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A hip replacement is a common type of surgery where a damaged hip joint is replaced with an artificial one (known as a prosthesis).
Adults of any age can be considered for a hip replacement, although most are carried out on people between the ages of 60 and 80.
A modern artificial hip joint is designed to last for at least 15 years. Most people experience a significant reduction in pain and some improvement in their range of movement.
When a hip replacement is needed
Hip replacement surgery is usually necessary when the hip joint is worn or damaged to the extent that your mobility is reduced and you experience pain even while resting.
The most common reason for hip replacement surgery is osteoarthritis. Other conditions that can cause hip joint damage include:
Who is offered hip replacement surgery
A hip replacement is major surgery, so is normally only recommended if other treatments, such as physiotherapy or steroid injections, haven’t helped reduce pain or improve mobility.
You may be offered hip replacement surgery if:
You’ll also need to be well enough to cope with both a major operation and the rehabilitation afterwards.
How hip replacement surgery is performed
A hip replacement can be carried out under a general anaesthetic (where you’re asleep during the procedure) or an epidural (where the lower body is numbed).
The surgeon makes an incision into the hip, removes the damaged hip joint and replaces it with an artificial joint made of a metal alloy or, in some cases, ceramic.
The surgery usually takes around 60-90 minutes to complete.
Read about how a hip replacement is performed.
There is an alternative type of surgery to hip replacement, known as hip resurfacing. This involves removing the damaged surfaces of the bones inside the hip joint and replacing them with a metal surface.
An advantage to this approach is that it removes less bone. However, it may not be suitable for:
Resurfacing is much less popular now due to concerns about the metal surface causing damage to soft tissues around the hip.
Your surgeon should be able to tell you if you could be a suitable candidate for hip resurfacing.
Choosing a specialist
Choose a specialist who performs hip replacement regularly and can discuss their results with you.
This is even more important if you’re having a second or subsequent hip replacement (revision surgery), which is more difficult to perform.
Your local hospital trust website will show which specialists in your area do hip replacement. Your GP may also have a recommendation, or arrange for you to follow an enhanced recovery programme.
Preparing for hip replacement surgery
Before you go into hospital, find out as much as you can about what’s involved in your operation. Your hospital should provide written information or videos.
Stay as active as you can. Strengthening the muscles around your hip will aid your recovery. If you can, continue to take gentle exercise, such as walking and swimming, in the weeks and months before your operation.
You may be referred to a physiotherapist, who will give you helpful exercises.
Read about preparing for surgery, including information on travel arrangements, what to bring with you and attending a pre-operative assessment.
Recovering from hip replacement surgery
The rehabilitation process after surgery can be a demanding time and requires commitment.
After the operation you’ll need a walking aid, such as a frame or crutches, to help support you.
You may also be enrolled on an exercise programme that’s designed to help you regain and then improve the use of your new hip joint.
It’s usually possible to return to light activities or office-based work within around 6 weeks. However, everyone recovers differently and it’s best to speak to your doctor or physiotherapist about when to return to normal activities.
Risks of hip replacement surgery
Complications of a hip replacement can include:
However, the risk of serious complications is low – estimated to be less than 1 in a 100.
There’s also the risk that an artificial hip joint can wear out earlier than expected or go wrong in some way. Some people may require revision surgery to repair or replace the joint.
There have been cases of some metal-on-metal (MoM) hip replacements wearing sooner than would be expected, causing deterioration in the bone and tissue around the hip. There are also concerns that they could leak traces of metal into the bloodstream.
The Medicines and Healthcare products Regulatory Agency (MHRA) has issued new guidelines that certain types of MoM devices should be checked every year while the implant is in place. This is so any potential complications can be picked up early.
If you’re concerned about your hip replacement, contact your GP or orthopaedic surgeon. They can give you a record of the type of hip replacement you have and tell you if any follow-up is required.
You should also see your doctor if you have:
These symptoms don’t necessarily mean your device is failing, but they do need investigating.
Any changes in your general health should also be reported, including:
REVISED HIP REPLACEMENT SURGERY
Revision Total Hip Replacement
Total hip replacement is one of the most successful procedures in all of medicine. In the vast majority of cases, total hip replacement enables people to live more active lives without debilitating hip pain. Over time, however, a hip replacement can fail for a variety of reasons.
When this occurs, your doctor may recommend that you have a second operation to remove some or all of the parts of the original prosthesis and replace them with new ones. This procedure is called revision total hip replacement.
Although both procedures have the same goals—to relieve pain and improve functionand quality of life—revision surgery is different than primary total hip replacement. Revision hip replacement is a longer, more complex procedure. It requires extensive planning, as well as the use of specialized implants and tools, in order to achieve a good result.
In order for a total hip replacement to function properly, an implant must remain firmly attached to the bone. During the initial surgery, the hip replacement components were either cemented into place or were “press fit” into the bone to allow bone to grow onto them. Sometimes, however, bone may fail to grow onto press-fit components. In addition, cemented or press-fit components that were once firmly fixed to the bone can eventually loosen, resulting in a painful hip.
The cause of loosening is not always clear, but repetitive high-impact activities, excessive body weight, and wear of the plastic liner between the ball and the metal cup are all factors that may contribute.
In addition, patients who are younger when they undergo the initial hip replacement may “outlive” the life expectancy of their artificial hip. For these patients, there is a higher long-term risk that revision surgery will be needed due to loosening or wear.
In some cases, tiny particles that wear off the cup’s plastic liner accumulate around the hip joint and are attacked by the body’s immune system. This immune response also attacks the healthy bone around the implant, leading to a condition called osteolysis In osteolysis, the bone around the implant deteriorates, making the implant loose or unstable.
Fortunately, plastics have improved greatly over the years, so plastic wear and osteolysis occur less frequently today than they did with earlier generations of implants.
Infection is a potential complication of any surgical procedure, including total hip replacement. Infection occurs when bacteria attach in and around the surface of the prosthesis. Infection may occur while you are in the hospital or after you go home. It may even occur years later.
If a total hip replacement becomes infected, it can be painful and the implant may begin to lose its attachment to the bone. Even if the implant remains properly fixed to the bone, there may still be pain, instability, and drainage from the infection. Because bacteria cannot be easily eliminated from a joint replacement with antibiotics alone, revision surgery is usually necessary.
Revision surgery for infection can be done in different ways. To determine which procedure is best for you, your doctor will consider a number of factors, including:
Debridement. In this procedure, your doctor will open up your hip, wash out the bacteria, and exchange the ball and plastic liner. The metal implants that are firmly attached to the bone are left in place. After debridement, you will receive intravenous antibiotics for several weeks to help cure the infection.
Staged surgery. In some cases, the implants must be completely removed. If the implants are removed to treat the infection, your doctor will usually perform the revision in two separate surgeries.
In the first surgery, your doctor will remove the implants and place a temporary cement spacer in your hip. This spacer is treated with antibiotics to help fight the infection and will remain in your hip for several weeks. During this time, you will also receive intravenous antibiotics.