An in-depth guide to total hip replacements

Total hip replacement is a major surgery that can offer life-changing improvements in mobility and pain relief for many patients. In his latest article, renowned consultant orthopaedic surgeon Mr Mark Webb explains in detail everything you need to know regarding the procedure. 

 

What is a total hip replacement?

In a total hip replacement, the ball and socket of the hip joint are surgically removed and swapped out for an artificial joint. The goal is to relieve pain, which will enhance function.

 

When is a hip replacement performed?

The vast majority of hip replacements are done to treat an injured or painful joint. This typically results from osteoarthritis and can be a natural aspect of ageing. Hip joints can deteriorate and become painful at any age, but in younger individuals, this is typically caused by other factors including an abnormally shaped hip joint, fractures, or hip issues from childhood.

Common signs and symptoms

Patients frequently present with the following reports:

• A limp

• Groin and/or buttock pain

• Stiffness

 

Since some patients also present with knee and back pain, diagnosing hip pain can be challenging.

How do I know if a total hip replacement may work for me?

You will be questioned specifically about your symptoms, employment, hobbies, and prior medical history. Additionally, if you smoke, you will be questioned if you have any issues with healing or infection. A physical examination will also be necessary. To evaluate the severity of degenerative changes within the hip, X-rays are useful.

To evaluate the level of wear and tear, an MRI scan can be useful but is typically not required.

If a hip replacement is still a viable choice for treatment, a specialized CT scan will be carried out to enable precise virtual 3D patient planning and to help decide the best possible location for the hip replacement, given the patient's anatomy.

 

What are the treatment options?

Treatment options depend on several different factors:

Non-surgical treatment:

Before visiting their doctor, the majority of patients would have tried a variety of treatments.

• Physiotherapy –an effective rehabilitation program helps many patients with their symptoms.
• Pain relievers – There are several different painkillers that can keep a person active and prevent surgery.
• Injections– In the past, surgery could be postponed by administering steroid and local anaesthetic injections. Today, a variety of various injections are available that can significantly reduce people's discomfort.

 

Surgical treatment:

The purpose of surgery is to remove the painful, damaged joint. The vast majority of patients who undergo hip replacements are satisfied with the outcome, making this procedure exceedingly successful.

 

How to decide on treatment?

Before deciding on your treatment, the following elements should be taken into consideration:

• How long you’ve experienced symptoms;
• The effect the pain has on your daily activities and quality of life
• Does the pain keep you up at night?
• What medical procedures have already been tried?
• Other health issues
• Expectations, smoking status, etc.

 

How is the procedure planned?

The treatment can be planned and carried out using virtual reality software. Once the ideal position for the hip replacement has been established, adjustments are made to a patient-specific virtual 3D model, and a customized surgical plan is created with the goal of minimizing risk and maximizing function. Normally, this procedure takes six weeks.

 

What does the surgery involve?

To replace a hip, a surgical incision is made over the hip's outer surface. Following a hip dislocation, the new hip is then prepped for insertion by removing the old hip's ball and socket.

A replacement cup is physically bonded to your bone (uncemented). The next step involves inserting a liner, which is either composed of ceramic or durable plastic. The femur, which is the bone in the thigh, is then prepped to accept a metal stem. Depending on a number of variables, including age, gender, and the bone's strength, this can either be uncemented or cemented.

The hip is then put back in its proper position after a ceramic ball is fitted to the stem's top.

 

Does the surgery come with any risks?

It is crucial to talk about the dangers so that you can decide if surgery is the best option for you. The following are some specific dangers of having a hip replacement:

• Infection — There is a lower than 1 in 100–200 case risk of infection. At the beginning of the anesthetic, antibiotics are frequently administered.
• Blood clots - The likelihood of forming a blood clot is one in one hundred. Deep vein thrombosis (DVT) and pulmonary embolism (PE) are clots that originate in the leg. A blood thinner will be provided in an effort to lessen this risk.
• Pain – The majority of patients endure pain after surgery.
• Stiffness – Feeling stiff after the operation is typical. It's crucial to adhere to a recovery program.
• Nerves/blood vessels – The area where the procedure is conducted is adjacent to certain sizable blood vessels and nerves.
• Fracture – There is a chance that the bone surrounding the hip joint will shatter. Fixation will be tried if this happens while the procedure is being performed.
• Dislocation – Because a hip replacement is less stable than a natural hip, the hip may dislocate under certain conditions or after an injury.
• Change in leg length – A hip replacement frequently results in a change in leg length. Most changes are imperceptible. Planning beforehand can assist to lower this danger.

 

What happens before surgery?

Consent:

It's critical that you comprehend both the advantages and potential risks of surgery. You'll get the chance to discuss these with Mr. Webb. You will receive an electronic permission document outlining the hazards in full prior to the treatment.

Prehabilitation:

It is advised that you start a physiotherapy programme.

The aims of prehabilitation are to:

• Improve range of movement
• Increase muscle strength and control
• Practice using crutches

 

What happens on the day of surgery?

When you arrive at the hospital, a nurse will help you prepare for the surgery. You will meet with the anaesthetist to go over the type of anaesthesia and the postoperative pain management strategy. Mr. Webb will go over the specifics of the surgery with you, respond to any last-minute inquiries, and mark your leg for the surgery.

Normally, the operation takes between one and two hours. You will proceed to the ward once you have recovered from the anaesthetic.

 

What happens after surgery?

Following this kind of surgery, discomfort and swelling are typical. To help minimize the swelling, cold therapy equipment is available. Within the first week after surgery, it's a good idea to visit your physical therapist.

When you are resting, use ice or cold therapy and keep the leg elevated. You will have to keep the sticky dressings on until your two-week review. If you were not x-rayed immediately after the operation, x-rays will be taken during this review. A six-week review will also be organised.

 

Mr Mark Webb is leading consultant orthopaedic surgeon with over 15 years of experience. If you would like to book a consultation with Mr Webb you can do so today via his Top Doctors profile.