Total hip replacement is an elective procedure this gives the opportunity to make sure you are as well as possible before the operation.

The femur is a hollow tube and a metal stem is placed into it. most often but not always  this is fixed with cement.

The new ball is attached to this stem and the hip is put back together.

Implant choice
There are large number of different types of hip replacement available. The long term success of these implants is not the same.

Hip replacement devices are classified by the Orthopaedic Device Evaluation Panel (ODEP).

I will use implants that have been shown to perform well and discuss my choice of implant with you.

Surgical approach
There are several different ways a surgeon can approach the hip joint. during my training I was taught to perform the posterior approach and have used it in all my hip replacement operations over the past twenty years. It is well established, and safe. The data from the National joint Registry shows that the risk of complications and need for further surgery is lower with this than other approaches. 

Postoperative rehabilitation
When possible you will get out of bed and start your physiotherapy on the day of surgery.

you will be given advice on day to day activity. We will make sure that you are safe and confident on your feet before you leave hospital.

Complications
The most common things complications of hip replacement.

Hip replacement surgery is very successful and considering the complexity of the procedure complications are relatively uncommon.

Well over 90% of people having hip replacement are very pleased with the result of their surgery

Complication rates vary on your state of health, weight, age, smoking status, compliance with post-operative guidance. We will discuss any specific concerns we have with you. Serious complications of a hip replacement are uncommon, occurring in less than two per 100 operations. These are described below:

Blood clots
There is a small risk of developing a blood clot in the first few weeks after surgery.

There are two main places a blood clot can develop:

• inside one of your legs – which is known as a deep vein thrombosis (DVT)
• inside your lungs – which is known as a pulmonary embolism(PE)

Symptoms of a DVT are:

• pain, swelling and tenderness in one of your legs (usually your calf)
• a heavy ache in the affected area
• warm skin in the area of the clot

Symptoms of a pulmonary embolism include:

• breathlessness, which may come on suddenly or gradually
• chest pain, which may be worse when you breathe in
• coughing

If you suspect that you have either of these types of blood clots you should seek immediate medical advice from your GP or the doctor in charge of your care

In order to reduce your risk of blood clots you may be given foot pumps or stockings to wear in hospital and blood thinning medication to take after discharge. You risk can also be reduced by making sure you drink enough fluids and moving around as soon as possible after your operation.

Infection
Everything possible is done to reduce the risk of infection. You will be given antibiotics at the time of surgery and the wound will be washed out with antiseptic solution. The surgery will take place in an ultra-clean air ventilation operating theatre. Despite this there is always a small risk (<1%) that some bacteria could work their way into the tissue in and around the artificial hip joint, triggering an infection. Treatment may be antibiotics, a wound washout or in rare cases, revision surgery. It is important we make the right decision for you.

Symptoms of an infection include:

• a discharge of fluid or blood from the surgical wound
• a high temperature (fever) of or above 38°c (4F)
• shaking and chills
• redness and swelling at the site of the surgery
• worsening hip pain, that can persist even when resting

Hip dislocation
In around 1 in 50 cases the hip joint can come out of its socket. This is most likely to occur in the first few months after surgery when the hip is still healing.  A manipulation under anaesthetic/sedation will be required to put the joint back into place. Occasionally revision surgery may be required to stop further dislocations.

Wear and tear
Another common complication of hip replacement surgery is caused by the wear and tear of the artificial sockets. Particles that have worn off the artificial joint surfaces can be absorbed by surrounding tissue, causing inflammation in and around the joint. With current implants the risk of wear causing the hip to fail in less than 10% at 10 years and less than 50% at 25 years.

Loosening of the joint
The most common problem that can arise as a result of a hip replacement is loosening of the joint. This can be caused by the shaft of the prosthesis becoming loose in the hollow of the thigh bone, or due to thinning of the bone around the implant or the cup becoming loose in the pelvis.  Signs that the joint has become loose include pain and feeling that the joint now feels unstable.  Another operation (revision surgery) may be necessary, although this cannot be performed on all patients.  Loosening can occur at any time but is rare in the first 15 years. 

Leg Length Discrepancy
The length of the leg may be changed by the surgery, it is rare for this to be greater than 1 cm. Getting leg lengths exactly right can be very difficult. Some leg length difference may be unavoidable. Sometimes the leg will be deliberately lengthened in order to stabilize the hip or to improve muscle function.

A shoe-raise may be necessary if the difference is noticeable. In the first weeks after surgery, patients can complain that the operated leg feels “too long”, even when the legs are perfectly equal in length. This is an artificial sensation which should resolve after a few months.

Fracture
Fracture of the femur (thigh bone) can occur during hip replacement. This can be a small crack or a major break, requiring fixation or a period of non-weight bearing. It is more common during revision hip surgery, but can occur with first time hip replacement. It can also fracture later from any trauma, such as falling down stairs. Significant fractures during surgery are very rare. On rare occasions if a crack occurs in a bone at the time of the operation you may have to keep all weight off the leg for 6 weeks.

Bleeding complications

This always occurs but is usually small and requires no treatment. A blood transfusion following surgery may be required in around 1 in 50 cases. Please advise us if you are a Jehovah’s Witness or do not wish blood transfusion. Sometimes bleeding (haematoma) can occur into the wound in the days after surgery. If it is excessive, it may require re-opening the wound under anaesthesia to clean the blood out.

Injury to the blood vessels or nerves of the leg

Injury to the arteries or nerves of the leg is an exceedingly rare but possible complication. The major arteries of the leg lie close to the front of the hip joint. The damaged vessel can usually be repaired by a vascular surgeon if recognised in time. If the nerves to the leg are injured they usually recover; but it may take 6 months or more. You may have foot weakness and require a splint. Occasionally, they don’t recover at all. Most patients have some numbness around their wounds which may be permanent.

Ankle Swelling
This occurs in most cases after hip replacement.  It is worse after standing or sitting with the leg hanging down, it improves overnight when the leg is elevated in bed. It usually resolves on its own within 2 months.

Urinary Catheterisation
There is a risk of needing a urinary catheter after your operation.  The risk is greater for men than women and is more likely in men who have had previous prostate problems.

Death
This is fortunately very rare, it has only happened once in many hundred operations. The risk of death after hip replacement has declined over the past 10 years.

A BMI between 25 and 30 kg/m2  is associated with the lowest risk of mortality, highlighting the importance of losing weight to decrease the risk of surgical complications and also heart attacks, strokes and chest infections..

You should keep in mind that the chances of any significant complication that permanently affects the overall result and your satisfaction with the joint replacement are very small. 

Major surgery is not without risk. Everything will be done to minimize the risks that you undertake.