When to have a hip replacement?
You may need a hip replacement operation if your hip joint is badly damaged by arthritis. This sort of damage is mostly caused by osteoarthritis but it can be due to other causes such as rheumatoid arthritis. Surgery is not needed by everyone with arthritis of the hip joint. Surgery is only recommended when the pain and disability are having really serious effects on your daily activities. Treatment with medication, using a walking stick, physiotherapy etc can be tried before deciding on surgery. The patient needs to feel the need for surgery when medical management is not working.
What can be expected from a hip replacement?
Pain should no longer be a problem. The benefit is obvious immediately after the surgery – less disability with greater mobility and a better quality of life. But it is important to remember that an artificial hip is not as good as a natural hip as it does have some limitations.
What is the new joint?
The hip is a ball-and-socket joint. In arthritis, both the ball and socket are damaged or deformed giving pain on movement due to irregular mating surfaces and also stiffness. So the ball is replaced with a smaller one which is securely fixed to the rest of the femur with cement. A cup is also cemented inside the natural socket into which the newly placed small head sits.
The artificial head is usually made of metal and the socket is usually made of plastic. In younger, more active patients, one part or both parts may be inserted without cement. If cement is not used, the surfaces of the implants are roughened or specially treated to encourage bone to grow onto them. Younger patients may also be given more durable surfaces on the socket (such as ceramic or metal).
What happens after the operation?
After recovering well from anesthesia after the operation patient may be able to take light diet or liquids in the evening. From the second day, patient is helped to start walking, first with a frame and soon with elbow crutches or sticks. How quickly you get back to normal depends on many factors – including your age, your general well-being, the strength of your muscles and the condition of your other joints. But generally, it takes about 6 weeks for you to start walking well. But even at that stage, you may still have to use a crutch for a period of 3 months. One should not try to do too much too soon.
The physiotherapist will help to get the patient moving freely and advise on exercises to strengthen the muscles. The physiotherapist will also tell the “dos and don’ts” after hip replacement surgery. It is very important to follow these rules. Avoid too much bending at the hips (such as squatting, sitting in a low chair, etc.) and never to cross legs are some rules because these positions could dislocate a new hip. Some additional gadgets may be needed (a raised toilet seat, aids to help dress up, putting on socks etc.).
Hospital period & Discharge
Most people can leave the hospital within four to six days. We shall see the patient again after about 10 days for suture removal. The patient may continue physiotherapy at home. When happy with normal walking then start training for climbing stairs.
First three months
Most people are relieved that the pain from arthritis has gone. You may find that you cannot bend your leg upwards as far as you would like – it is important not to test your new joint to see how far it will go. Great care should be taken during the first eight to 12 weeks after the operation.
People can go back to work after four to six weeks, but only if you have a job which does not mean too much moving around. Patients can start driving a car after about 2 months but getting in and out of a car can be difficult – you may need to sit sideways on the seat first and then swing your legs around. A physiotherapist can help on how to do this and other tasks safely.
You must take regular exercise – exercise is good for your mind and body. After all, that is one of the reasons for having the operation. Walking, swimming (but avoid breaststroke) and riding a bicycle is fine. Avoid running, playing squash, competitive tennis, etc., as all of these produce an excessive impact on the new hip joint. If you are unsure about a specific activity, ask your surgeon or physiotherapist.
What are the long-term effects of hip replacement?
Nowadays there are many different types of artificial joints. While some do better than others, many other factors affect the outcome. Over 80% of cemented hips should last for 15 years or more. The newer uncemented hips are being shown to give even better long-term results and hence are being used in young and active middle-aged patients.
Can there be any complications?
Hip replacement is major surgery. Risks vary according to the general health and you should discuss the risks and benefits with the surgeon. After hip replacement, some people suffer from clots which form in the deep veins of the leg. There are various ways to reduce this, including special stockings and different drugs.
There is a more serious complication where some of these clots, particularly those in the thigh veins, can detach and become stuck in the lungs (pulmonary embolism). This is very serious – it may cause sudden breathlessness or collapse, and even sudden death. Fortunately, this complication is rare.
The artificial hip may dislocate. This occurs in less than one in 20 cases and usually needs putting back into place under anesthetic. In most cases, this will make the hip stable, although patients may need to spend some time doing exercises to strengthen their muscles or keeping the joint still in some form of the brace.
To reduce the risk of infection we perform surgery in specially ventilated ‘clean air’ operating theatres. We also use a short course of antibiotics at the time of the operation. Despite this, a deep infection can occur (but only in around one in 200 cases). This is a serious complication. The artificial hip usually has to be removed until the infection clears up. The hip is then re-implanted six to 12 weeks later.
The plastic in the artificial socket may wear over time. The worn particles cause inflammation and this can wear away the bone next to the new hip. To reduce this problem we are using special plastic sockets and ceramic heads, especially in younger patients.
The most common cause of ‘failure’ of hip replacements is when the artificial hip loosens. This can happen at any time but is most common after ten to 15 years. It usually causes pain and your hip may become unstable. When this happens, the old hip joint needs to be removed and a new one inserted again. This type of surgery has made significant advances in recent years. Failed hips can be revised, with over 80% of patients reporting success for between five to ten years. Some revisions may need a bone graft. The hip can be revised almost as often as necessary, although the results are slightly less good each time.