Overview

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Total Hip Replacement (THR) surgery, also known as Total Hip Arthroplasty, is a surgical procedure in which damaged and diseased parts of the hip are removed and replaced with an artificial joint (prosthesis). The aim is to replace a painful and stiff hip with one that is pain-free, mobile, and correctly aligned.

 

The artificial joint consists of two parts to recreate the ball and socket joint:

 

• One to replace the head of the femur (the ball shaped part of the thigh bone)

• Another to replace the acetabulum (hip socket).

 

The components are fixed to bone using bone cement (cemented fixation), or via a specialised roughened surface that helps the component bond to bone (uncemented fixation).

 

The femoral component usually consists of a stem inserted into the femur, onto which is attached an articulating head. The stem is made of metal, and the head is made from ceramic or metal.

 

The head articulates with the socket. This can either consist of a plastic (polyethylene) cup cemented into the bone of the pelvis, or an uncemented metallic cup into which is snapped a plastic liner.

 

Mr. White will discuss with you which type of hip replacement may be best suited for you.

Risks of Surgery

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As with all procedures, a total hip replacement carries some risks and complications.  

 

The common risks (2-5%) of the procedure include Blood clots, Bleeding, Pain, Prosthesis wear/loosening, Altered leg length, Joint dislocation.

 

The less common risk (1-2%) of the procedure is Infection.  If infected, the joint will likely require one or more additional operations and prolonged antibiotics, with a risk of increased disability and dissatisfaction.

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The rare risks (<1%) of the procedure include Altered wound healing, Nerve damage, Fracture, Blood vessel damage, Excess bone formation, Implant failure, Pulmonary embolism, Death.

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All complications can lead to a temporary or permanent deficit which can affect your ability to carry out activities of daily living or specific tasks related to your occupation, hobbies, or interests.

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The Operation

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Upon arrival on the day of your surgery, you will be evaluated by a member of the Anaesthesia team. The most common types of anaesthesia are spinal anaesthesia (you are awake but your body is numb from the waist down) or general anaesthesia (you are asleep). Either option may be combined with a nerve block for added pain control during and after the operation. The anaesthesia team will make a joint decision with you to determine which type of anaesthesia is best.

 

The procedure usually takes 60 – 90 minutes.

 

The damaged cartilage and bone is removed and replaced with new metal, plastic, and/or ceramic components to restore the alignment and function of your hip.

​After the Operation

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• Pain relief – Making sure that you are comfortable, and your pain is acceptable after surgery is one of the main tasks of the team of people who will be looking after you.

 

Pain management begins whilst you are in the theatre suite and continues according to your individual requirements throughout your admission.

 

The anaesthetic used is focused on minimising pain after your operation, but pain is a normal part of the recovery process.  The aim of pain relief after your operation is to make the pain bearable and to allow you to get up and start using your new joint.  It is not possible to eliminate pain altogether and a certain level of pain should be expected. 

 

Early mobility is very important in helping to prevent post-operative complications and can speed up your general recovery.  You should be able to take a deep breath and move with the minimum of discomfort.

 

• Hospital stay is usually 1 - 3 days.

 

• Physical therapy – Your rehabilitation and its effect on your outcome is down to you. You will start to put weight on the hip with support from a frame or crutches from the day of your surgery. You should expect to be able to walk independently or using a single crutch by 6 weeks following your surgery.

 

It is important to do your exercises regularly and increase your activity day-by-day. This not only improves your rehabilitation and functional outcome, but it also helps prevent complications like a blood clot. Movement also helps to unlock the pain cycle.

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• Wound care - Your wound will be covered with a special dressing in theatre. We do not disturb the dressing unless it is heavily soiled, this allows healing to take place and reduces the risk of infection. The dressing will be reviewed daily by the nursing team whilst you are in hospital.

 

Your skin closure will be performed with dissolvable sutures. It will take approximately 10-14 days to heal. A waterproof dressing will be used to cover the wound and showers are permitted, but it is recommended that you do not immerse the dressing in a bath or expose the wound to water until it has healed.

 

Mr. White and/or your physiotherapist are more than happy to discuss in more detail issues surrounding:

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• Returning to work

• Using your hip following your operation

• Driving

• Anticipated length of rehabilitation

• Positions to avoid the risk of dislocation.

 

Please notify us if undergoing any other operations, hospital tests, dental work, or if you develop any infections or soft tissue wounds before your scheduled operation. Your operation may have to be deferred to reduce the risk of developing a deep infection of your total hip replacement. If you are unsure, then please discuss this with Mr. White and the team.

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Avoiding Problems after Surgery

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Recognising the Signs of a Blood Clot

 

Please follow the advice and instructions from the hospital to reduce the risk of blood clots developing during your recovery. You will be discharged with blood thinning medication for the first two weeks following your knee replacement. Notify your GP and/or seek immediate medical attention if your develop any of the following warning signs:

 

Warning signs of a blood clot in the leg (deep vein thrombosis; DVT):

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• Increased pain in your calf and leg that is unrelated to your incision

• Tenderness or redness above or below your knee

• New or increasing swelling in your calf, ankle, and foot

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Warning signs of a blood clot in the lung (pulmonary embolism; PE):

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• Sudden shortness of breath

• Sudden onset of chest pain

• Localised chest pain with coughing

 

Preventing Infection

 

A common cause of infection after a hip replacement is from bacteria that enters your bloodstream during dental procedures, urinary tract infections, and/or skin infections. Theses bacteria can lodge in your hip replacement and cause a deep infection.

 

After a hip replacement, patients with certain risk factors may need to take antibiotics prior to dental work and before any surgical procedure that could allow bacteria to enter the bloodstream.

 

Warning signs of infection. Notify Mr. White, your GP, and/or seek immediate medical attention if you develop any of the following signs of a possible knee replacement infection:

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• Persistent fever

• Chills

• Increasing redness, tenderness, or swelling around the hip wound

• Drainage from the hip wound

• Increasing hip pain with both activity and rest

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Avoiding Falls

 

A fall after your surgery can damage your new hip and may result in a need for further surgery, due to loosening of the components, wound issues, or a fracture around the replacement joint. Stairs are a particular hazard until your new hip is strong and mobile. You should continue to use crutches, a walker, handrails, and/or have someone to assist you until you have improved your balance, confidence, and strength.

 

Other Precautions

 

There are some general precautions that must be considered especially in the first 6-8 weeks following hip surgery:

 

• Do not bend your hip to more than a right angle to avoid a dislocation. This includes avoiding low chairs and toilet seats

• Do not twist your hip or cross your legs

• It is better to lie on the operated side if you need to sleep on your side usually for the first three months.

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Outcomes

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Currently, more than 90% of modern total hip replacements are still functioning well 15 years after surgery.

 

Living with a Hip Replacement

 

You may experience some numbness around the incision. You may also get some stiffness, especially with excessive bending exercises. This tends to diminish with time and most patients find these symptoms tolerable when compared to the pain, limited function, and reduced quality of life experienced prior to surgery.

 

Your new joint may activate metal detectors at security checks in airports and some buildings. Please inform the security agent about your knee replacement if the alarm is activated.