Hip Replacement - Overview

Overview-Hip replacement




A hip replacement is a common type of surgery where a damaged hip joint is replaced with an artificial one (known as a prosthesis).
Adults of any age can be considered for a hip replacement, although most are carried out on people between the ages of 60 and 80.
A modern artificial hip joint is designed to last for at least 15 years. Most people experience a significant reduction in pain and some improvement in their range of movement.

When a hip replacement is needed

Hip replacement surgery is usually necessary when the hip joint is worn or damaged to the extent that your mobility is reduced and you experience pain even while resting.
The most common reason for hip replacement surgery is osteoarthritis. Other conditions that can cause hip joint damage include:

Who is offered hip replacement surgery

A hip replacement is major surgery, so is normally only recommended if other treatments, such as physiotherapyor steroid injections, haven't helped reduce pain or improve mobility.
You may be offered hip replacement surgery if:
  • you have severe pain, swelling and stiffness in your hip joint and your mobility is reduced
  • your hip pain is so severe that it interferes with your quality of life and sleep
  • everyday tasks, such as shopping or getting out of the bath, are difficult or impossible
  • you're feeling depressed because of the pain and lack of mobility
  • you can't work or have a normal social life
You'll also need to be well enough to cope with both a major operation and the rehabilitation afterwards.

How hip replacement surgery is performed

A hip replacement can be carried out under a general anaesthetic(where you're asleep during the procedure) or an epidural (where the lower body is numbed).
The surgeon makes an incision into the hip, removes the damaged hip joint and replaces it with an artificial joint made of a metal alloy or, in some cases, ceramic.
The surgery usually takes around 60-90 minutes to complete.

Alternative surgery

There is an alternative type of surgery to hip replacement, known as hip resurfacing. This involves removing the damaged surfaces of the bones inside the hip joint and replacing them with a metal surface.
An advantage to this approach is that it removes less bone. However, it may not be suitable for:
  • adults over the age of 65 years – bones tend to weaken as a person becomes older
  • women who have gone through the menopause – one of the side effects of the menopause is that the bones can become weakened and brittle (osteoporosis)
Resurfacing is much less popular now due to concerns about the metal surface causing damage to soft tissues around the hip. 
Your surgeon should be able to tell you if you could be a suitable candidate for hip resurfacing.

Choosing a specialist

Choose a specialist who performs hip replacement regularly and can discuss their results with you.
This is even more important if you're having a second or subsequent hip replacement (revision surgery), which is more difficult to perform.
Your local hospital trust website will show which specialists in your area do hip replacement. Your GP may also have a recommendation, or arrange for you to follow an enhanced recovery programme.
You can also read a guide to NHS waiting times.

Preparing for hip replacement surgery

Before you go into hospital, find out as much as you can about what's involved in your operation. Your hospital should provide written information or videos.
Stay as active as you can. Strengthening the muscles around your hip will aid your recovery. If you can, continue to take gentle exercise, such as walking and swimming, in the weeks and months before your operation.
You may be referred to a physiotherapist, who will give you helpful exercises.
Read about preparing for surgery, including information on travel arrangements, what to bring with you and attending a pre-operative assessment.

Recovering from hip replacement surgery

The rehabilitation process after surgery can be a demanding time and requires commitment.
After the operation you'll need a walking aid, such as a frame or crutches, to help support you.
You may also be enrolled on an exercise programme that's designed to help you regain and then improve the use of your new hip joint.
It’s usually possible to return to light activities or office-based work within around 6 weeks. However, everyone recovers differently and it’s best to speak to your doctor or physiotherapist about when to return to normal activities.

Risks of hip replacement surgery

Complications of a hip replacement can include:
  • hip dislocation
  • infection at the site of the surgery
  • injuries to the blood vessels or nerves
  • a fracture
  • differences in leg length
However, the risk of serious complications is low – estimated to be less than 1 in a 100.
There's also the risk that an artificial hip joint can wear out earlier than expected or go wrong in some way. Some people may require revision surgery to repair or replace the joint.
Read about the risks of a hip replacement.

Metal-on-metal implants

There have been cases of some metal-on-metal (MoM) hip replacements wearing sooner than would be expected, causing deterioration in the bone and tissue around the hip. There are also concerns that they could leak traces of metal into the bloodstream.
The Medicines and Healthcare products Regulatory Agency (MHRA) has issued new guidelines that certain types of MoM devices should be checked every year while the implant is in place. This is so any potential complications can be picked up early.
If you're concerned about your hip replacement, contact your GP or orthopaedic surgeon. They can give you a record of the type of hip replacement you have and tell you if any follow-up is required.
You should also see your doctor if you have:
  • pain in the groin, hip or leg
  • swelling at or near the hip joint
  • a limp, or problems walking
  • grinding or clunking from the hip
These symptoms don't necessarily mean your device is failing, but they do need investigating.
Any changes in your general health should also be reported, including:
  • chest pain or shortness of breath
  • numbness, weakness, change in vision or hearing
  • fatigue, feeling cold, weight gain
  • change in urination habits

The National Joint Registry

The National Joint Registry (NJR) collects details of hip replacements carried out in England and Wales. Although it's voluntary, it's worth registering. This enables the NJR to monitor hip replacements, so you can be identified if any problems emerge in the future.
The registry also gives you the chance to participate in a patient feedback survey.
It's confidential and you have a right under the Freedom of Information Act to see what details are kept about you.

Hip operation: animation
This detailed animation explains how a hip replacement is done and why it would be needed.
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