What is it

• Hip replacement surgery (sometimes called total hip replacement) involves replacing damaged parts of your hip joint with metal, plastic or ceramic parts.
• It’s most commonly used to treat pain and stiffness in the hip joint caused by osteoarthritis.
• It may be recommended if other treatments or lifestyle changes have not worked and hip pain and loss of movement is affecting your daily life.
• You’ll have the operation in hospital. It can take several months to recover from surgery.
• A hip replacement can last for at least 15 years and can significantly improve daily life for people with hip pain and stiffness.

Why it's done

A hip replacement may be recommended if hip pain and stiffness is having a big effect on your life and other treatments have not worked.

The most common reason you might have a hip replacement is because of problems caused by osteoarthritis. This is a condition that causes joints to become painful and stiff.

Other conditions that can also be treated with a hip replacement include:

• rheumatoid arthritis – a condition where the immune system causes joint damage, pain and stiffness
• pain and stiffness caused by damage to the hip after a fall, injury or accident

The hip usually moves smoothly because the ends of the bones are covered with a layer of tough tissue called cartilage. If the cartilage is worn away or damaged by an injury, the bones rub against each other, making your joint painful and stiff.

During a hip replacement, the damaged parts of your hip are replaced with metal, ceramic and plastic parts.

Hip replacements are usually very successful and most people will have less pain and better movement.

Alternatives

There are other treatments you can try first before having a hip replacement.

Treatments that may be tried first

Before having a hip replacement, your GP or doctor will talk to you about non-surgical treatments to help with your hip pain and stiffness.

These may include lifestyle changes and some types of pain relief, such as:

• weight loss to reduce the strain on your hip if you’re overweight (find out about managing your weight)
• low-impact exercise such as swimming, walking or cycling, and muscle strengthening in the hips – a physiotherapist may advise and support you with exercising
• using walking aids
• wearing special footwear or insoles for your shoes
• pain relief medicines, gels or creams
• hydrocortisone (steroid) injections – an injection into the hip joint to help with pain and swelling

If you’ve tried these and they have not helped, your doctor may talk to you about having a hip replacement.

Preparation

Before your hip replacement, your doctor will talk to you about the things you can do to prepare.

This might include advice on:

• muscle strengthening exercises to do before and after the surgery that will help with your recovery
• losing weight if you are overweight
• stopping smoking
• having a healthy diet and sticking to the recommended weekly limits on alcohol units

It’s important to do these things while you wait for a hip replacement because waiting lists can be long. This is because these things may lower your risks of complications and speed your recovery time.

Pre-admission clinic

You will probably be asked to go to a pre-admission clinic a few weeks before the operation. This is to make sure you’re well enough for surgery to go ahead.

You may need to have a blood test, X-rays, a urine (pee) test to check for infections, or an electrocardiogram (ECG) to check your heart health.

You may also meet the team involved in your care so you can learn more about the operation and recovery afterwards, and ask any questions you might have.

Prepare for recovering at home

It’s a good idea to prepare for when you get home after your operation.

You might want to think about:

• asking for any help you might need at home with day-to-day activities
• making sure things you use often are easy to reach
• stocking your freezer with cooked meals
• arranging transport, as you’ll be unable to drive for at least 6 weeks after the operation
• speaking to your employer and making a plan for returning to work if you need to
• borrowing, hiring or buying any equipment that you may find very useful, such as a raised toilet seat or a hand-held "grabber" that helps you pick up objects

Your care team should be able to provide more advice on where to get equipment you may find useful.

How it's done

If you’re having a hip replacement, you’ll usually go into hospital on the day of the operation.

You’ll either have a local anaesthetic in your spine (you’re awake but will have no feeling from the waist down), or a general anaesthetic (you’re asleep during the operation).

If you have a local anaesthetic, you may also be offered a sedative to help you feel relaxed and sleepy.

The operation usually takes about 1 to 2 hours. The type of surgery you have depends on things like how damaged your hip is, what caused the damage and your general health.

Some hip replacement operations are carried out using what is known as a minimally invasive approach. This means the surgeon will only make small cuts.

A minimally invasive approach is not suitable for everybody. Your doctor will discuss what type of operation is best for you.

Total hip replacement

A total hip replacement is the most common type of hip replacement. This is where the "ball" of the hip joint (the top end of the thigh bone) and the "socket" (the connected section of hip in your pelvis) are replaced with metal, ceramic or plastic parts.

The main steps of total hip replacement surgery are:

1. The surgeon makes a cut, or a number of cuts, in the back or side of your hip .
2. The damaged hip joint is taken apart.
3. The top end of the thigh bone (ball joint) is cut off and removed.
4. A new metal (or sometimes ceramic) ball is fitted to the end of the thigh bone.
5. The hip socket is drilled out and a new plastic (or sometimes ceramic) socket is fitted.
6. The new hip is put back together.
7. The surgeon closes the cut or cuts using stitches or clips and covers it with a dressing and bandage.
8. You’ll be taken to a recovery room so you can fully recover from the anaesthetic. You may be given medicines to help with any pain you have.

Partial hip replacement

A partial hip replacement involves only removing the "ball" of the joint (the top of the thigh bone) and leaving the "socket" (the connected section of hip in your pelvis) in place.

This usually has a faster recovery time than a total hip replacement. But it does not usually last as long.

