure that there are no immediate complications of the operation. Once the nursing staff are happy with your recovery, you will be taken to your room.

Your hip surgery will be undertaken by expert hip replacement surgeons, supported by a large number of healthcare professionals that include anaesthetists, theatre practitioners, and nurses. Everyone involved in your care is there to make you feel safe and well cared for.

As with all procedures, there are a few risks. For hip replacements these can include:

  • Dislocation of the hip – this occurs when the head pops out of the cup. This is most common whilst you are still healing and before your tissues are back to their full strength.
  • Infection – a micro-organism grows either in the hip or elsewhere. This is very rare. You may be given antibiotics during your operation to prevent this, and the procedure itself will be performed under sterile conditions.
  • Blood clots – the risk of these is increased after an operation, particularly on the leg. You can help reduce this risk by taking any blood-thinning medication prescribed and by getting back to full activity as soon after the operation as possible.
  • Fracture – a fracture occurs whilst the implant is being inserted. This happens very rarely, but particularly in patients with fragile bones. If this happens it will be managed at the time of the procedure.

If you have any concerns about any of the risks associated with hip replacement surgery, speak to your consultant at your appointment.

There are a number of things that you can do before your operation that will help make the procedure and recovery easier.

Learn about the procedure

Your surgeon and other healthcare professionals will give you information about what has caused your hip problem, what to expect from the operation and how your recovery will proceed. You will often be directed to other sources of information which you can learn from.

Physiotherapy

You will have contact with physiotherapists prior to your operation. It is not unusual to be given exercises to perform or activities to complete prior to your surgery.

Following the advice of your physiotherapist will help ensure that you are in optimal shape for your procedure and start your recovery off in the best way possible.

Make any changes at home

If you need to make any adjustments in your house, for instance making essential household items more accessible or exchanging very low chairs for ones of the correct height, occupational therapists may be able to assist you.

Attend any preoperative assessments

As part of your preparation for surgery, you will be seen by the preoperative team. You may need other investigations (such as blood tests) and might also talk to an anaesthetist.

On the day of surgery

You will be told when and where to arrive for your operation. Pay strict attention to any instructions regarding the time to stop eating and drinking, as missing this could delay your operation. Make sure you bring in everything that you will need for your stay.

“It is important to keep you active, mobile and healthy.”

– Mr Tom Pollard, Consultant Orthopaedic Surgeon, Circle Reading Hospital

The course of recovery from hip replacement surgery varies from person to person. You will likely be in the hospital for 2–3 days after the operation. You will be seen by your surgeon to ensure that the operation has gone well.

The physiotherapy team will make sure that you are getting out of bed and mobilising correctly. They will give you exercises that you must carry on doing when you get home.

Once both surgeon and physiotherapist are happy with your recovery, you will be allowed to go home. You will be advised on the level of activity that you can undertake.

You will see your surgeon again as an outpatient to follow up on your progress and to answer any questions you might have.

We understand that having surgery could be a daunting prospect. We have designed the entire experience to put your mind at ease. From your first meeting with our expert hip surgeons to the day of your surgery and on to your recovery, you will feel supported throughout.

The hip unit is situated in our modern, friendly hospital where your needs are put first.

Outpatient appointments will be conducted in one of our private consulting rooms. State of the art diagnostic imaging is provided by x-ray, CT, MRI and ultrasound techniques, backed up by expert radiologists.

Your surgery will take place in one of our modern operating theatres, and you will be cared for throughout by our expert theatre staff.

Hip surgery aftercare

After surgery, you can recover in your private room, where you will start your recovery with our musculoskeletal physiotherapist team. When both you and your surgeon are happy, you will be discharged home. At home, you will still have access to regular outpatient physiotherapy appointments to keep your recovery on track.

Your surgeon will see you again in the clinic to check on your progress and answer any questions you might have.

If you think you might need a hip replacement and want to have your surgery at a hospital where all the staff are committed to your health, and safety, and getting you back to leading your normal life, get in contact now. 

Specialists offering Hip replacement

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Mr Tom Pollard

Consultant Orthopaedic Surgeon

MBChB, MRCS, FRCS, MD, BSc

Circle Reading Hospital

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Mr Chinna Arvind

Consultant Orthopaedic Surgeon

MB BS, D Ortho, M S Ortho, FRCS, FRCS (Tr. & Orth)

Circle Reading Hospital

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