When is the best time for hip replacement surgery?
My personal philosophy is the best hip in your body is your own. We should try and do everything we possibly can to exhaust all other options before we start thinking about a hip replacement. The reason for that is, although hip replacements have a very good result and hundreds of thousands of them are frequently done a year, they're obviously not 100 per cent risk free, and there's always risk and complications. They're small, but they do exist, and therefore the timing of a hip replacement is quite important in the sense that we have to make sure it's the right thing for the patient; make sure it's a tailored approach and making sure that we've exhausted all other options before we start thinking about doing surgery.
But once you've made a decision, and we've exhausted all other options i.e.; activity modification, painkillers, injections, then really, we're in the realm of hip replacement surgery. The decision to go down that path, is multifactorial; it's not just on the measures that I've talked about just now, i.e., the conservative measures, but also the age of the patient is important.
Remember, hip replacements are artificial joints made from metal and plastic generally, and therefore they don't last forever; they do have a finite life and therefore you want to try and time the hip replacement so it's one operation that will hopefully last for the rest of your life. Occasionally, you're in situations with people who are relatively young and need hip replacements. It's important that hip replacement does know they are likely to have a further procedure down the line, should the hip replacement wear out at some point in their life.
What are the different types of hip replacement surgery?
The different types of hip replacements are, broadly speaking, cemented or uncemented. That means the components are fixed into place inside the bone with either bone cement, or bone cement isn't used. There's advantages and disadvantages for both. Not every single patient, for example, can have an uncemented replacement; it depends on the strength and thickness of the bone. Where uncemented hip replacements are used, they have a slight advantage in the sense that it's a biological fixation, which means that the implant or the bone grows onto, or into, the implant. That allows a biological fixation that isn't reliant on cement, and again the cement can loosen over time, or it might degrade over time. Whereas with a biological fixation, because it's a bone, the growth is much more likely to be stronger over a period of time.
Going further down the cemented or uncemented path, the next thing is the articulation. And by the articulation, I mean the type of ball and socket. There are different types and the general one that's commonly used is a metal head, i.e., a metal ball and plastic socket. Again, the plastic isn't ordinary plastic but it's medical plastic which is specially formulated to be used in hip replacements. There are different options, so for example there are ceramic heads and cups which may offer an advantage.
How are these procedures performed?
A hip replacement is big procedure. It takes quite a bit of time to get over, but generally patients are brought into hospital on the day of surgery. They usually have a conversation with the anaesthetic doctors and a decision is made as to what type of anaesthetic that's more suitable for them. They can either have a general anaesthetic, i.e., they're completely knocked out, wake up in the recovery room with the operation completed and don't remember anything at all, or the other option is they can have spinal anaesthetic which where everything is numb from the waist down, and they're awake during the operation.
Again, depending on the conversation and plan by the anaesthetist, they may be awake but have some light sedation. They don't have any tubes down their throat, or aren't on a ventilator; they're breathing for themselves. They might be slightly drowsy and may not remember much of the operation, or they may decide to have no sedation and completely awake. I've had that often, where I can talk to the patient throughout the operation, and they can tell me how they're feeling. I can tell them how things are going. Patient choice and anaesthetic choice to a large degree, is a conversation that we always have and we come up with a tailored approach to every single patient.
In terms of the operation, it's done where the patient is positioned on their opposite side, with the hip replacement facing up. There's a small cut usually about 10 to 15 centimetres on the outer aspect of your thigh, following which I would go down to the hip joint, identify it and take the ball part of the hip joint out of the cup part of the hip joint. It will take an artificial socket, and once the socket is in and in the right place, I would then prepare the ball part of the hip replacement; i.e., in the femur bone. I'd put the stem of the ball into the femur bone, and again, I do both cemented and uncemented hip replacements depending on the patient's X-ray and the shape of the bones.
Depending on what type of hip replacement I'm doing, I will then either cement the stem in situ, or put the uncemented stem in. Once we've done that, we'll do some trials to make sure that everything is working, in the right place, and stable. Once everything is in the right place, we know that we've got the right size and shape of implants, then we'll put the real implants in and again reassess, recheck and lastly close everything up and stitch the skin up to give a nice, clean scar which hopefully heals well.
Is hip replacement surgery safe and effective?
Yes, absolutely. Again, there's no surgery that's 100 per cent risk free and there's always going to be risks attached to any procedure. The main risks with a hip replacement are:
- damage to nerves and arteries;
- occasionally hip replacements loosen and need to be redone;
- there's a small risk of the legs being slightly different lengths;
- there's a small risk of dislocation;
- small risks of clots to lungs and legs;
- swelling, and;
- in particular at this moment in time there's always a risk of having any procedure during COVID times.
They all sound very scary but the risks are actually quite small. We're talking about 1 to 2 per cent. But if you're one of the small number of people that do have complications with a hip replacement, then it's obviously quite a major thing. The majority of people do extremely well after their hip replacements, and are very happy with the outcome.
How long does it take to recover from hip replacement surgery?
There's lots of variables involved here. So, patient age and mobility are very important factors, although with co-morbidities the preoperative state is very important. The presence, or if there were any complications during or after the surgery, that can slow down the recovery.
Generally, most people would stay in hospital between one to two days. Most people would need crutches for a few weeks, so 60 to 70 per cent of people that come to see me six weeks after a hip replacement have been off their crutches for quite a while. A significant proportion of them have stopped taking pain killers. So, I'd say that most people would be 60 to 70 per cent recovered by about the six-week mark.
I think for recovery, it usually takes three to six months, but again, the operation even if it's gone completely smoothly with no issues, the important thing after the operation is strengthening physiotherapy and building up muscles. That is crucial, so if people follow all the instructions that's been given to them then around that three-to-six-month mark, they generally feel as though if they've recovered completely.
If you'd like to arrange an appointment with Mr Malik, you can do so via his Top Doctors profile.