If you have severe arthritis of the hip (i.e. pain on walking and disturbed sleep) and have not responded to painkillers then total hip replacement can be considered.

The aim of surgery is to provide pain relief and improve mobility.

Hip replacement surgery is common around 100,000 being performed each year in the U.K.

Diagnosis

Your surgeon will ask you some questions about your hip symptoms and also enquire about your general health.

Your surgeon will also arrange for x-rays of your hip to be taken, to give further information about the extent of osteoarthritis.

After taking a history, examining your knee at the x-rays your surgeon will be able to discuss surgery

He will listen to do your ideas, concerns and expectations of hip replacement surgery and present objective information about expected benefit of surgery and also inform you about the rare but important risks that are associated will hip replacements.

The risks include infection, nerve and blood vessel damage, fracture, dislocation, leg length inequality, the need for further hip surgery should the implant wear out.

There are also general complications that are even rarer and include blood clots in the legs going to the lungs, heart attack, stroke and the risk of dying.

Prior to surgery you will undergo pre-assessment which aims to ensure optimum health before surgery.

You will undergo blood test investigations and a heart tracing (ECG). Skin swabs as well as a sample of urine will be taken.

Finally the team will evaluate your social and home circumstances. It is important that after you are able to cope with activities of daily living when you get discharged. A number of modifications around the home can make the convalescence period after surgery much easier, e.g. handrails on the staircase, a safety bar in the shower and a toilet seat raise.

You will come to surgery on the day of surgery and admitted to the ward where the Consultant Anaesthetist will see you. The commonest form of anaesthesia is a general anaesthetic or a spinal (where a fine needle is placed in your back, causing you to feel numb below the waist). You can have the option to be sedated if you want to be unaware of the procedure if you have had a spinal.

Spinal blocks offer a number of advantages such as reducing the risk of blood clots in the legs and reduce the requirement for opiate painkillers, which have the side effect of nausea and drowsiness.

The surgical procedure lasts between 1^1/2 to 2 hours. It starts with an incision about 8 inches over the hip.

The diseased ball and socket are the removed and the hip implants are inserted.

At the end of the operation local aneasthetic is inserted, the wound is stitched and glued and a dressing is applied.

You undergo a Rapid Recovery Programme after surgery, the aim of which is to promote early mobilisation. This occurs on the day of surgery and is supervised by the Physiotherapist. They will assist you out of bed, walk a few steps with a Zimmer frame and sit in a chair. From then on the Physiotherapist will assess your mobility and supervise and encourage your post-operative rehabilitation.

You will be given injections to thin your blood to reduce the risk of blood clots- this is called Tinzaparin.

The day after your surgery blood tests will be performed and an x-ray of your replaced hip will be taken.

You may require a blood transfusion after the operation.

You will be discharged from hospital once your consultant and physiotherapist are happy with your surgical wound and your ability to mobilise (often with a stick).

The physiotherapist will then see you as an outpatient to supervise you rehabilitation.

In particular it is important to take precautions to prevent the complication of hip dislocation:

• Do not bend more than a right angle as this could cause your hip to dislocate.
• Do not cross your legs.
• Do not bend down to touch your toes, cut your nails or tie your shoe-laces.
• Avoid low chairs or low toilet seats.
• Do not lie on your side for 6 weeks.

You will be seen by your Consultant surgeon 6 weeks after the surgery and then followed up at 6months and 1 year.

Outcome - What You Should Expect

The aim of hip replacement surgery is to significantly reduce the pain of an arthritic hip and improve mobility. It does take between 3 and 6 months to feel the full benefit of surgery, but most patients find this improves their quality of life significantly.

Hip replacements are man made implants and do wear out eventually and need re-doing (revision). It should be expected to last 15-20 years