Overview

Introduction

The hip joint is a ball and socket joint. A hip replacement provides a long-term solution for worn or damaged hip joints, which can cause severe pain and loss of mobility.

At least 50,000 total hip replacements a year are carried out in Britain.

The operation replaces both the natural socket (the acetabulum) and the rounded ball at the head of the thigh-bone (the femoral head) with artificial parts. These parts replicate the natural motion of the hip joint.

Hip resurfacing

Total hip replacement surgery is usually very successful, but it can be invasive and require a lengthy recovery period. An alternative method, known as metal-on-metal hip resurfacing, involves replacing the diseased or damaged surfaces in the hip joint with metal plating, which requires less prosthetics and less bone removal.

Hip resurfacing can be considered for people with advanced hip disease. Resurfacing is likely to last longer than a conventional replacement joint. Because the technique is still relatively new, it is not known precisely how long the resurfacing will last.

All types of hip replacement surgery are beneficial, offering an end to joint pain, increased mobility and a better quality of life.

Why it is done

Why it should be done

Hip replacement is the most effective treatment for a hip joint that cannot function adequately and painlessly. The most common causes for surgery are:

• osteoarthritis - this is the most common form of arthritis and occurs when connecting tissue between the joint is damaged, causing bones to rub together painfully,
• rheumatoid arthritis - this is caused by the immune system attacking the lining of the joint, resulting in pain and stiffness,
• septic arthritis - this is a form of arthritis that occurs when the joint becomes infected,
• fracture of the neck of the thigh bone (femur) - this causes a loss of blood supply to the rounded head of the bone and may also lead to crumbling (avascular necrosis),
• Paget's disease of bone - this affects bone growth and can make bones weak and deformed,
• bone tumours, and
• other joint injuries.

Hip replacements are also sometimes required:

• in late cases of developmental dysplasia of the hip, which is a condition that prevents the ball and socket hip joint from developing properly. If left untreated, it can cause permanent deformity and walking problems.
• for hip joint fractures caused by osteoporosis, which affects the bones, making them thin and weak. Certain cells within the bone are no longer able to break down old bone and replace it with strong, healthy bone.

Getting ready

Preparing for the operation

A couple of weeks before the operation you will usually be asked to attend a pre-operative assessment clinic to meet your surgeon and other members of the surgical team. They will take a medical history, examine you and organise any tests needed, to make sure you are healthy enough for an anaesthetic and surgery.

They give you advice on anything you can do to prepare for surgery and ask you about your home circumstances so your discharge from hospital can be planned. If you live alone, have a carer or feel you need extra support, tell the team so that help or support can be arranged before you go into hospital.

Take a list or the packaging of any medication you are taking. Some (rheumatoid) arthritis medications suppress the immune system, which can affect healing. For this reason you may be asked to stop taking them before surgery. Your surgeon can advise on alternative medications.

Make use of this opportunity to ask any questions you have.

How can I prepare for the operation?
Stay as active as you can. Strengthening the muscles around your hip will aid in your recovery. You may be referred to a physiotherapist, who can give you helpful exercises. If you're able, keep up any gentle exercise, such as walking and swimming, in the weeks and months before your operation.

The following exercises can help maintain your muscle strength and movement before surgery:

• Put one foot on the second stair or a kitchen stool (hold on to the banister or other firm support). Lean forward to bend the top leg while stretching the front of the standing leg. Hold this for about 30 seconds, then repeat with the other leg.
• Stand on the affected leg for short periods, lifting the good leg off the floor. Concentrate on holding the pelvis level. Use a support as necessary for balance.
• Lie on your back. Pull your legs alternately up on to your chest, keeping the other leg flat down on the bed. (Note: this should only be done if you have not already had a hip replacement on one side.)
• Lie on your back. Bend your knee up so that your foot rests flat on the bed, and allow the bent knee to fall out to the side as much as is comfortable.
• Lie on your stomach and then flat on your back for approximately 20 minutes once or twice a day (early morning or late at night while in bed is often a good time), to stretch the front and back of your hip.

When will I go into hospital and what will happen?
You will usually be admitted to hospital the day before your operation (or earlier if you have any additional medical problems such as heart disease). The surgeon and anaesthetist will usually come and see you again to discuss what will happen and give you the opportunity to ask any more questions.

How can I prepare for my hospital stay?

• Get informed. Find out as much as you can about what is involved in your operation. Your hospital may provide written information or videos.
• Arrange help. Line up a friend or relative to help you at home for a week or two after coming home from hospital.
• Sort out transport. Arrange for someone to take you to and from the hospital – either a friend or relative or a taxi.
• Prepare your home. Before you go for your operation put your TV remote control, radio, telephone, medications, tissues, address book and glass on a table next to where you will spend most of your time when you come out of hospital.
• Stock up. Get in a stock of food that is easy to prepare such as frozen ready meals, cans and staples, such as rice and pasta, or prepare your own dishes to freeze and reheat during your recovery.
• Clean up. Before going into hospital have a good long bath or shower, cut your nails – don’t forget to take off any nail polish – and wash your hair. Put on freshly washed clothes. This helps prevent unwanted bacteria coming into hospital with you and complicating your care.

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