You may be offered a partial hip replacement if :

• you are in poor health or are frail
• you've had a serious hip injury

Hip resurfacing

Hip resurfacing involves removing the surface of the "ball" of the joint (the top of the thigh bone) and putting a metal cover over it, rather than removing the whole joint.

Hip resurfacing does not work well for people with weaker bones. You may be offered it if you're aged around 50 or younger.

National Joint Registry

After surgery, you’ll be asked if you consent to giving your personal details and details of your hip replacement to the National Joint Registry (NJR).

The NJR collects and monitors details of hip replacements to help improve patient safety, experience and outcomes.

Recovery

It may take several months to recover from a hip replacement. This can vary depending on your age and general health.

It's important to follow the advice you have been given on looking after your hip to have a good recovery.

Recovering in hospital

After surgery, you’ll spend some time in a recovery room where you may be given medicines to help with the pain.

You’ll continue to have painkillers in the days after the operation as your hip will be sore. You may also have a tube in your hip to drain away any fluids.

You'll have help from nurses and physiotherapists to start walking as soon as possible after the operation so you can go home as soon as possible. You'll need crutches or a walking frame at first.

Recovering at home

You can usually go home if your wound is healing well and you can safely get around.

If you are generally fit and the surgery went well then you can usually go home around 1 to 3 days after the operation.

Before you go home a physiotherapist or occupational therapist will talk to you about managing daily activities and home exercise programmes.

Following the exercises early on in your recovery will help with the long-term strength and movement in your hip.

You'll probably have some pain and swelling in your legs and feet. These symptoms usually get better in a few weeks. You'll usually be given painkillers to help manage the pain.

A nurse will take out your stiches or clips after about 10 days. You'll also have a follow-up appointment around 6 to 12 weeks after your surgery to check how you are recovering.

Do

• regularly walk every day as far as it is comfortable – talk to your physiotherapist if you have any problems
• follow the exercises your physiotherapist has recommended
• wait at least 6 weeks to drive (check with your doctor that you’re fit to drive)
• try to avoid sex for 6 to 8 weeks after you operation
• return to work when you feel ready – this usually takes about 6 weeks, but will depend on the type of work you do
• sit in a reclining position, but also try to avoid sitting still for long periods of time – this will help with swelling

Don’t

• do not sit with your legs crossed
• do not bend your hip more than 90 degrees (a right angle)
• do not bend down to touch your feet or ankles
• do not sit down in a low chair or toilet seat, or a chair without arms, as you will have problems pulling yourself up again (raised toilet seats are available)
• do not do exercises involving jumping, sudden turns, or where there is a high risk of falling while your hip is recovering
• do not lift or move heavy objects until you're told it's safe for you to do so

Complications

Possible complications of a hip replacement

A hip replacement is a common and safe procedure. However, as with any type of surgery there are risks. Your doctor will explain these to you.

Blood clots or DVT (deep vein thrombosis)

Blood clots or DVT (deep vein thrombosis) are possible after a hip replacement because of how the blood flows and clots after surgery.

If you have a blood clot that causes pain or swelling, your doctor can give you anticoagulant medicines to help.

A blood clot that forms in the leg can sometimes travel to your lungs (pulmonary embolism). This can cause serious complications.

To reduce the risk of blood clots it is likely that you will be given compression stockings to wear.

Wound infection

There’s a small chance that your hip wound could get infected after surgery. This is usually treated with antibiotics.

If the infection spreads deep into the hip joint, you may need further surgery.

Difference in leg length

Hip replacement surgery can sometimes mean the leg where your hip has been replaced ends up slightly longer than your other leg. Your surgeon will try hard to avoid this.

Often, the difference is so small that most people do not notice it. Sometimes you may need to wear a raised heel, or similar, on your other leg.

Damage to nerves or tissue

During surgery, there’s a chance that a blood vessel, nerve or ligament around the hip joint could be damaged.

This is not common and can either be repaired during surgery or will heal afterwards.

Hip dislocation and wear

Sometimes your hip replacement can dislocate. This is not common, but can be painful or cause swelling. Some people may also hear clicking or popping noises coming from the joint.

It could happen soon after surgery before the joint is fully healed. It can also happen many years after surgery.

Modern hip replacement joints are designed to last for at least 15 years. But they can get worn over time causing pain or swelling.

If your replacement hip dislocates or wears out, you may need another surgery to fix it.

If you are worried about your hip replacement, contact your GP or care team.

Metal-on-metal hip replacements

In the past, many hip replacements used a metal ball and a metal socket. These are sometimes called metal-on-metal implants.

Metal-on-metal implants can wear over time causing health problems. If you have a metal-on-metal hip implant, you should have regular check-ups.

Contact your GP or care team if you notice any problems with your metal-on-metal hip joint, such as:

• new hip pain
• you feel less mobile than usual
• a popping or clicking sound coming from the joint

Ask for an urgent GP appointment or get help from NHS 111 Wales if:

You’ve recently had a hip replacement and you have:

• throbbing or cramping pain in your hip or leg
• a high temperature
• chills and feel shivery
• oozing or pus from your wound
• redness, tenderness, swelling or pain in your hip or leg that is not getting better or is getting worse

These could be signs of an infection or a blood clot.

Call 999 or go to A&E if:

You have pain and swelling in your hip or leg, and:

• you're having difficulty breathing
• you have chest pains

This could be a blood clot in the lungs (pulmonary embolism), which needs to be treated immediately.

Find your nearest A&E