Hip replacement: preparation, the procedure and recovery

Thousands of hip replacements are performed each year in the UK. Leading consultant orthopaedic surgeon and expert in complex hip and knee surgery Mr Nicholas Beattie discusses how patients can prepare for a hip replacement, the different surgical options available, and the recovery period following surgery.

How should patients best prepare for a hip replacement, and is exercise required beforehand?

The best way to prepare for a hip replacement beforehand is to come to the operation as fit and able as you can. It is crucial to maintain a healthy weight and diet, and to perform exercise when possible. Patients with hip arthritis usually find that they are able to perform exercises such as swimming and cycling, whereas long-distance walking or jogging are not possible.

It is also important for patients to prepare mentally before undergoing hip replacement.  They should read about the operation and ensure that they understand it and know what to expect when they come to the hospital.

Furthermore, the evening before surgery, patients should have a good meal, try and sleep well, and ensure that they are rested and relaxed before coming into the hospital. It is also advisable for patients to bring a loved one with them if possible and ensure that they are prepared for the first few days of rehabilitation.

How is a hip replacement performed and where are the different surgical approaches?

The way I think about hip replacement surgery and the way I perform it is minimally invasive, muscle-sparing, and biological. What that means is that when I perform the hip replacement, no muscles are cut during surgery. Two muscles are removed from the bone and are anatomically repaired at the end. This is the minimally invasive posterior approach.

Biological means that I favour uncemented fixation, which is when the implants integrate into the bone and become part of the patient's body, reducing the chances of the implants becoming loose and wearing out prematurely. The hip that I use is also hypoallergenic, which reduces the risk of the body reacting to the hip almost to zero.

The way we do that is by using a highly cross-linked polyethene liner and a ceramic head. Although metal is used to fix the implants of the bone, there is no metal in the articulation, therefore there's no risk of the body reacting poorly to the hip replacement.  

In some elderly patients, I choose to cement their femoral stem because some femurs, especially for those over the age of 70, are more suited for cemented fixation.

How long does the hip replacement procedure take?

The whole procedure typically takes around three hours. This includes the time taken for the patient to be brought to the anaesthetic room, have the spinal anaesthetic, and then be positioned in the operating theatre. The operation itself takes around 45 minutes and is deliberately quick, as we want to have the hip open for the minimum amount of time possible, in order to reduce the risk of infection. We also spend the right amount of time making sure the implants are in an optimal position.

What does the recovery period involve? Will patients need a walker or crutches?

After your hip replacement, you'll be fully weight-bearing and will be able to walk the day following surgery.

On day two, you will be able to climb the stairs, use the bathroom, and walk a straight line. Patients will typically require the use of crutches for the first couple of weeks, at which point the clips come out of the skin. The target for all patients after their physiotherapy and hydrotherapy in the first six weeks is to come back to the six-week check appointment without needing any sticks to walk.

At six weeks post-surgery, patients can begin to drive again and get back to more normality. I recommend that patients wait until 12 weeks after surgery to return to their normal sporting activities such as golf, tennis, or skiing.

Why might revision hip replacement be required?

Revision hip replacement is required because not all hip replacements last forever. For some patients, they are in a situation where their hip replacement was performed a long time ago and the components are worn, provoking pain or problems with the stability of the hip replacement (e.g it's popping out of a joint). The best solution for this is to redo the hip replacements.

We normally do a bone-preserving anatomic reconstruction of the hip in order to allow patients to optimise their function. I have many patients with revision hip replacements who are still taking part in sporting activities, etc.

Alternatively, revision hip replacement may be required because of an infection or a break in the bone around the joint.

If you are considering a hip replacement and would like to book a consultation with Mr Beattie, simply visit his Top Doctors profile today.