Hip Replacement Surgery

The Anaesthetic
There are different types of anaesthetic that can be used. The three main ones are general anaesthesia, spinal and epidural anaesthesia. An anaesthetist will discuss the advantages and possible disadvantages of each type of anaesthetic with you prior to surgery.

The Operation
A single 6 inch incision is made along the outer hip and thigh. The muscles are then split to expose the hip joint. The damaged bone and cartilage are removed, and replaced with a prosthetic femoral head (ball) and acetabulum (socket) with prosthetic parts made of specialized types of metal and plastic. The type of prosthesis depends upon the needs of the particular patient.

The hip replacement may be cemented (in which the prosthetic parts are fastened to healthy bone with a special cement) or uncemented (in which the prosthetic parts have a porous surface that allows the patient's bone to hold the new parts in place). The type of prosthesis used will be discussed prior to surgery. All prosthesis I use are well established with a good track record of success.

I personally do not carry out the Resurfacing replacements. If you are deemed to be a suitable candidate, I will refer you to one of my colleagues who carry out this procedure.

After Surgery
Management - Postoperative management includes controlling pain with intravenous or oral medication. Patients are also given an antibiotic (generally for 24 hours following surgery) to prevent infection.
An anticoagulant medication such as low molecular weight heparin will be given to help prevent blood clots in the legs. Compression support stockings are often used to prevent  blood clots. The support stockings are usually worn for several weeks following surgery. On disharge home you may be asked to take Aspirin for a few weeks to help decrease the risk of blood clots.
Most patients are able to try standing and walking, with the help of a physiotherapist, as early one day after the procedure.

Rehabilitation — Physical therapy is an important part of the recovery process. Most patients spend four to seven days in the hospital, during which they work with a physiotherapist to develop an exercise and rehabilitation program. The rehabilitation program generally includes exercises to improve range of motion and strengthen the muscles surrounding the hip joint, as well as training in activities of daily life (eg, stair climbing, bending, walking). Patients can usually resume their normal activities within three to six months.
The goal of the rehabilitation period is to regain strength and motion; it is important to avoid overworking or straining the joint during this recovery period. While high-impact sports such as running or contact sports should be avoided, patients can typically participate in activities like walking, cycling, and swimming.
Most hip replacements last 10 to 15 years or longer, and patients are generally very satisfied with the outcome.

Complications
Serious complications after hip replacement surgery are not common. 90-95% of replacement operations are successful. Complications can occur during surgery, in the immediate postoperative period, or many years after surgery. It is important to understand these potential risks before deciding to undergo hip replacement. For most patients, the benefits of reduced pain and improved function outweigh the small risk of complications.

Complications during surgery
Very rarely, complications can occur during the actual hip replacement procedure. These include fractures (typically of the femur), injury to the surrounding nerves or blood vessels, and a drop in blood pressure during the insertion of a cemented prosthetic femoral head. Most of these complications can be treated during the course of the surgery.

Thromboembolism
People undergoing hip replacement are at increased risk for developing blood clots after surgery. With appropriate preventive treatments (eg, anticoagulation, compression devices), the risk is minimized as much as possible. Clots affect the legs most commonly, but can affect the lungs on rare occasions (Pulmonary embolism).

Infection
Infection following hip replacement is uncommon (less than 1% of patients). Numerous measures are taken to keep the infection rate as low as possible. Prompt medical attention is needed if these problems develop. Superficial infection can be successfully treated with antibiotics. Deep infection around the prosthesis is far more serious and will require further surgery.

Dislocation
Dislocation of the artificial hip joint can occur if the ball becomes dislodged from the socket. It occurs in less than 2 percent of patients. You will be advised about measures you can take to reduce the risk of this.

Periprosthetic fracture
A periprosthetic fracture is a fracture that occurs in a bone near the implant. This occurs in less than 1 percent of hip replacement patients. This type of fracture may be treated nonsurgically (in less severe cases) or surgically (if the fracture is unstable or the prosthesis has failed).

Leg length discrepancy
Before, during, and after hip replacement surgery, I will measure the length of your legs in an attempt to make them equal length. However, in rare cases, the procedure results in one leg being slightly longer than the other.

Aseptic loosening
Loosening of the joint implant is most often caused by wear of the prosthetic components. Loosening is often painful and is the most common long-term problem associated with total hip replacement, although the incidence is decreasing as improvements in prostheses are made.