The body contains numerous joints which are subject to wear and tear, injury and arthritis. The hip joint is especially susceptible to damage due to it being the largest ball and socket joint in the body. Although non-surgical methods can be used to treat hip pain, a hip replacement surgery may be necessary.
1. Is a total hip replacement a common procedure?
If you’re considering a hip replacement, also known as arthroplasty, then you’re not alone. Hip replacement surgery is a very common procedure. In England and Wales there are approximately 160,000 total hip and knee replacement procedures performed each year. Approximately the same number of hip and knee joints are replaced¹.
Advances in surgical techniques and technologies have revolutionised hip replacement surgery to allow more patients to consider treatment sooner and regain a better quality of life.
2. What is a total hip replacement?
Hip replacement is a surgical procedure performed to remove the diseased or damaged parts of the hip joint and replace them with new artificial parts, called prosthesis.
The hip joint is located where the upper end of the thigh bone meets the hip bone. A ball at the end of the thigh bone fits in a socket in the hip bone to allow a wide range of movement.
3. What's involved in a total hip replacement?
A traditional hip replacement usually takes around 60 to 90 minutes to complete and can be carried out under a general anaesthetic (where you are asleep during the procedure) or an epidural (where the lower body is numbed).
Once you’ve been anaesthetised, your surgeon will make an incision over the side of your hip to remove and replace the damaged ball and socket with artificial parts.
The prosthesis can be plastic (polyethylene), metal or ceramic, used in different combinations including:
• metal-on-plastic (a metal ball with a plastic socket) is the most widely used combination.
• ceramic-on-plastic (a ceramic ball with a plastic socket) or ceramic-on-ceramic (ball and socket are ceramic). Both these combinations are often used in younger and more active patients due to their hard wearing nature.
• metal-on-metal (a metal ball with a metal socket) is occasionally used in younger and more active patients.
The artificial joint components can be held in place by being:
• cemented - the prosthesis is secured to healthy bone using acrylic cement.
• uncemented - the surfaces of the implants are roughened or specially treated to encourage the existing healthy bone to grow onto them and hold them inplace. Bone is a living substance and, as long as it’s strong and healthy, it’ll continue to renew itself over time and provide a long-lasting bond. This method is becoming more common, especially in younger, more active patients.
Recently some surgeons have begun performing minimally invasive hip replacement, which requires smaller incisions and a shorter recovery time than traditional hip replacement.
4. Who should have a hip replacement?
If you have hip joint damage or disease with persistent pain symptoms that interfere with your daily activities then you may be a candidate for hip replacement surgery.
Your orthopaedic surgeon will discuss the best options of pain relief for you and if you should consider a hip replacement.
5. Conditions that require hip replacement surgery
Some common reasons why a hip joint can become damaged include:
• osteoarthritis - known as "wear and tear arthritis". The cartilage (a tough, flexible tissue that acts as a shock absorber and mould) inside a hip joint becomes worn awayand causes the bones to rub against each other. Osteoarthritis is the most common cause of this type of damage².
• rheumatoid arthritis- caused by the immune system. The body mistakenly attacks the lining of the joint whilst trying to defend the body against infection resulting in pain,stiffness and swelling
• hip fracture - a fall or similar accident can severely damage the hip joint so that a replacement is required.
6. What are the benefits of a total hip replacement surgery?
Hip replacement surgery aims to increase your mobility and improve the function of your hip joint to relieve pain and ultimately improve the quality of your life. Many people find that their life is transformed as they regain their mobility and independence without the acute pain they suffered before theirhip replacement.
7. What are the complications that may occur?
The risk of serious complications during and after hip replacement surgery is low, estimated to be less than 1 in a 100. These include blood clots (deep vein thrombosis and pulmonary embolism) and infection. The most common complication of a hip replacement is that something goes wrong with the joint, which occurs in around 1 in 10 cases³.
These can include:
• loosening of your joint - caused by your prosthesis becoming loose in the hollow of your thigh bone or thinning of your bone around the implant.
