Hip arthritis is a very painful and disabling condition. Typically, the smooth lining of the hip joint (the cartilage) dissolves away, resulting in the painful rubbing of bone on bone.
Unfortunately, the non-surgical treatment options for hip osteoarthritis are limited. Weight loss, exercise and swimming are all very important. Physiotherapy can also help to strengthen your hip muscles and help maintain your range of motion. Appropriate use of painkillers is vital; starting with Paracetamol as required, increasing to regular Paracetamol usage, and ultimately the addition of an anti-inflammatory under the guidance of your family doctor. Hip replacement is only recommended when the level of pain is affecting your quality of life, despite trying all the non-surgical treatments.
1. Total Hip Replacement
The hip joint is a “ball in socket” joint. A total hip replacement is when the socket of the hip joint (the acetabulum of the pelvis) and the top of the thigh bone (the femoral head or ball) are replaced with a new socket and head (a new ball in socket joint). By replacing the bone rubbing on bone, the pain should be alleviated. Thankfully, 95% of patients are satisfied with their hip replacement operation. However, there is a 5% (or 1 in 20) risk of a complication with hip replacement surgery, so surgery needs to be considered very carefully.
Complications of Total Hip Replacement Surgery
Infection is a very serious complication and can occur in 1% of patients. We will take all possible steps to reduce your infection risk. It is important that you tell us of any infections you may be experiencing, such as a urinary tract infection, tooth abscess or painful in-growing toenails. All infections need to be treated prior to surgery, including a dental visit to get a Dental Certificate saying that you do not have any active dental infections. Occasionally hip replacement surgery may have to be deferred for dental work, to limit your infection risk.
Dislocation occurs in 1 – 2% of patients. This is when the ball pops out of the socket. We spend a lot of time showing you the correct way to move, walk, dress, etc. Crutches are very important for the initial six weeks, to help you balance and avoid putting all your weight through the new hip.
Venous Thrombosis (Lung or Leg Clots) are a significant risk with Hip Replacement Surgery, especially in the Covid era. Leg clots which can travel to your lungs (Pulmonary Embolus) occur in less than 1% of patients. We prescribe blood thinners (Aspirin 150mg daily) to take for 4 weeks after the surgery and encourage early mobilisation (out of bed the next morning) and active ankle movement to reduce the risk of a clot.
Leg Length Discrepancy
Leg length discrepancy (one leg longer than the other) can occur after hip replacement. Typically, the arthritic hip shortens the affected leg, and on occasion, it can be difficult to restore your legs to equal length. Heel lifts either on or in shoes (on the non-surgical side) are sometimes necessary to equalise your leg lengths after surgery.
Sciatic Nerve Injury
This can occur following hip replacement, resulting in a ‘Dropped Foot’. This can happen if the leg is lengthened or exposure of the hip joint causes trauma to the nerve. Typically, the nerve recovers over 6 months, however a Dropped Foot Splint will be needed while the nerve recovers.
Wear and tear
Wear and tear of your new mechanical hip joint eventually happens over time. The current literature suggests that 90% of hip implants are expected to survive for 20 years, with the wear rate slightly increasing thereafter. So if you are having a hip replacement at the age of 70, this means when you are 90 years old (20 years later), there is a 90% chance the implant will be performing well, but a 10% risk that the implant will have failed.
2. Revision Hip Replacement
Revision hip replacement is when part or all of your prosthetic hip needs to be revised or replaced. Failure typically arises from normal wear and tear of the implant over time. Other reasons for revision surgery are if the hip replacement was unstable (causing recurrent dislocations), loose in the bone secondary to infection (causing residual ongoing pain) or if the implant became infected causing pain and needed to be removed.
Surgery – What to expect?
All the evidence shows the more you and your family know about the surgery, the smoother and easier the experience will be – knowledge is power! Joint School is a free educational program run by UPMC/Whitfield, aimed at pre-operative education and answering any questions you may wish to ask. Everyone should attend Joint School and to book your place, call Jo Breheny on 051 319 845. Patient satisfaction rates improve the more you understand about your surgery and when you have realistic expectations. I also recommend you explore educational websites.
All patients need to attend the Pre-Assessment Unit before their surgery, for blood tests and risk assessment. Please bring all your medications to Pre-Assessment, as some may need to be stopped prior to the surgery, especially BLOOD THINNERS. Likewise bring all your medical details, like previous Cardiology appointments etc.
Prior to admission, I recommend you shower twice a day for three days, cleaning the skin about your groin gently with normal soap. I also advise that you take a shower when admitted to UPMC/Whitfield.
Patients are typically admitted on the morning of their surgery, so do not eat from mid-night, so your tummy is empty on arrival at the hospital. Most patients spend 2 – 3 days in hospital, for pain control, while working with physiotherapy. Before theatre, you will be fasting, so we may give you a sugar drink. You will also receive some painkillers (pre-emptive analgesia) before coming to theatre.
You can be discharged once your pain is controlled and you have reached our physiotherapy targets including safe use of crutches on stairs. You will be given a prescription for pain relief and Aspirin to reduce your clot risk and advised to attend your GP for clip removal around 12 days after the surgery. Once your wound is healed, you can exercise in a pool or on a stationary bicycle. It is okay to sleep on either side with pillows between your legs. Everyone is sore initially, but in general the pain is very manageable with routine painkillers.
You must use your two crutches, until I see you again at 6 weeks with new x-rays. I suggest it is best to have someone at home with you for the first two weeks and I do not recommend driving until you are off both crutches.