A total run-through of the total hip replacement

Written by: Mr Constant Busch
Edited by: Jay Staniland

There are a number of conditions that cause arthritis of the hip joint. Some are congenital, meaning we get them at birth, and others are acquired as we get older. They may all lead to a degenerative condition of the hip, which in most patients will cause pain, stiffness, and a loss of function. The natural progression of any arthritic hip joint is that ultimately, it will get stiffer and stiffer until it fuses up altogether. That can be useful in the sense that because the joint doesn't move, it will not be painful. However, the function of the hip joint is much reduced. This is where an orthopaedic surgeon can help out with a total hip replacement, which is very good at relieving the pain, making the joint move again and returning the patient back to normal function.


When should you have a total hip replacement?


Most patients with a painful hip secondary to arthritis will try and avoid having surgery. They’ll try to optimise their conservative management, meaning they will take pain killers such as an anti-inflammatory or paracetamol, use dietary supplements such as glucosamine, chondroitin sulphate, they may want to lose some weight, or have the help of a physiotherapist.

However, at some stage the symptoms may become quite obtrusive. Patients may get pain at night which can stop them from sleeping, the function of their hip may become reduced, which makes it difficult to walk any distance or to even put on their socks and shoes. At that stage, they may consider a total hip replacement.


How do you prepare for a total hip replacement?


It is a good idea for the patient to be in the best possible shape for undergoing the operation, which means making sure they are as physically fit as possible. This could be done at a gym, or with a physiotherapist if possible. Being in the best possible fitness means that post-surgery, the rehabilitation is much easier and the patient will regain mobility and function as quickly as possible.

Quite a few patients are concerned about the amount of pain that they may be in. An anaesthetist will discuss with the patient the type of anaesthetic that will be used. Most commonly, most people will have a spinal anaesthetic, which involves a needle in the back causing numbness from the waist down. At the same time, they will get some sedation and most patients elect to be completely unaware of the operation.


How long does it take to recover from a total hip replacement?


Most patients will stay in hospital for two to five days to recover from a total hip replacement, and will be mobilised on the day of surgery if not the following day.

Most patients will be able to go up and down stairs either by the first or the second day after the operation. Crutches will probably be needed for two to three weeks after the operation. Most people will be able to drive their car either between four to six weeks following surgery.

People who like to play golf can be chipping and putting after around six to eight weeks and most people will be able to proper round of golf by about three months.

People who play tennis or bowls or any similar sport, walk the dog, or do gardening, will be able to return to these activities after around three months.

After around six to nine months, most people will have forgotten about the operation and they can do most things they could do before the operation. Little niggles can take up to a year to 14 months before they get better.

Total hip replacement is one of the most successful operations that surgeons can do. In fact, 95% of patients are very happy with their joint replacement, compared to 85% of patients having total knee replacement.


What are the possible complications?


Clearly, complications can happen, though they are rare. Around 1% of patients will get some form of a complication. The most common complication is infection, though it is rare as most patients are given antibiotics before and after surgery. Dislocation of the hip and the hip popping off the joint, are other complications, but again, very rare. Damaged nerves and blood vessels, and developing a clot in the leg vein called deep vein thrombosis are other possible risks. Again, the patient will be given medications before, during, and after surgery to stop that from becoming a problem.

Another possible problem is that patients can sometimes get a leg length problem. The operated leg is sometimes a little longer than the other. A shoe raise is then often applied and this will hopefully return the gait to normal.

If you are considering a total hip replacement, you can make an appointment with Mr Constant Busch here.

By Mr Constant Busch
Orthopaedic surgery

Mr Constant Busch is a leading orthopaedic surgeon, specialising in primary hip and knee replacement surgery. His sub-specialty includes hip problems in young people, and revision hip and knee replacement surgery. He is originally from the Netherlands.

Mr Constant Busch has studied and gained experience at the Duke University, USA, Ontario, Canada, and in London, UK. Mr Busch performs over 500 surgical procedures per year, and is known for his personalised treatment of patients, and the use of the latest in implant technology, and rehabilitation processes. He discusses procedure options in depth with patients, ensuring they understand and are in agreement with the proposed treatment. These include non-operative management as well as range of current surgical treatment. Alongside his clinical practice,

Mr Busch has also contributed to numerous peer-reviewed publications in medical journals, along with reviewing articles related with joint replacement for the British Journal of Bone and Joint Surgery.

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