Total Hip Replacement surgery

Total Hip Replacement is a proven procedure to address significant pain associated with hip arthritis.

In earlier stages of hip arthritis pain killers, anti-inflammatory medications, physiotherapy and steroid injection can help in pain relief. Hip injection with steroid can help with pain associated with mild to moderate hip arthritis. Total hip replacement can relieve pain associated with advanced arthritis and help improve mobility.

Type of anaesthesia for total hip replacement

The surgical procedure is usually carried out under a regional anaesthetic (spinal anaesthetic where your legs are numb for the duration of the operation) and sedation. The procedure can be carried out under a general anaesthetic (where you are asleep). The appropriate anaesthetic is chosen after pre operative assessment and discussion with the anaesthetist. You are made comfortable during the surgery and are not in any pain.

What happens during hip replacement surgery?

Antibiotics are given prior to starting the procedure to reduce the risk of infection. A cut is made over the side of the hip to expose the arthritic hip. The ball of the hip (femoral head) is removed. A polyethylene (plastic) component is cemented in your socket. A metal component (stem) is cemented in your thigh bone. A metal or ceramic head is fitted on the stem. At the end of your hip replacement surgery, the skin is closed with metal clips. Local anaesthetic is infiltrated in and around your hip to ensure good pain relief following the procedure.

What happens after hip replacement surgery?

Following your hip replacement surgery, you are made comfortable with pain killers as needed.  Once you have recovered from the anaesthetic, physiotherapists will help you with your walking and hip exercises. You are given walking aids like crutches to help with your early mobilisation. Your hip is x-rayed after the operation to confirm accurate placement of the hip replacement. You should be able to go home within a couple of days of your hip replacement surgery.

What happens after discharge from the hospital?

You need to continue with the exercises to improve the strength in your muscles around the hip.  Two weeks following the surgery your skin clips are removed.  It takes around six to eight weeks for the hip to settle down following the surgery. You will be reviewed in clinic at eight weeks following your hip surgery to ensure you are making good progress.

What can I expect from my hip replacement surgery?

Following your hip replacement surgery, you will be able to carry on with all your daily activities with certain precautions. The precautions need to be followed for three months after the surgery. Exercises and activities causing repetitive impact on the hip should be avoided to reduce the possibility of loosening or wear of the hip replacement. The hip replacement should last for about 15 years in 90% of the patients.

What are the risks of undergoing total hip replacement?

The significant and common risks are as follows:

  • Infection (around 1%): every effort is undertaken to avoid infection by performing the hip surgery in sterile conditions (laminar air flow theatre) and by giving antibiotics around the time of operation.  Despite this infection can still occur rarely.  Infection usually manifests by the incision becoming red, hot and painful, with possible discharge of fluid.  If this infection is superficial (not going deep to the joint) this can usually be treated with antibiotics and an operation to wash the wound. A change of bearing may be needed at times. In case of deep infection, which is fortunately rare, the artificial hip may need to be removed and replaced at a later date after the infection has been controlled.
  • Bleeding: Blood transfusion is kept on standby and may be required in the post-operative period.
  • Deep vein thrombosis and pulmonary embolus: deep vein thrombosis (DVT) is a blood clot in the veins of the leg.  The blood clot can go into the general circulation and go to the lungs, which is termed as a pulmonary embolus.  To reduce the risk of DVT you will be given blood thinners as well as stockings on your legs.  One of the best ways to prevent a DVT is to get the calf muscles working by ankle exercises and keeping yourself well hydrated.
  • Dislocation: Hip slipping out of place. The risk can be minimised by following precautions explained by physiotherapists. If dislocation occurs, may need manipulation of the hip to reduce the hip back in position.
  • Sciatic nerve injury: Can occur rarely leading to weakness in the leg or dropped foot.
  • Limp: Can be improved with physiotherapy to strengthen hip muscles
  • Unequal leg lengths: The operated leg may be slightly longer or shorter than the opposite leg.
  • Persistent pain: can occur in 10% of hip replacements due to scar tissue and overactivity of nerves around the hip. This may need input from pain clinic.
  • Loosening, wear and need for revision hip replacement: most hip replacements are expected to last for about 15 years or more.  If there is loosening of the components or wearing of the polyethylene component of the hip replacement the hip may need to be changed (revised).
  • Rare complications include fracture.