Hip Replacement

Post-operative pain is normal after a hip replacement. It can be controlled by many methods, from pain pumps (Patient Controlled Analgesia, PCA) to simple tablets, and usually lessens dramatically after the first 2-3 days. The pain of arthritis usually disappears within a day or two of surgery.

Occasionally, the bladder stops working after a spinal anaesthetic; a catheter may need to be inserted into the bladder for a day or two. Once removed, most people have normal return of bladder function.

Blood tests and X-rays will be taken in the early post-operative period to ensure that blood levels have not substantially changed and that the hip replacement is in a satisfactory position.

The physiotherapists will assist patients in mobilising after the operation and will supervise an exercise programme. It is extremely important that patients follow this exercise programme and take the necessary precautions with their new hip.

Patients can usually return to work after 8-12 weeks although this period may be longer for heavy manual work. By three months most patients can participate in low impact sports such as golf, bowls, cycling and swimming.

The majority of patients undergoing hip replacement do not experience any complications. In fact 95-98% of patients are extremely happy with their hip replacement and report that it has given them back their life. However no operation can guarantee success.

Complications can occur as a result of the anaesthetic, the hip replacement itself or as a general result of having major surgery:

Infection
The risk of infection after hip replacement is about 1%. The majority of infections are superficial and require nothing more than antibiotics. Occasionally, however, further surgery is required to deal with infection, and rarely the hip replacement needs to be removed until the infection is under control.

Antibiotics are used in every hip replacement and the operation is performed under sterile conditions.

Deep vein thrombosis (DVT) and Pulmonary embolus (PE)
Blood clots can form in the veins (DVT), break off and travel around the bloodstream and lodge in the lungs (PE). This can be life threatening, but the risk is very low.

Measures that are taken to reduce the risk of DVT and PE are the use of foot pumps and elastic stockings, blood thinning injections and early mobilisation.

Dislocation
Since an artificial hip joint is not as stable as your own original joint there is a risk that it may dislocate; the risk is approximately 2%. The hip is most unstable during the first 6-12 weeks; after this dislocation is rare.

Leg length inequality
In some cases the leg length must be lengthened in order to stabilise the hip and thereby reduce the risk of dislocation. It is very difficult to ensure a resulting equal leg length during hip replacement surgery, but most patients (80%) do not notice any great difference after their operation. Any minor leg length discrepancy can be treated with a heel raise.

Nerve damage
Occasionally one of the nerves supplying the leg is stretched and does not function properly for a period of time. The most common effect of this is to cause a foot drop. Over 90% of these nerve injuries recover on their own without the need for further surgery.

Wear
95% of modern conventional hip replacements will last for 10-15 years. Technological advances, however, have produced bearing surfaces such as metal-on-metal or ceramic-on-ceramic which can withstand higher activity levels and will probably last much longer.

When the hip replacement wears out, small wear particles are produced which can eventually cause the hip replacement to become loose and painful. In this situation, the hip replacement may need to be revised. (See Revision Hip Replacement)