Insights into Hip Replacement Surgery: Procedure, recovery, and potential complications

In his latest online article, Mr Simon Hoskinson gives us his insights into hip replacement surgery. He explains how it is performed, when surgery is recommended, the ideal candidate, what to expect after surgery, recovery and the risks and complications.

How exactly is a hip replacement performed?

The entire process of undergoing a hip replacement extends well beyond the actual surgical procedure. It entails a sequence of steps, starting with consultations and examinations by your surgeon. A comprehensive discussion takes place to determine whether hip replacement is suitable and advisable for your condition. Once this decision is reached, you proceed to the pre-assessment clinics of the chosen hospital where your surgery will occur. Here, they ensure your overall fitness, striving to optimise your health before the operation. This meticulous preparation is geared towards enhancing the safety and success of the impending surgery.

Later, your next interaction is on the day of admission to the hospital for the surgery. You meet with your surgeon and anaesthetist, addressing any remaining queries you may have. Following these discussions, the surgery commences. You're brought to the operating theatre, entering the anaesthetic room where the anaesthetist administers the anaesthetic. Once this step is completed, the surgical team takes charge, ensuring your positioning for the procedure is secure and stable. Typically, for hip replacement, the patient lies on their side. The surgical area is sterilised, and sterile drapes are placed around the hip. The actual surgery begins with an incision made in the hip region, using a scalpel. Careful dissection leads to access to the arthritic hip joint, which is then dislocated. This action exposes the hip socket, which is prepared to receive an artificial implant. Once secured, attention shifts to the upper portion of the thigh bone, where shaping is performed to accommodate the new metal implant. A simulated version of the actual implant, is temporarily inserted, and the hip is reinstated into its joint. Rigorous assessments are conducted to confirm stability and proper leg lengths.

Upon satisfaction, the final implants are introduced. These are either wedged and secured without cement or affixed with cemented implants, where bone cement is used to ensure fixation. Once the implants are securely in place and deemed satisfactory, the joint is meticulously reassembled. The layers of muscles, fascia, and skin are methodically sutured, with the sutures ranging from deep to the skin's surface. A dressing is applied to the wound. Following the surgery, the patient progresses to the anaesthetic room to begin the recovery phase.

When is this surgery recommended?

Hip replacement surgery is typically advised for patients who generally experience discomfort due to arthritic hip joints, leading to difficulties in everyday activities and functional constraints such as the ability to put on footwear or socks. Persistent pain, unresponsive to basic painkillers, is also a common example for this procedure. There are other conditions that necessitate hip replacement, including those affecting the blood supply to the hip joint, and specific instances of fractured hips.

However, predominantly, the surgery is recommended for individuals dealing with arthritic hip pain who have attempted non-surgical approaches such as pain medications and lifestyle adjustments like using walking aids or managing weight. When these non-surgical interventions prove ineffective, the next course of action, if suitable, is hip replacement.

Who is the ideal candidate for a hip replacement?

The ideal candidate for hip replacement is a dedicated and cooperative patient who has been coping with hip arthritis over an extended period. They should have diligently explored various non-surgical avenues such as pain relief medications, physiotherapy, walking aids, and lifestyle adjustments. When these simpler approaches no longer yield positive results, it could be appropriate to contemplate the option of undergoing a hip replacement procedure.

What can patients expect after surgery? What is recovery time like?

Following a hip replacement, the initial relief from the arthritic-type pain occurs swiftly. However, this is exchanged for post-operative discomfort, which necessitates the use of pain relief medication for a brief period. This discomfort gradually diminishes over the course of the first three to six weeks. During the initial fortnight, it is crucial to maintain the wound's dryness and retain the dressing in place. Subsequently, the wound heals by the end of two weeks, allowing the removal of the dressing. In the immediate aftermath of the procedure, patients typically require the support of two crutches or walking sticks to ensure safety and stability while walking. This precaution is due to the initial weakness and pain felt in the hip. As walking ability improves, patients can transition to using a single stick or crutch. Around the six-week mark, most patients discard their walking aids altogether and begin walking more naturally. Some discomfort around the hip region is normal for three to six months, but, generally, patients experience significant improvement compared to their pre-surgery state.

Primarily, a majority of patients express satisfaction with the outcomes of their hip replacements. More than 90% of patients encounter no complications. However, a minority does experience issues, either in the perioperative phase or postoperatively. Numerous measures are undertaken to minimise the risks of complications, although complete elimination of these risks is unfeasible. Notable complications encompass challenges such as infection, which can prove intricate to manage. Another concern involves blood clots in the legs potentially migrating to the lungs. To mitigate this, patients receive mild blood-thinning medication for around a month after the procedure, alongside antibiotics during the surgery. It's noteworthy that during hip replacement surgery, there exists the potential to alter leg length. Although our goal is to achieve symmetry, variations in leg lengths may arise in specific scenarios. Most patients swiftly adapt to this new norm, while some may encounter difficulties stemming from leg length disparities.

What are the main potential post-surgical complications?

The artificial hip may experience dislocation, although this is a rare occurrence. If it does transpire, it could result from a fall, twist, or accident. In such instances, the hip can be readjusted back into its correct position, and the expectation is to avoid a recurrence. Should a patient encounter multiple instances of hip dislocation, additional surgery may become necessary. A minor risk applies to bone fractures, which could manifest either during the procedure or in later years for patients with hip replacements. Such fractures could necessitate further surgical intervention. Over time, hip replacements can undergo wear and tear, potentially leading to implant instability, which may require revision surgery. Nonetheless, the overall message remains that a majority of patients find satisfaction with their hip replacements.

Mr Simon Hoskinson is a highly regarded orthopaedic surgeon with over 20 years of experience. You can book an appointment with Mr Hoskinson on his Top Doctors profile.