Patient Information Hips and Knees
The hip joint is found at the top of the thighbone (femur), where it meets the pelvis. It is made up of a ball, known as the femoral head, and a socket called the acetabulum. Both the ball and socket are lined with cartilage, as well as a fluid that lubricates the joint and reduces friction.
Osteoarthritis of the hip is when the cartilage that lines the hip joint begins to wear out. This results in pain, inflammation and stiffness. The joint can also feel warm. Over time, significant wear to the cartilage can even deform and reduce the length of the leg.
By far the most common indication for hip replacement surgery (arthroplasty) is hip pain resulting from osteoarthritis; however, it can also be effective in treating injury-related arthritis, damage from fractures, as well as childhood problems relating to the hip, including FAI (femoral acetabular impingement), hip dysplasia and avascular necrosis. It can also be indicated when previous joint preservation treatments have failed.
Hip replacement surgery will usually be offered when other measures – such as pain control, lifestyle changes and activity restrictions – have been unsuccessful and pain is affecting your everyday quality of life.
Research from 2010 estimates that around 960,000 primary and revision hip replacements are performed annually worldwide, with numbers increasing year-on-year. Doctors recognise that hip replacement can bring significant benefits to the quality of life of patients suffering from hip pain, which is why 70,000 procedures are carried out each year in the UK alone.
There are many factors affecting the longevity of a hip replacement, including patient physiology and lifestyle, as well as the type of joint fitted. While more traditional hip replacements will last anything between 15 and 20 years, we hope that our use of state-of-the-art materials will ensure you can enjoy a lifetime of service from your new hip.
Just as our specialist surgeons have the expertise to replace arthritic and damaged natural hip joints, they can also perform replacement surgery on a damaged or faulty artificial joint – whether this is the result of component failure, infection or an issue from previous surgery.
Replacement hip joints can be manufactured using a range of different materials, including metal-on-plastic, metal-on-ceramic and ceramic-on-ceramic. In all cases, hip replacement (arthroplasty) surgery involves replacing both the ball and socket of your natural hip joint with a prosthetic joint.
Here at London International Patient Services, our specialist orthopaedic surgeons use the latest CT hip replacement planning technology to virtually anticipate every stage of the surgical procedure. In around 20 percent of cases, this form of virtual planning will indicate that the patient – especially younger individuals – would benefit from a custom-made hip replacement joint, designed specifically for his or her unique physiology.
Hip replacement surgery may be performed under general anaesthetic or a spinal anaesthetic (also known as a spinal block) to ensure that you experience no pain during the procedure. Your specialist surgeon will make an incision to the side of your hip, allowing removal of the damaged ball and socket. This aspect of surgery can now be carried out using a less invasive approach that preserves muscle and, consequently, expedites recovery. In place of the natural joint, your surgeon will then fit a new prosthetic joint – choosing the most appropriate replacement for your condition. The incision will then be closed and the procedure is complete.
After your operation, a small dressing will be placed over your hip wound to protect it. You will be allowed to walk with the supervision of a ward physiotherapist as soon as you have recovered from your anaesthetic. You will require walking aids such as crutches or a pair of walking sticks to support you during the early stages of your convalescence. You will also be given pain-control medication to help you sleep comfortably and allow you to exercise your hip during the healing process.
Hip replacement surgery patients generally spend an average of four nights in hospital after their operation.
When looked after correctly, your artificial joint is capable of providing many years – or even a lifetime – of faultless service. There are many things you can do to protect and prolong the life of your replacement joint:
- It is very important to mention your hip replacement to your dentist if you are planning to have a dental procedure. Your dentist may need to prescribe you antibiotics in advance of the treatment to ensure that no infection is transmitted to your artificial joint.
- Regular exercise will build up muscle strength around the joint and help to maintain mobility.
- Try to avoid situations where there is a risk of falling. Fracturing a bone around your implant could mean that you require additional surgery.
No surgical procedure is entirely risk-free; however, complications as a result of hip surgery are rare. It is common for there to be some swelling and bruising of the leg following surgery. Less common complications can include:
- In around 1-2 percent of cases, some infection can occur. This is usually treated with a course of antibiotics; however, further surgery may sometimes be necessary.
- The use of blood thinning medication means that pulmonary embolism and deep vein thrombosis (DVT; PE; clotting) affects less than 1 percent of hip surgery patients. It is nevertheless extremely important to keep active following surgery.
- Surgical intervention can sometimes lead to damage to the nerves around the operation site, which can lead to a localised reduction in skin sensation. This is not usually problematic. Surgery can also result in damage to the nerves that supply the muscles in the leg (sciatic nerve); however, this is very rare.
- One of the recognised risks of hip surgery is inequality in leg length, although orthotics are generally effective at mitigating any impact on the patient’s gait. Nevertheless, here at London International Patient Services, we do everything we can to reduce this problem. Our use of pre-operative CT Hip Plan technology allows the surgeon to perform a “virtual operation” in advance of surgery. This makes it possible anticipate any changes to the length of the leg and plan far more accurately than would be the case with traditional methods.
- Dislocation is rarely a problem, occurring in less than 1 percent of cases. It can be treated and once resolved, it is unlikely to recur.
Recovery times following surgery can vary from patient to patient; however, you should expect it to take anything up to around 8 weeks. Movement and exercise can help significantly and we will organise specialist physiotherapy to aid your recovery and restore comfortable movement. There are generally three stages to post-surgery recovery:
- Stage 1– Early recovery (around 0-2 weeks)
– Increase range of hip movement
– 2 daily walks of gradually increasing distance
– Improve mobility and increase daily living activities
- Stage 2– Middle recovery (2-6 weeks)
– Develop muscle strength, increased balance and confidence
– Reduced dependence on walking aids
– Exercise bike training
- Stage 3– Late recovery (6-12+ weeks)
– Improve overall personal fitness and ability to work, with the aim of resuming sports and hobbies.
It is generally safe to drive when you are able to effectively perform an emergency stop manoeuvre. This can take around six weeks; however, you should consult your surgeon for guidance. We would also strongly advise you to contact your vehicle insurer, as the majority of insurance companies suggest a minimum period of 6 weeks before resuming driving after hip replacement surgery.
The short answer is that it depends on the nature of your job. If your role is sedentary (involves sitting down), you should be well enough to return to work around 4 to 6 weeks after your surgery; if, on the other hand, your job involves manual work, it is possible you will require more time off. Please consult your surgeon for advice.
Once you have sufficient strength, flexibility and fitness, it is normally safe for you to participate in most activities. This process can take anything up to 12 weeks; however, you should consult with your surgeon and physiotherapists for advice in your individual case.
Deep vein thrombosis (DVT) is the most significant risk from flying after surgery and longer flights present a greater risk than flying short-haul. However, over time, your overall risk will decrease. London International Patient Services recommends that you avoid all air travel for the first four weeks following your surgery and refrain from flying long haul for around six weeks.
Most airport security alarms will detect a replacement hip. We recommend that you carry written evidence of your surgery or carry a photo of your hip replacement X-ray on your mobile phone to show security personnel.
We hope that we were able to answer some of your questions and that you found this information useful. Please be aware that rehabilitation times can vary between patients and the timescales we have provided are a rough guide only. For more information, please contact us at London International Patient Services, where one of our specialists will be delighted to answer your questions.