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 be 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

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.

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