Total Hip
Replacement
Total hip replacement is one of the commonest orthopaedic
operations carried out in the
Hip replacement surgery can be performed under either general or
regional anaesthesia, and these options can be discussed with your anaesthetist
prior to surgery.
Once the anaesthetic has been administered, a 15 to 20 cm
incision is made on the outside of the upper thigh, and the arthritic or worn
out hip joint is removed and replaced by the artificial hip components. The
skin is closed with a dissolvable stitch, and although the scar is in a
conspicuous area, it heals nicely and usually fades to a barely noticeable
white line.
After a short period of observation in the recovery area you
will be transferred back to the ward, the whole procedure taking about two
hours.
Total Hip Replacement
BEFORE SURGERY
Total Hip Replacement
AFTER SURGERY
Total hip replacement is a major operation and there is always
some swelling, discomfort and bruising afterwards which will steadily improve
over the first few weeks.
The medical and nursing staff will ensure that you are as
comfortable as possible, and will get you out of bed to start standing and
walking the day after your operation.
You will start with a walking frame under the supervision of a
physiotherapist, who will give you instructions and show you exercises that you
should continue once you return home. You will have an X-ray taken of the hip,
which you can look at and discuss with your surgeon, and by the time you are
discharged (about five days after surgery) you will be walking comfortably and
safely with two sticks or crutches. You should be able to go up and down stairs
one at a time, get yourself to the lavatory or on and off the bed
independently, although you may need some help with shopping and other domestic
tasks.
After returning home
Take
painkillers for discomfort as needed- usually 2-4 weeks is normal. It is usual
to have some leg swelling for several weeks after surgery.
Continue
your exercises.
Do
not bend your hip more than a right angle.
Do
not twist your hip inwards or outwards.
Generally
you shouldn't drive for at least six weeks.
You
may go back to office work after the six week appointment.
You
may go back to heavier work usually after about three months.
Walking
sticks can generally be discarded around 6 weeks. However, this will be determined
by your confidence and progress and you should follow the advice of your
surgeon and physiotherapist. It may be safer to use two sticks when you are out
of the house until about 8 weeks from surgery.
You
should avoid high-impact activities but will be encouraged to walk and follow a
gentle exercise programme. Your new hip will improve rapidly in the first three
to four months, but will continue to improve over a period of at least one
year.
You
will probably be able to have sex after about 6–8 weeks, although you should
avoid extreme positions of the hip. Don't be afraid to ask for advice about
suitable positions – you will not be the first to have asked!
Routine
dental work does not require antibiotic prophylaxis unless you are immuno-compromised e.g. diabetic, on steroids or have an
immunodeficiency disease.
If
there is any suspicion about infection of your new hip we recommend you contact
your operating surgeon or the hospital and do not accept antibiotics from your
GP.
You
will normally be reviewed by your surgeon 6 weeks after the operation.
Within
a year of your operation you should have resumed virtually all your normal
activities.
Unexpected problems
These
can occur during or after the procedure.
Side-effects
of a successful procedure are unwanted but usually temporary, for example,
feeling sick as a result of the anaesthetic and pain killing medication. Also
there is likely to be swelling in the leg, temporary pain or discomfort for
several weeks.
Complications
are usually less common and most people are not affected. Complications occur
in about 1 out of 20 operations. The chance of problems depends on the exact
type of operation you are having and other factors such as your general health.
Your surgeon will explain this to you clarifying the risks set out below and
any additional risks which may apply to your case.
Bleeding
during or soon after the procedure is not uncommon.
Occasionally,
a blood clot can form within a vein in the leg (called a “deep vein thrombosis”
or DVT). Sometimes this clot can break off and cause
a blockage in the lungs (a “pulmonary embolus” or PE). This can be a dangerous
condition. In the majority of clots, blood thinning medicine is all that is
needed.
Rarely
heart attacks or strokes are seen after surgery.
Extremely
rarely an abnormal reaction to the anaesthetic is seen.
Infection
is rare but very serious when it happens, and may result in a repeat operation.
The
ball may come out of its socket-‘dislocation’. If this happens repeatedly,
another operation may be needed.
The
hip can loosen over time, most commonly after about 15 years, possibly
requiring another operation to replace the loose hip with a new one.
Nerves
or blood vessels in the leg can get damaged during the operation. Although this
is very rare it can lead to weakness &/or numbness.
Tiny
cracks can be made in the bone while fitting the new joint. These usually heal,
but on rare occasions a fracture can result, needing additional treatment.
Rarely
the operated leg may be a slightly different length.
Occasionally
abnormal bone growth occurs beyond the normal ends of the bone (heterotopic bone formation). This can lead to stiffening of
the hip and some pain for up to 18 months after surgery.
And finally:
Remember
90-95% of patients undergoing this surgery are pleased or delighted with the
result. In general, well over 80% of hips should last for 20 years or more.