A-Z of health

Hip replacement

  • If your specialist has recommended that you have a total hip replacement, this leaflet provides some standard information and advice about the procedure. However, you should always follow the instructions of your own specialist.

    If you have any unanswered questions or concerns, please do not hesitate to ask your specialist or nurse for more information. It is natural to feel anxious, but often knowing what to expect can help.

    What is involved?

    The hip is a ball and socket joint. The "ball" is formed by the top of the thigh bone (femur), which fits into a "socket" (acetabulum), which is part of the pelvis. For a total hip replacement, the head of the femur is removed and a replacement ball on a stem is inserted into the center of the thigh bone. A plastic or metalbacked plastic cup is frequently used to replace the socket.

    An artificial joint will usually last for at least 10 years, after which it may need to be replaced.

    The operation is usually performed under a general anaesthetic, which means you will be asleep during the procedure. However, in some patients an epidural (using local anaesthetic) is preferable. Your specialist will discuss which is best for you. For more information on anaesthesia please see the separate leaflets.

    Preparing for your operation

    Your specialist or hospital will talk to you about admission procedure, however before you come into hospital for your hip replacement, you will also be asked to:

    • attend a pre-assessment clinic for routine tests two or three weeks before your operation. This will also be an opportunity for you to ask questions, and for a physiotherapist to talk to you about your home requirements, so that any arrangements for aids and services can be made in advance of your admission
    • have a bath or shower on the day of your admission
    • remove any make-up, nail varnish and bulky or sharp jewellery. Rings and earrings that youd prefer not to remove can usually be covered with sticky tape
    • follow any fasting instructions given to you. Typically, you must not eat or drink for about six hours before the operation. However, some anaesthetists allow occasional sips of water until two hours beforehand

    After you have been shown to your room, your nurse will check you have been well since the pre-assessment. Your surgeon and anaesthetist will also visit you. The surgeon will clearly mark the leg to be treated. This is a good time to ask any outstanding questions about your treatment.

    The nurse will help you prepare for theatre and will do some simple tests such as taking your blood pressure and pulse, and may ask you for a urine sample. You may be asked to put on compression stockings to help prevent blood clots from forming in the veins of your legs.

    Consent

    You will be given a consent form to sign. By doing this, you confirm that you understand what the procedure involves, including the benefits and risks, and give your permission for it to go ahead.

    Please see later for further information about the possible side-effects and complications of this procedure. You need to know about these in order to give your informed consent.

    About the operation

    An incision, usually around 6-12 inches (15-30 cm) long is made along the hip and thigh. When the joint has been replaced, your consultant closes the incision with stitches or clips. Fine plastic drainage tubes may be left in for up to 48 hours after the operation. A special pillow may be placed between the legs to hold the new joint still and prevent dislocation.

    The operation usually takes one to two hours, so your relatives should expect you to be away from your room for at least three hours.

    After your operation

    You will be taken from the operating theatre to a recovery room, where you will come round from the anaesthetic under close supervision.

    After this, you will be taken back to your room, where a nurse will make you comfortable. When you feel ready, you can begin to drink and eat, starting with clear fluids such as water or apple juice.

    Back on the ward

    You will need to stay in hospital for five to seven days after your operation. During this time, every effort is made to keep any discomfort to an acceptable level. Your anaesthetist will discuss pain relief with you. After the first week, you will probably only need mild painkillers in tablet form.

    The physiotherapist will visit you every day to guide you through exercises to help you recover. You will generally be encouraged to move your new hip from the first day after the operation. By the time you go home, you will be able to walk with sticks or crutches and will have learned how best to move about and manage daily tasks.

    Going home

    You will need to make arrangements to be driven home. Before you go home, a nurse will advise you about caring for surgical wounds, hygiene and bathing. A follow-up appointment in the outpatient clinic will be arranged for you.

    After you return home

    If you need them, continue taking painkillers as advised by your specialist or the hospital.

    You will be able to move around your home and manage stairs, but you will find that some routine daily activities are difficult for a few weeks and you will need to ask for help. For example, you will not be able to go shopping for the first few weeks.

    When you are not walking or doing your exercises, you can sit in an upright chair. You will not be able to drive until your specialist advises you that it is safe.

    It is crucial that you continue with the exercises that have been recommended by the physiotherapist, as these will promote healing and help you recover more quickly. Your new hip will continue to get better for at least six months.

    What are the risks?

    A planned hip replacement is generally a safe surgical procedure. However, all surgery does carry some element of risk. This can be divided into the risk of side-effects and the risk of complications.

    Side-effects

    These are the unwanted but mostly temporary effects of a successful treatment. Examples of short-lived side-effects include feeling sick as a result of the general anaesthetic and painkillers, and having a poor appetite to begin with. After a hip replacement operation, the new joint is likely to be uncomfortable for several weeks. There may also be some temporary pain and swelling in the knee (caused by the handling of the leg during the operation) and it is quite common to have a swollen ankle for up to three months afterwards.

    Complications

    This is when problems occur during or after the operation. Most patients will not be affected.

    The main possible complications of any surgery are excessive bleeding during or soon after the operation, infection, and an unexpected reaction to the anaesthetic.

    The main specific complications of a hip replacement are listed.

    • damage to the nerves that control the leg. This is usually very slight and rarely permanent. Most patients dont notice it
    • occasionally, tiny cracks are made in the bone while fitting the new joint. These usually mend by themselves but on rare occasions a fracture can result, needing additional treatment
    • the operated leg is slightly longer than the other. When this occurs, the difference may be hard to notice, but sometimes its necessary to wear a raised shoe on the shorter side
    • the new joint dislocates. This is most likely to happen immediately after the operation and is easily dealt with. Occasionally, dislocation happens repeatedly and another operation may be needed
    • the bowels and urinary system are close to the hip joint and may be affected by the surgery. The bowels may take a while to become active again and there may be difficulty passing urine. A urinary catheter (a thin flexible tube) may be inserted to enable urine flow. A urinary tract infection, requiring antibiotic treatment, is also possible
    • for up to six weeks after the operation its possible to develop a blood clot (known as a deep vein thrombosis, or DVT) in the veins of the leg. This clot can break off and cause a blockage in the lungs. In the majority of cases, this is treatable, but it can be a dangerous condition. You may be given preventive drugs or compression stockings

    This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

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