Your hip replacement
Information about your planned total hip replacement at the John Charnley Wing, Wrightington Hospital. Please read it carefully and use it as a starting point for discussion with me and the healthcare team.
A total hip replacement is a very common and successful operation to replace a damaged hip joint with an artificial one (a prosthesis).
Why is a hip replacement recommended?
The most common reason is severe osteoarthritis, where the smooth cartilage covering the ball and socket has worn away, so the bone surfaces rub together. This leads to:
- persistent pain;
- stiffness;
- reduced mobility and difficulty walking.
A hip replacement may also be recommended for other conditions such as rheumatoid arthritis, a severe hip fracture, or avascular necrosis. The decision to have a hip replacement is made when non-surgical treatments are no longer controlling your pain or giving you the quality of life you want.
What implants will be used?
Implants are selected using the most up-to-date evidence to reduce the overall risk of needing a further major operation, so that the likelihood of a smooth recovery and uninterrupted function of your hip is maximised.
The choice depends on your personal attributes, your X-rays and sometimes findings on the day of surgery. If you would like to discuss this, please get in touch, or read how I work.
Before your surgery
| Pre-operative assessment | You will attend a clinic for tests (blood tests, ECG, X-rays) and a health check to ensure you are fit for surgery. |
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| Medication and fasting | Specific advice about fasting times and which medications to stop or continue will be given to you by the Pre-Operative Assessment Team. Please follow their instructions exactly. |
On the day of surgery
| Admission | You will be admitted directly to the John Charnley Wing on the morning of your surgery. |
|---|---|
| Nursing admission | The nursing team will complete your admission paperwork, check your observations and prepare you for theatre. |
| Anaesthetic and consent | The anaesthetist will assess you and discuss the best anaesthetic plan. Most patients have a spinal anaesthetic, which numbs the lower body, but the final decision is made after discussion with you. You will also sign the final consent form for the surgery. |
| Surgery | The operation normally takes under one hour. The worn joint is replaced with an artificial one (prosthesis) to relieve your pain. |
After the operation: enhanced recovery
Our goal is to get you moving safely and home within 24 hours of surgery.
| Mobility | You will be encouraged to walk on the day of surgery. The aim is to return to safe, independent mobility as quickly as possible. After a Röttinger approach I do not usually ask you to follow hip precautions. If I use a different approach, or your operation is a revision, I will tell you what to avoid. |
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| Physiotherapy | The physiotherapists will help you walk safely before you go home. Crutches or sticks can be used and put aside as your pain and mobility improve; this can take days or weeks, depending on your own speed of recovery. |
| Rehabilitation | Choose a physiotherapist you get on well with and enjoy working with: that matters a great deal for a good rehabilitation programme and for staying motivated. Find someone convenient for you, near where you live: it makes it much easier to stick with your exercises. Physiotherapy after your operation is not included in the price of your surgery. |
| Before you go home | The nursing and therapy teams will carry out a full safety and function assessment. |
Risks and complications
All major surgery carries risks. I will discuss these with you in detail, but the main risks of hip replacement include:
| Complication | Approximate risk | Management |
|---|---|---|
| Blood clots (DVT/PE) | About 2 to 3 in 100 within 90 days, mostly clots below the knee | Prevented with blood-thinning medication and early walking. |
| Infection | Low (about 1 in 100) | Prevented with antibiotics and sterile techniques. |
| Dislocation | About 1 in 30 within two years, including dislocations put back without surgery | The ball comes out of the socket; implant choice and position are planned to reduce this risk. |
| Leg length difference | Uncommon | Planned for before surgery; small differences are common and usually not noticed. |
| Fracture around the implant | About 1 in 100 in the first ten years; higher if you are over 70, have weaker bone, or have your replacement after a hip fracture | Can happen during the operation or after a fall; may need further surgery. I choose the stem to lower this risk, and will give you your own figure at your consultation. |
| Nerve or blood vessel injury | Rare | Can lead to weakness or numbness in the leg or foot. |
| Heart attack | About 1 in 200 in the first six weeks | Your anaesthetist and I check your fitness beforehand. |
| Stroke | Rare: about 1 in 1,000 within 30 days | Your anaesthetist and I check your fitness beforehand. |
| Death | About 1 in 220 within 90 days | Higher in older people and those with other serious illnesses. Your anaesthetist and I check your fitness beforehand. |
| Ongoing pain or stiffness | Studies report long-term pain in between about 1 in 14 and 1 in 4 people | Some people still have some pain or are not fully satisfied with their hip, even when the operation has gone well. |
| Implant wear or loosening | Long term | The prosthesis may eventually wear or loosen, sometimes needing further surgery (revision) after many years. |
This leaflet does not list every risk. I will go through the risks that matter for you before you decide, and you will have time to think before you sign.
Life after your hip replacement
| Normal activities | You can return to normal daily activities as soon as you feel able and comfortable. |
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| Driving | Only drive when: 1. you are not taking strong pain-relieving medication; 2. you are not distracted by pain or discomfort; 3. you feel safe and confident enough to perform an emergency stop. This is normally between 2 and 6 weeks after surgery. Check with your insurer before you drive again; some policies set their own rules. |
| Follow-up | After private surgery I check your recovery with a short questionnaire at about six weeks. I will see you in clinic if the answers suggest you need it, or if you would like a visit. Tell Michelle if you would prefer to be seen. |
| Long-term care | If you have any problems in future, contact Michelle (private) or the Arthroplasty Practitioner Service. |
If you have any further questions, please do not hesitate to discuss them with me or any member of the healthcare team in the John Charnley Wing. See when to get in touch and the contact page.