Hip replacement: when is it necessary?

What are the indications for a hip replacement?

A hip replacement is indicated when pain and limited function are having a significant impact on a person’s quality of life.

There are a number of options prior to surgery, including pain-relieving medications such as:

• paracetamol
• codeine
• ibuprofen
• nutritional supplementations
• physiotherapy
• walking sticks
• lifestyle modifications

When these options no longer control pain or a person finds that their ability to function is significantly restricted, surgery will be indicated.

The most common cause of hip pain is due to osteoarthritis, which occurs when the articular cartilage is worn. In certain cases, this wear can lead to bone loss. As a result, hip replacement surgery is crucial, to prevent further bone loss.

Is there an 'optimum' age for having a hip replacement?

There is no optimum age to have a hip replacement. Younger patients who undergo hip surgery often recover faster, however, there is a possibility that they will require further hip surgery in the future due to wear of the implants.

There is an optimal time to have hip surgery, and the decision to undergo the surgery is a balance between the benefits and risks of surgery.

Although hip replacement is a commonly performed procedure with brilliant success rates, there are occasional complications. As a result, it is advisable to avoid having surgery if symptoms are mild and are not affecting a patient’s quality of life.

Similarly, if patients present to their surgeon late with very limited mobility or significant bone loss they may not fully recover, no matter the expertise of the surgeon and rehabilitation team.

How is a hip replacement performed? Is it painful?

A hip replacement is performed in an operating room with the patient anaesthetised either by a general anaesthetic or spinal anaesthetic. The surgery lasts an hour.

There are several different surgical approaches to the hip, however, I prefer to use the posterior approach. During this approach, the hip is dislocated, the head and neck are removed and the acetabulum of the pelvis is prepared to accept an artificial socket, constructed from either metal and plastic (uncemented fixation) or plastic (cemented fixation).

Following this, the stem is inserted into the canal of the femur (thigh bone) and is fixed with cement or for uncemented stems is press fit. A ceramic or metal ball is inserted onto the stem, the hip is relocated into the socket and the soft tissue is closed. Throughout the operation, the hip is trialled with different-sized components to ensure that the leg length is corrected and the hip is stable to reduce the risk of dislocation.

Pain is well controlled both during and after surgery. Patients are given regular pain medications for the first 2 weeks and additional pain medications are available if required.

What are the possible risks and complications involved?

Unfortunately, as with any surgery, there are some complications associated with hip replacement. Common surgical risks include stiffness and swelling (especially the first 3 months after surgery).

Less common surgical risks are as follows:

• infection
• deep vein thrombosis  (DVT)
• pulmonary embolism (PE)
• dislocation
• significant leg length discrepancy
• loosening
• fracture
• neuro-vascular injury
• long term pain
• requirement for revision surgery

Will a hip replacement eliminate joint pain entirely?

For the majority of patients, their hip replacement eliminates hip joint pain entirely. However, a small number of patients do experience some long-term discomfort, which can be situated around the wound site, around the greater trochanter region (side of the hip) or in the groin or thigh.

If you are considering hip replacement surgery and would like to discuss this in further detail with Mr Veitch, do not hesitate to book an appointment by visiting his Top Doctors profile today.