Hip replacement and hip revision

Hip replacement surgery is a procedure to replace your hip joint with artificial parts when it’s been damaged or worn away. This helps to reduce pain and improve movement. A hip revision operation is a repeat hip replacement. It’s an operation to replace your artificial hip joint if it’s become loose, worn out or .

As the illustration is being removed (no longer accurate/suitable), there is a replacement image saved in the folder.

About hip Replacement

You may be offered a hip replacement if you have arthritis in your hip and have a lot of pain. Osteoarthritis is the most common cause of hip pain. It happens when the cartilage inside the hip joint becomes thin and damaged and the joint can’t move as easily. 

During surgery, the top of your thigh bone is replaced with a stem and head and your hip socket is replaced with a cup.

Artificial hips can be made from materials such as metal and plastic. Very few surgeons do hip replacements where both pieces are made from metal. This is because metal-on-metal hip replacements can cause problems for some people. Your surgeon will speak to you about the best type of hip replacement for you.

After a while, artificial hip joints can loosen or wear out and may need replacing again. But for more than half of people who have a hip replaced, the joint will last for 25 years. 

About hip revison

After many years, hip replacement joints can break or loosen through wear and tear. And sometimes they can become infected. If this happens, you may need to have the joint replaced again. This is called a hip revision.

Hip revision surgery is often more complicated than the original hip replacement surgery. Your surgeon will need to take out the existing artificial hip joint and some of the bone may need reconstructing. This can make the operation and recovery longer and you may be more likely to have complications.

Preparing for hip replacement and hip revision

Your surgeon will explain how to prepare for your operation. If you smoke, try to stop  Smoking makes it more likely you’ll get complications, and it can slow down healing and recovery.

It’s a good idea to follow a healthy lifestyle in the weeks and months before your operation. Being active, losing any extra weight and eating healthly, will help you to prepare for recovery and to manage at home afterwards. You may also be asked to do some specific exercises before your operation.

You may be asked to wear compression stockings before and after your operation. This is to help prevent from forming in the veins in your legs. You may also need to have injections of an anticlotting medicine as well as or instead of wearing compression stockings.

You should see an occupational therapist and/or a physiotherapist before your operation. They will help you prepare for recovery and manage at home afterwards.

Your surgeon or nurse may also give you information about your operation and your recovery. It’s important to read this if you can because it will help you prepare well and aid your recovery. Some hospitals have a ‘joint school’ where a group of people having hip replacement learn about what they can expect.   

Your operation can be done under spinal or epidural anaestheia. This completely blocks feeling from below your waist, but you’ll stay awake during the operation. Or you may be able to have the operation under general anaestheisa, which means you’ll be asleep during the operation. An anaesthetic can make you sick so it's important that you don't eat or drink anything for six hours before your operation. Follow your doctor's advice. If you have any questions, just ask. Your surgeon will discuss with you what will happen before, during and after your surgery. If you’re unsure about anything, don’t be afraid to ask. No question is too small. It’s important that you feel fully informed, so you feel comfortable to give your consent for the operation to go ahead. You’ll also be asked to sign a consent form.

Hip replacement and hip revision Procedure

A hip replacement operation usually takes about an hour or so. Hip revision surgery takes longer. Hip replacement is usually a big operation. Sometimes hip replacement can be done as ‘keyhole’ surgery, though this isn’t suitable for everyone. Keyhole surgery is when your surgeon makes a small cut and uses special instruments to replace the joint. This kind of operation usually means less trauma to the surrounding muscles and bones.  

During hip replacement surgery, your surgeon will make a cut (between 8 and 20 centimetres long) over your hip and thigh. They’ll then divide your hip muscles and separate (dislocate) your ball-and-socket joint.

Your surgeon will replace both the ball and socket parts of your hip joint. That means removing the ball at the top of your thigh bone and putting in a replacement on a long stem. This can either be fitted tightly into the inside of your thigh bone or sometimes it’s ‘glued’ in using a special cement. A shallow cup is made in your hip bone and an artificial socket put into it. Then your surgeon will then put your hip joint back together (they’ll fit the ball into the socket).

Finally, your surgeon will close the cut in your skin with stitches, clips or glue and cover it with a dressing.

If you’re having hip revision surgery, your surgeon will need to remove the old artificial hip joint before putting in the new one.

Aftercare for hip replacement and hip revision

After surgery, you may feel some discomfort or pain as the anaesthetic wears off. You'll be offered pain relief if you need it. You may not be able to feel or move your legs for several hours after a spinal or epidural anaesthetic.

You may have a pad or pillow between your legs to hold them apart and keep your hip joint in one position. This will help to stop your hip from dislocating (moving out of position).

Getting up and starting to walk early on is an important part of your recovery. A physiotherapist or occupational therapist will visit you quite soon after your operation and will see you regularly afterwards. They’ll get you up and out of bed and give you some exercises to do. You’ll be given a walking frame or crutches to help you walk.

You may be asked to take iron supplements as it’s normal to lose some blood during the operation. These will help your recovery.

