Hip replacement surgery | Pokanga hope

Total hip joint replacement surgery is an operation that’s done to replace your damaged or diseased hip joint. Your hip joint is known as a ‘ball and socket’ joint and is made up of the head of the femur (ball) and the acetabulum (socket) of your pelvis. In most hip replacement surgeries, both the ball and the socket are replaced with parts made of metal and plastic.

Image credit: Injury map via Wikimedia Commons(external link)

Hip replacement is done if your range of movement is reduced and you have difficulty bearing weight on that side. There is also likely to be evidence (from X-ray) that your joint is damaged.

Things you can try before getting to the point of needing surgery include:

• exercise
• using equipment to help you stay independent with daily activities
• managing pain through:
  • pacing yourself
  • organising routines and habits to make them more manageable
  • reducing weight if needed – if you’re overweight, weight loss is especially helpful and may even mean you no longer need surgery.

A hip replacement is only likely to be offered when these approaches haven't helped with your mobility and pain.

You’re likely to recover better if you take an active part in your care before and after the operation. There are many things you can do before your operation, during your stay in hospital and when you get home, that will help your recovery. See what to do before and after surgery below. 

You can improve the outcome of your surgery by getting yourself as fit and healthy as possible beforehand. This may include exercising, stopping smoking, eating a balanced diet, managing sleep and limiting or avoiding alcohol.

A video called 'inside hip replacement' is available on this WebMD page(external link).

The most common reason a hip needs replacing is osteoarthritis of the hip. 

You may be offered hip replacement surgery if:

• you have severe pain, swelling and stiffness in your hip and your ability to move is reduced
• your pain is so severe that it interferes with your quality of life and sleep
• everyday tasks, such as shopping or getting out of the bath, are difficult or impossible
• you're feeling depressed because of your pain and lack of mobility
• you can't work or have a normal social life
• other approaches (such as regular exercise, losing weight, using mobility aids and equipment, altering your routines, taking pain relief medicines) haven't worked.

You'll also need to be well enough to cope with both a major operation and the recovery afterwards. 

Benefits

The aim of hip replacement surgery is to relieve pain, reduce stiffness and improve your ability to walk. Over 90% of people experience dramatic pain relief and improved hip function with a new hip joint. 

Risks

As with all surgeries, complications sometimes occur with hip replacement surgery. Smoking, being very overweight or having some illnesses may increase your chance of complications. Complications include the possibility of:

• blood clots or deep venous thrombosis (DVT) of the veins in your legs or pelvis
• bleeding
• infection
• one leg being longer than the other
• damage to arteries and nerves in your leg
• bone fracture during or after the operation.

These are uncommon, but if they do happen they may delay or limit your full recovery.

To decide whether a hip replacement is right for you, talk to your healthcare provider about the risks and benefits of the surgery. Also, find out about alternatives to hip replacement surgery if surgery isn’t appropriate for you or if you don’t want surgery.

If you don’t meet the criteria for a publicly funded hip replacement, talk to your general practice team about being referred to a private orthopaedic surgeon. You can also go privately if you want surgery before it is available through the public system, or you want to choose the timing of your surgery or the surgeon you want to do the operation.

This is the first of a series of videos providing an overview of preparing for, undergoing and recovering from hip replacement surgery. 

Video: Your guide to hip replacement surgery – welcome

(Ministry of Health, NZ, 2015)

You can watch the other videos in the series by clicking on the link below. It gives you the option to choose which one to watch, or to play them all. 

Your guide to hip replacement – recover faster, return home sooner.(external link) 

There are many things you can do to take part in your care before your operation, during your stay in hospital and when you get home after discharge. Research has shown that doing these things will improve your chances of a better recovery after your surgery.

You’re encouraged to be a partner in your own care. The sooner you get out of bed and begin to walk, eat and drink after your operation, the quicker and more comfortable your recovery will be and you’ll return home earlier to your normal life, work and play. All going well, you’re likely to return home after 2 to 4 nights in hospital.

See this hip replacement guide(external link) for more details. 

