Hip Replacement - why and how?

Hip replacement surgery is used as a treatment option for a variety of different conditions including deformity, hip injury, bone tumour, bone loss due to insufficient blood supply (avascular necrosis), and arthritis.  Both rheumatoid arthritis and osteoarthritis can bring about the onset of symptoms but osteoarthritic change is much more common than rheumatoid problems. 

This article on hip replacement surgery is written by Duncan Whitwell, Consultant Orthopaedic and Oncology Surgeon, Knee and Hip Specialist, Oxford.

Hip replacement is usually considered once other therapies including pain medications have failed.  Sometimes by the time a patient sees a consultant however the degenerative changes are too severe to address conservatively. 

The symptoms

The symptoms of osteoarthritis of the hip can present at different times depending on the activities a person is carrying out at any given time. The description of the symptoms in the most general sense is that a person will experience hip pain. This pain often presents as follows:

• Pain resulting in loss of sleep at night

• Slight or no relief of pain when taking medications

• Problems going up and down flights of stairs

• Pain or difficulty when moving between a prone and standing position

• Being unable to participate in leisure activities due to hip pain

When these kind of symptoms become limiting on mobility and activities of daily living, primary care practitioners (or General Practitioners) will make a referral to an orthopaedic specialist.  The specialist, a consultant hip surgeon, will examine the hip, its movement and the strength of the muscles around the hip.  An x-ray will be necessary to show the surgeon the extent of the osteoarthritic change. 

Treatment - surgery

Before a patient is admitted for hip replacement they will be asked to make a visit for a pre-operative assessment.  This is a thorough examination and education process during which routine tests are carried out.  It is a very good opportunity for patients or their relatives to ask any questions to address their concerns about operation or preparing for it. 

The hip replacement operation itself at the most basic level involves replacing the ball at the end of the femur and fitting a new lining to the socket. 

The operation normally takes around two hours and is performed under anaesthetic.  It is possible to use either regional or general anaesthetic, the latter being used in most instances.  Working around the muscles and healthy tissue the ball and socket are separated and the diseased bone and tissue is removed from the socket allowing a new liner to be pressed into place. 

Once the diseased femoral head is removed the thighbone is partially hollowed out and a metal stem is inserted at the end of which a new ball is affixed.  Sometimes the surgeon may use ceramic femoral heads and or socket lining instead of high density polymer and metal. 

After surgery

A patient will normally stay in hospital for three to four days following a hip replacement.  With minimally invasive advances in surgical techniques it is even possible to sit up and walk short distances with the aid of crutches or a walker only hours after surgery.  Nurses and physiotherapists will spend the most time with each patient and determine the most appropriate mobilisation programme tailored to each individual. 

The exercises learned while in hospital will be a very important part of the long term success of the hip replacement and should be continued as a part of a daily routine as prescribed by the physiotherapists while in hospital.

Normally a patient will be asked to attend a follow up six to eight weeks after leaving hospital to see their consultant surgeon who will review progress and, if appropriate, make recommendations or adjustments to a patient’s activities at that time. 

Profile of the author

Mr Duncan Whitwell is a specialist in knee and hip surgery especially hip and knee arthroscopy, knee replacement, hip replacement and resurfacing arthroplasty, complex reconstructive surgery, revision hip and knee surgery, sports injuries and the treatment of orthopaedic oncology and bone and soft tissue tumours. Mr Duncan Whitwell is a Consultant Orthopaedic Surgeon at the Nuffield Orthopaedic Centre NHS Trust, Oxford. He also undertakes NHS clinics in Bristol, Abingdon and Newbury. He regularly lectures on hip and knee surgery at international meetings and is a European surgical demonstrator on the hip resurfacing arthroplasty. Most of Mr Whitwell’s private treatment is carried out at the Oxford Clinic for Specialist Surgery. 

View more information about the Oxford Clinic for Specialist Surgery

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