Hip Joint Replacement

Joint replacement surgery is a very successful operation, with a 95% success rate. It is recommended for patients who have moderately severe persistent pain which is not adequately relieved by an extended course of non-surgical management, and which interferes with activities of daily living (e.g. washing, dressing, lifestyle and sleep).

As a rule of thumb, if you have pain which:

Significantly limits your day-to-day function and quality of life
Disturbs your sleep on a regular basis
causes you pain even at rest
cannot be adequately managed with more conservative measures (such as those mentioned above),

then joint replacement may be a suitable treatment option for you.

When coming to a decision about whether joint replacement is the right decision for you, it is important to weigh up the risks against the benefits. If you feel the benefits of joint replacement (in terms of the improvements it will have on your pain and quality of life) outweigh the risks, then it may be the right choice for you.

What are the benefits?

Pain relief – 85% of people are pain free following hip replacement
Increased walking tolerance – most people find that they can walk further than they could, with less pain, following hip replacement.
Improved sleep – due to reduced pain at night
Reduced dependency on pain killers

What are the Risks?

Ongoing pain or discomfort – 10% of people have ongoing discomfort following hip replacement, whilst 5% have ongoing pain. This is sometimes due to a separate problem affecting the lower back, which can refer pain around the hip region and may have been present before your initial surgery. Sometimes the muscles and tendons around the hip joint can be a source of pain as well, which can generally be helped with physiotherapy.
Stiffness – generally, if you have a stiff hip prior to the operation, you will have a stiff hip after the operation. Sometimes bone can form in the muscles around the operation site following surgery, which can cause further stiffness, although this generally isn’t painful.
Infection – around 1% of hip replacements become infected during the post-operative period, which may require further surgery to manage and control.
Blood clots – following any major surgery there is a risk of blood clots (less than 1 in 20), which can be potentially fatal if they were to move to your heart, lungs or brain. Thankfully the risk of fatality following joint replacement surgery is low (approximately 1 – 2 in 1000), and the orthopaedic team make sure that the risk of blood clot is minimised by giving you blood thinning medication and compression stockings following the surgery.
Blood loss – rarely you may require a blood transfusion due to blood loss during the surgery.
Dislocation – the hip joint can become dislocated in less than 1 in 100 patients following hip replacement surgery. This is most likely to occur within the first 6 weeks after surgery. You are therefore advised not to put your hip into certain positions for the first 6 weeks after surgery. This involves not allowing your leg to cross past your midline, and you therefore need to sleep on your back for the first 6 weeks. You also cannot bend your hip too far, and you are therefore given a long handled shoe horn and sock aid to help with dressing. Once all the surrounding muscles have healed from the surgery then the risk of dislocation reduces dramatically, and most surgeons are happy for you to return to most of your usual activities.
Loosening of the artificial joint due to wear and tear – your artificial joint may eventually wear out requiring further surgery. Overall, 90 out of 100 joint replacements last more than 10-years. Premature loosening may occur, needing revision surgery.

What does joint replacement involve?

The surgery is performed with a spinal anaesthetic (epidural), whilst you are sedated, so you don’t have the side-effects associated with a general anaesthetic to contend with.
You are generally in hospital for 3-5 days, and get sent home using 2 sticks after you have managed to progress your mobility to walk a decent distance and climb a flight of stairs (if necessary).
You have to wear compression stockings and take the blood thinning medication for 6-weeks following the operation.
You cannot drive for 6-weeks following the operation.
You have go be careful about the positions you put your hip into for the first 6 weeks after surgery, to minimise the risk of it moving into a position where it could dislocate. This means you have to sleep on your back, and can't bend to put your shoes and socks on (you have to use a long handled shoe horn and sock-aid).

Further information about Hip replacements can be found in our patient information leaflet here.

Current Funding Restrictions for hip replacement

It is worth noting that the York CCG (Clinical Commissioning Group) will not fund hip replacement surgery if your BMI is above 30, nor if you are a current smoker. If this applies to you then you would need to:

Give up smoking for a period of 8 weeks, OR wait for 6 months, before you can be referred to the orthopaedic surgeon for consideration of surgery.
Bring your BMI down to 30 (or below) or lose 10% of your body weight (whichever is less), OR wait 12 months, before you can be referred to the orthopaedic surgeon for consideration of surgery. However, if your BMI remains above 35 you would still not be able to be referred for surgery until you had brought your BMI down below this upper threshold limit.

Where can I find further information to help me to make a decision about my ongoing treatment options?

The NHS and Versus Arthritis have collaborated to create a “decision aid” document which you can use to help weigh up your options for managing your knee pain. You can find it here.

Treatment options for Hip Osteoarthritis

Treatment options: Exercise & Activity

Treatment options: Weight Loss

Treatment options: Medications & Injections

Treatment options: Joint Replacement Surgery