You’ll need to stay in hospital until you're ready to go home. For some people, this can be just one or two days after having their operation. For others it may be four to eight days. When you're ready to go home, make sure someone can take you.

You’ll have a wound on your hip and thigh. If it’s closed with staples or stitches, keep your wound covered until these are taken out. A Doctor  will remove your stitches after about 10 days. If you have dissolvable stitches, they won’t need to be removed. 

Recovery for hip replacement and hip revision

Everyone recovers differently from hip replacement or revision surgery. Many people feel quite tired after a big operation like this, and you might feel like you want to just rest. The important thing is to keep moving but to pace yourself and build up activity gradually. Walking every day and keeping up with the exercises you have been given will help you recover well.

In the first eight to 12 weeks after surgery you’ll need to take extra care of your hip, to prevent it from dislocating. That’s likely to include things like not crossing your legs and using a pillow between your legs when you sleep on your side. Your physiotherapist or occupational therapist will tell you what you need to do. In the first week or so after the operation, you’re likely to have some pain and discomfort, as well as swelling and bruising. Try not to sit for long periods. Walk regularly and lie down to help any swelling go down. Take over-the-counter painkillers if and when you need them. Always read the patient information leaflet that comes with your medicine and if you have any questions about your medicines, ask your pharmacist.

You may be a bit constipated after surgery. Some people don’t have a poo for two to four days afterwards. Eating fruit and vegetables and drinking plenty of fluids (up to two litres a day) should help to prevent constipation.

By the second week after your operation, you’ll probably feel a lot better, and you may be walking with just a stick. Some people will need to carry on with crutches for a while though. As time goes on, you’ll probably be able to do more and more. But to begin with, ask friends or family to help you with daily tasks like shopping.

By around six to eight weeks, you should be able to walk as you usually would, as well as swim or cycle. If you do activities such as golf or dancing, it’s best to wait until three months after surgery before starting them again. This is because these activities and others like them involve twisting and turning.

Getting back to work and driving

If your job is office based or light physically, you can usually go back to work after about six weeks. But if your work involves a lot of walking, standing or lifting, you may need to stay off for longer – sometimes for up to three months. Speak to your Doctor or occupational health advisor for advice.

You should be able to drive after about six weeks but check with your surgeon. You shouldn’t drive while taking any medicines that can make you drowsy. Getting in and out of a car as a passenger can be difficult for the first few weeks. Your therapist may suggest sitting sideways on the seat and swinging both your legs around together to get in and out.

Side-effects of hip replacement and hip revison

After hip replacement surgery, you may have some temporary side-effects. These include:

• a sore hip and leg for a few weeks – if this gets worse speak to your doctor, as it can be a sign of a blood clot in your leg (deep vein thrombosis)  
• swelling in your leg – this might last for several weeks
• constipation – this may happen in the first few days after your operation
• tiredness, which can take a few weeks to get better

Complications of hip replacement and hip revision

Most people don’t get serious complications after hip replacement surgery. The chance of complications is also small after a hip revision. But you’re more likely to have complications after a hip revision than if you’re having the joint replaced for the first time.

Some of the main hip replacement complications include the following.

• The joint can dislocate (move out of position). If this happens, you may need another operation to put it back in place. A dislocation is more likely to happen after hip revision.
• A blood clot in your lower leg or lungs.
• An infection around the new joint. Although this is unusual, it can be serious. It’s more likely to happen after hip revision surgery. Your surgeon may prescribe  during and after surgery to help prevent this.
• Difference in leg length. One leg may be slightly longer than the other after surgery.
• Loosening of the joint and hip fracture. The artificial joint can become loose over many years, which can cause the bone around it to become thin and break.
• Some people develop a limp after hip revision surgery. This can get better over time, but sometimes it’s permanent.

Considerations for hip replacement and hip revision

Before deciding to have surgery, it’s important to think about if it’s right for you. Your doctor can discuss if there are any alternatives and help you to decide.

Here are some of the things you might want to consider.

• After a hip replacement, most people find that their hip pain gets better or goes completely.
• A hip replacement can help you move around more easily, and that can improve your quality of life. You should find many activities easier to do and you may sleep better if pain has been keeping you awake.
• You’ll need to stay in hospital for a few days after the operation and it will take time to recover.
• Full recovery from a hip replacement or revision can take up to one year, though most of the healing happens in the first three months. During that time, your movement and the things you can do may be limited.
• As with any surgery, there are some risks involved and complications from the operation are possible.
• Your new hip joint may need replacing eventually, and you may need to have a hip revision operation in the future.
• You’ll have a hip replacement scar between 8 and 20 centimetres long.

Alternatives to hip replacement

Your surgeon will usually only recommend you have a hip replacement if other treatments haven’t worked. These include changes to your lifestyle, and taking painkillers.

It’s possible you could have a hip resurfacing operation rather than a conventional hip replacement. This involves removing the damaged bone and covering the surfaces of the ball and socket of your joint with metal caps.