Total Hip Replacement

Operation

Total Hip Replacement

Procedure

The hip joint is a “ball and socket joint”. It is a very important joint as it allows a great deal of movement but is also weight-bearing. As a result of this, it is often prone to “wearing away”. This is a simplified reason as to why arthritis occurs. Arthritis can be a very painful disorder which may slow down your mobility/ walking or even stop you from sleeping.

A hip replacement is an operation which replaces the severely damaged hip bone with an artificial ball and socket that does the function of the natural joint. It may reduce the pain and help with walking and sleeping.

If you hold any x-rays, please bring them with you when you come into the hospital.

You will be visited by your surgeon before the operation. If you have any questions, now might be a good time to ask them. The surgeon will mark your leg with a felt pen. This is to make sure the correct leg is operated on.

An anaesthetic will be given in theatres. This may be a general anaesthetic (where you will be asleep) and/ or a regional block (e.g. Where you are awake but the area to be operated on is completely numbed) for example an injection into the spine. You must discuss this and the risks with the anaesthetist. If you have any allergies, please also tell them. You will lie on the opposite side of the one being operated on. Your skin will be cleaned with antiseptic fluid and clean towels (drapes) will be wrapped around the hip.

The surgeon will make a cut (incision) using a surgical knife (scalpel). The exact location of the incision depends on your surgeon’s technique. The length of the incision also depends upon the surgeon and your leg. A cut is made through the fat and muscles which lie in the way of the hip bones. The top of the thigh bone (femur) which forms the neck and ball will be cut away. A replacement stem and ball can then be placed in the remaining thigh bone.   The socket part of the hip joint will also be drilled smoothly. The surgeon will try and remove as much arthritic bone and make a smooth base for the new “cup”. In some cases, surgeons will use special bone cement to hold the stem and/ or the cup in position. The implants are made of different materials including different types of metals, polyethene (like plastic) or very tough ceramic. When satisfied with the position, the surgeon will close the wound and then the skin.  Some surgeons use stitches, while others prefer metal clips (skin staples). Both methods are equally successful and come down to surgeon preference.

When you wake up, you will feel sore around the hip, this is normal. You will be encouraged to start walking as soon as possible with the aid of the physiotherapists.

An X-ray and blood tests may be taken within 48 hours.

The surgeon participates in National Joint Registry, and every joint that is inserted requires assessment with a questionnaire. Before and after surgery you will be asked to fill in forms on your progress that will be used to assess your outcome. These will be sent to the National Joint Registry.

It is important to note that hip replacement surgery is a major procedure and recovery can take several weeks to several months. It’s important to have clear communication with the surgeon and follow the post-operative instructions very carefully.

Approximate Operating Time

90 Minutes

Alternatives

Hip replacements are usually performed on patients suffering from severe arthritis (although there are other reasons). Most patients are above the age of 55yrs.

Other alternatives include:

• -Losing weight,
• -Stopping strenuous exercises or work,
• -Physiotherapy and gentle exercises,
• -Medicines, pain killers or anti-inflammatories (e.g. Ibuprofen or steroids),
• -Using a stick or a crutch,
• -Arthroscopy,
• -Injections
• -Hip fusion (arthrodesis)

Some of the above are not appropriate if you want to regain as much physical activity as possible, but you should discuss all possibilities with your surgeon.

Risks-Common

PAIN: the surgical site will be quite sore after the operation. If you are in pain, it’s important to tell the staff so that medicines can be given. Pain will improve with time. Rarely, the pain will be a chronic problem & may be due to any of the other complications listed below, or, for no obvious reason. Rarely, some replaced knees can remain painful.

BLEEDING: A blood transfusion or iron tablets may occasionally be required. Rarely, the bleeding may form a blood clot or large bruise within the knee which may become painful and require an operation to remove it.

DVT:(deep vein thrombosis) is a blood clot in a vein. The risks of developing a DVT are greater after any surgery (and especially bone surgery). DVT can pass in the bloodstream and be deposited in the lungs (a pulmonary embolism –PE). This is a very serious condition which affects your breathing. Your surgeon may give you medication to try and limit the risk of DVTs from forming. Some centres will also ask you to wear stockings on your legs, while others may use foot pumps to keep blood circulating around the leg. Starting to walk and moving early is one of the best ways to prevent blood clots from forming

HIP STIFFNESS: may occur after the operation, especially if the joint is stiff before the surgery. Manipulation of the joint (under general anaesthetic) may be necessary

PROSTHESIS WEAR: Modern operating techniques and new implants, mean that most hip replacements last over 15 years. In some cases, this is significantly less. The reason is often unknown. Implants can wear from overuse. There is still debate as to which material is the strongest. The reason for loosening is also unknown. Sometimes it is a secondary infection. This may require the removal of the implant and revision surgery.

JOINT DISLOCATION: if this occurs, the joint can usually be put back into place without the need for surgery. Sometimes this is not possible, and an operation is required, followed by the application of a hip brace or rarely if the hip keeps dislocating, a revision operation may be necessary.

ALTERED LEG LENGTH: the leg which has been operated upon, may appear shorter or longer than the other. This rarely requires a further operation to correct the difference or shoe implants.

Risks- Less Common

INFECTION: You will be given antibiotics at the time of the operation and the procedure will also be performed in sterile conditions (theatre) with a special ultraclean airflow and with sterile equipment. Despite this infections still occur (1 to 2%). The wound site may become red, hot and painful. There may also be a discharge of fluid or pus. This is usually treated with antibiotics and an operation to wash out the joint may be necessary. In rare cases, the prostheses may be removed and replaced at a later date. The infection can sometimes lead to sepsis (blood infection) and strong antibiotics are required.

Risks-Rare

ALTERED WOUND HEALING: the wound may become red, thickened and painful (keloid scar), especially in Afro-Caribbean.

NERVE DAMAGE: efforts are made to prevent this, however damage to the nerves around the hip is a risk. This may cause temporary or permanent altered sensation along the leg. In particular, there may be damage to the Sciatic Nerve, which may cause temporary or permanent weakness or altered sensation in the leg.

BONE DAMAGE: bone may be broken when the prosthesis (false joint) is inserted. This may require fixation, either at the time or at a later operation.

BLOOD VESSEL DAMAGE: the vessels at the back of the knee may rarely be damaged. May require further surgery by a vascular surgeon.

PE: a Pulmonary embolism is the spread of a blood clot to the lungs and can affect your breathing. This can be fatal.

DEATH: This very rare complication may occur after any major surgery and from any of the above.