Before your hip surgery

What to expect

• Most people have their first assessment for their fitness for surgery with a nurse in a pre-admission clinic.
• This clinic usually takes place about 4 to 6 weeks before your surgery.

What you can do

• Attend the pre-admission clinic.
• Find out as much as you can about what's involved in your operation. Your hospital should provide written information or videos.
• It's a good idea to take along one key person to your appointments, so they know what’s happening and can support you. The more you inform family/whānau and friends about your health, the more helpful they can be, eg, with housework, transport and preparing meals after your surgery.
• Your anaesthetist will talk to you about your health, the types of anaesthetic and pain relief that can be used, and their risks and benefits. You’ll also be asked to sign a consent form for your anaesthetic at this time.
• Ask questions about what to expect after surgery.  
• Get yourself as fit and healthy as possible before surgery by stopping smoking, exercising as advised by your doctor, eating a balanced diet, managing your sleep and limiting or avoiding alcohol.
• Visit your dentist before your operation. Loose teeth, cavities or poor mouth hygiene can lead to infections in the area of the operation. 

While you’re in hospital

What to expect

• Before your operation, you’ll see your anaesthetist and surgeon. You may like to ask them questions. It's a good idea to have your questions written down as you may not remember them on the day.
• Your surgeon or their registrar (a doctor who is undergoing specialist training) will review and confirm your operation details and will mark your skin with a marker pen to show the area to be operated on.
• Your anaesthetist will also explain the anaesthetic options available to you.
• You’ll be fitted with a blood-clot prevention stocking on the leg that isn’t being operated on. This helps to keep your blood flowing while you’re not mobile.
• Your blood pressure, temperature and heart rate will be measured. You’ll be washed with a disinfecting solution.
• After your operation, you’ll be encouraged to get up and move as soon as it’s practical and safe.
• Research shows that moving early reduces some complications of big operations and starts you on the road to a quicker recovery.
• You’ll be shown simple exercises that you can do in bed and you’ll be helped to sit in a chair for all your meals.
• Staff will help you to walk short distances with crutches or a walking frame, once your anaesthetic has worn off and staff have assessed that you’re safe to move.
• Your rehabilitation and mobilisation will be supervised by a physiotherapist and/or an occupational therapist. 

 What you can do

• Do your exercises to assist you in your recovery.
• Give yourself a goal to achieve every day.
• Ask questions if you have any concerns.

When you go home

What to expect

• You’ll be discharged on day 3 after your operation.
• Usually, this is done in the morning. If you need to wait for transport you may be moved to the discharge lounge.
• A physiotherapist may visit you to ensure that you can do your exercises independently and walk safely with crutches or a frame.
  You may also be seen by an occupational therapist who will ensure you can manage essential everyday tasks, such as getting on and off a bed, chair and toilet, having a shower and getting dressed.
• You’ll be given advice about looking after your hip at home. 

 What you can do

• Make sure you understand how to take care of yourself and your hip, such as how to take care of the operation site, how to take your pain relief, what side effects to expect from the medication and what to do about them, etc.  
• Getting support from whānau and friends is important for your recovery. The more you tell them about your condition and what you need, the more helpful they can be.
• Give yourself a goal to achieve every day.
• Do your exercises to assist you in your recovery.
• Attend follow-up clinics.
• Follow any advice you've been given about how to move your hip. 

If you have any concerns about your health after you’re discharged from hospital, get advice from your healthcare provider, an after-hours clinic or the emergency department at your nearest hospital.

Your surgeon will normally see you again 4 to 6 weeks after your hip replacement. By then, you should have been able to get back to most of your normal daily activities. This includes walking without a walker or crutches and showering. If you work, you should be able to return to work. If you drive, you are likely to be advised not to drive until you've been cleared by your surgeon. 

Talk to your general practice team or allied health team (physiotherapist/occupational therapist) if you’re still having problems with daily activities. Also talk to them if you want to want to restart a strenuous activity or sport. It might help if they design a specific exercise programme for you.

Most people have dramatic pain relief and improved hip function with a new hip joint, and more than 90% of hip replacements last more than 10 years.