• hip dislocation - the ball can become dislodged from the socket if the hip is placed in certain positions.
• wear and tear - particles can wear off your artificial joint surfaces and be absorbed by surrounding tissue and cause loosening of your joint.
• joint stiffening – the soft tissues can harden around the implant, resulting in reduced mobility.
Further complications of a hip replacement can include injuries to the blood vessels or nerves, a fracture and differences in leg length.
8. What are the alternatives to hip replacement?
There are some non-surgical options that can be effective in helping you to avoid or delay hip replacement surgery.
Pain killers, such as paracetamol and ibuprofen, can help control your pain. A walking stick can make walking easier. An exercise program can strengthen the muscles around the hip joint and help to reduce stiffness. A steroid injection into the hip joint can sometimes reduce pain and stiffness. However if your pain worsens and becomes unmanageable then hip replacement surgery may be the best option for you.
Hip resurfacing is a surgical alternative to hip replacement. It involves removing the damaged surfaces of the bones inside the hip joint and replacing them with a metal surface. Hip resurfacing removes less bone but is usually only effective in younger adults who have relatively strong bones. Also there is concern about the metal surface causing damage to soft tissues around the hip.
9. How long will my total hip replacement last?
An artificial hip joint is designed to last for at least 15 years². However it could wear out or go wrong in some way before this time and then further surgery is required to repair or replace the joint, known as revision surgery. It is estimated that around 1 in 10 people with an artificial hip will require revision surgery at a later date.
10. Am I too young for a hip replacement?
In the past hip replacement surgery would primarily be offered to people over 60 years of age as they are typically less active, putting less stress on the artificial hip, than younger people.
More recently, with new technology that has improved the artificial parts so that they withstand more stress and strain and last longer, hip replacement surgery has proved to be very successful in younger people. Now a person’s overall health and activity level are more important than age in predicting a hip replacement’s success.
11. How can I get prepared for a total hip replacement?
Before you go into hospital there are some things you can put in place to make your recovery easier you return home. These include:
• Arrange for help. You will need a lift to and from the hospital. It is also beneficial to have someone to help you around the house for a week or two after coming home from hospital.
• Place items you use or will need and want every day when you return home within arm’s reach. These might include the TV remote control, books, telephone, and medicine.
• Stock up on food supplies especially easy to prepare foods such as frozen ready meals and tinned soups.
12. After a total hip replacement surgery
You should be able to go home after 4 to 7 days. You will need to use a walking aid such as crutches or walking sticks for a few weeks after your operation. Your surgeon or physiotherapist will advise you about exercises that will help you regain and improve the use of your new hip joint and allow you to return to normal activities as soon as possible.
Most people are able to resume their ordinary lifestyle within 2 to 3 months but it can take up to a year before you make a full recovery and experience the full benefits of your new hip.
Getting back to your normal work routine sooner rather than later can actually help you to recover more quickly. In most cases it’s usually safe to return to light work or an office-based job within 6 weeks of the operation. If your job involves heavy duties, you may need to be off work for several moreweeks⁴.
If you want to learn more about joint replacements and ski related knee injuries you may find answers in our orthopaedic posts.
Total Hip Replacement Surgery at Ramsay Health Care UK
At Ramsay Health Care we are proud to work in partnership with some of the highest qualified and experienced consultant orthopaedic and hip surgeons in the UK to deliver high quality hip replacements throughout our private hospitals.
Please contact us if you would like to discuss hip replacement surgery in more detail.
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References
¹ http://www.njrcentre.org.uk/njrcentre/Patients/Jointreplacementstatistics/tabid/99/Default.aspx
²http://www.niams.nih.gov/Health_Info/Hip_Replacement
³http://www.nhs.uk/Conditions/Hip-replacement/Pages/Complications.aspx
⁴https://www.rcseng.ac.uk/patients/recovering-from-surgery/total-hip-replacement/returning-to-work