Hip Replacement Surgery

Hip joints undergo degeneration (wear and tear) with increasing age. This is called osteoarthritis. Thereby the cartilage becomes thin and worn with exposure of underlying bone. Bone on bone contact causes pain and stiffness especially with activities. Prior trauma, infection or inflammatory diseases lead to early osteoarthritis even in younger patients.

When the pain interferes with the patient’s walking ability, work or everyday activities there is a need for intervention. Short term relief can be established with medication but most patients will eventually need surgery in the form of a hip replacement.

During a total hip replacement the old arthritic femoral head (ball) is removed and replaced with a stem with metal or ceramic head. The socket or acetabulum is also replaced with polyethylene or ceramic lining. Most hips can be inserted cementless but in older patient cement fixation of the prosthesis is still done.

Pre-Operative

The worst complication in replacement surgery is infection, either early or late. Fortunately the incidence is rare (<1% worldwide) but numerous test are performed pre-operative to identify any infective focus so that it can be treated. Blood thinning drugs such as Disprin/Ecotrin needs to stopped 3-5 days before surgery. Ask your surgeon if unsure about this. Patients are admitted on morning of surgery but sometimes also the previous day.

Post-Operative

Post-operatively patients stay in hospital for 3-4 days until they can walk comfortably. Sometimes it may include 1 night’s stay in High Care. Mobilization starts on the same day or sometimes day 1 and includes support with crutches or walking frame for 4-6 weeks. A Physiotherapist will help with the mobilization. Drainage tubes will be removed on day 1 and the intravenous access stopped on day 1-2. The wound is sutured with dissolvable stitches. It is advised to rather shower than bath for the first 4-6 weeks after operation The patient can drive their car after 6 weeks. Contact your surgeon if the wound starts draining or get more sore post-operative. Patients are followed at 2 and 6 weeks post-operative and then 6-12 monthly.

Further information

There is a higher probability for blood clot formation (DVT) for 6 weeks post-operative. DVT will cause severe swelling and pain which will not subside with elevation or medication. Prophylactic therapy includes early mobilization, DVT stockings 4-6 weeks, Clexane injections in hospital and Pradaxa/Xarelto tablets 3-4 weeks after discharge.

There is danger of dislocation of the hip prosthesis especially in first 6 weeks:

Physiotherapist will show how to walk, bend and sit.

You may not sit on low chair/toilet seat. A raised toilet seat is advised.

Sleep on back or with cushion between knees.

Shower rather than bath.

No self-driving of car before 6 weeks.

After 6 weeks the danger of dislocation is less but patients should always be aware of the risk.

There is a change of leg length discrepancy post-operative, especially if severe pre-operative. Most discrepancies are well tolerated with shoe insets but rarely surgery is indicated.

Antibiotic prophylaxis needs to be taken before future surgery, especially dental or urogenital work. This entail 1 dose 1 hour before procedure, e.g. Augmentin 1 g or Clindamycin 300mg for Penicillin allergy. Contact your surgeon beforehand.

There will be improvement of function after hip replacement for 12 – 18 months. The life span of the prosthesis is on average 20 years and it will provide a painless functional joint with which the patient can walk comfortably and resume their activities. They can even participate in low demand sport such as golf, doubles tennis, swimming, bowls and cycling.