What is a total hip replacement?
Hip replacement is a surgical procedure performed to remove the diseased or damaged parts of the hip joint and replace them with new artificial parts, called prosthesis. The aim of a hip replacement is usually to gain pain relief from a diseased arthritic hip, and as a result to improve a person’s quality of life
The hip joint is located where the upper end of the thigh bone meets the hip bone. A ball at the end of the thigh bone fits in a socket in the hip bone to allow a wide range of movement.
Who should have a hip replacement?
If you have hip joint damage or disease with persistent pain symptoms that interfere with your daily activities then you may be a candidate for hip replacement surgery.
Mr Webb will discuss the best options of pain relief for you and if you should consider a hip replacement.
What's involved in a total hip replacement?
A traditional hip replacement usually takes around 60 to 90 minutes to complete. It is usually carried out under a spinal anaesthetic, whereby you are numbed from the waist down. Most people prefer to receive some sedation as well. Alternatively, sometimes a general anaesthetic can be used.
Once you’ve been anaesthetised, Mr Webb will make an incision over the side of your hip to remove and replace the damaged ball and socket with artificial parts.
The prosthesis can be plastic (polyethylene), metal or ceramic, used in different combinations, the commonest including:
• metal-on-plastic (poly)(a metal ball with a plastic socket) is the most widely used and tried and tested combination.
• ceramic-on-plastic (poly) (a ceramic ball with a plastic socket) or ceramic-on-ceramic (ball and socket are ceramic). Both these combinations are often used in younger and more active patients due to their hard wearing nature.
The artificial joint components can be held in place by being:
• cemented – the prosthesis is secured to healthy bone using a special tough cement.
• uncemented – the surfaces of the implants are roughened or specially treated to encourage the existing healthy bone to grow onto them and hold them in place. Bone is a living substance and, as long as it’s strong and healthy, it’ll continue to renew itself over time and provide a long-lasting bond. This method is used especially in younger, more active patients.
Is a total hip replacement a common procedure?
Hip replacement is a very common procedure. In England and Wales there are approximately 160,000 total hip and knee replacement procedures performed each year. Approximately the same number of hip and knee joints are replaced.
Advances in surgical techniques and technologies over the last decades have revolutionised hip replacement surgery to allow more patients to consider treatment sooner and regain a better quality of life.
What conditions may require total hip replacement surgery?
Some common reasons why a hip joint can become damaged include:
• osteoarthritis – known as “wear and tear arthritis”. The cartilage (a tough, flexible tissue that acts as a shock absorber and mould) inside a hip joint becomes worn away and causes the bones to rub against each other. Osteoarthritis is the most common cause of this type of damage².
• rheumatoid arthritis- caused by the immune system. The body mistakenly attacks the lining of the joint whilst trying to defend the body against infection resulting in pain,stiffness and swelling
• hip fracture – a fall or similar accident can severely damage the hip joint so that a replacement is required.
What are the benefits of total hip replacement surgery?
Hip replacement surgery aims to increase your mobility and improve the function of your hip joint to relieve pain and ultimately improve the quality of your life. Many people find that their life is transformed as they regain their mobility and independence without the pain they suffered before their hip replacement.
What are the complications that may occur?
The risk of serious complications during and after hip replacement surgery is low, estimated to be less than 1 in a 100. These include blood clots (deep vein thrombosis and pulmonary embolism) and infection. The most common complication of a hip replacement is that something goes wrong with the joint, which can include:
• loosening of your joint – caused by your prosthesis becoming loose in the hollow of your thigh bone or thinning of your bone around the implant.
• hip dislocation – the ball can become dislodged from the socket if the hip is placed in certain positions.
• wear and tear – particles can wear off your artificial joint surfaces and be absorbed by surrounding tissue and cause loosening of your joint.
Further complications of a hip replacement can include injuries to the blood vessels or nerves, a fracture and differences in leg length, ongoing pain, or future revision surgery. These are only generalised and it is important that you discuss with Mr Webb your own individual risk profile and concerns before you decide on surgery
What are the alternatives to hip replacement?
There are some non-surgical options that can be effective in helping you to avoid or delay hip replacement surgery.
Pain killers, such as paracetamol and ibuprofen, can help control your pain. A walking stick can make walking easier. An exercise program can strengthen the muscles around the hip joint and help to reduce stiffness. A steroid injection into the hip joint can sometimes reduce pain and stiffness. However if your pain worsens and becomes unmanageable then hip replacement surgery may be the best option for you. It sis impoetant to discuss all the options before making a decision on the best way forward for you
How long will my total hip replacement last?
An artificial hip joint is designed to last for at least 15 years. However it could wear out or go wrong in some way before this time and then further surgery is required to repair or replace the joint, known as revision surgery.
Other hip joints can last a lot longer than 15 years. It is estimated that around 1 in 10 people with an artificial hip will require revision surgery at a later date.