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Hip replacement surgery | Pokanga hope

Key points about hip replacement surgery

Hip replacement surgery (pokanga hope) involves removing damaged parts of your hip and replacing them with new parts made of metal and plastic.
It's carried out when severe pain is stopping you doing your daily activities and it's clear that surgery will help.
It's only offered when things like physiotherapy and lifestyle changes haven't helped with your pain and mobility.
You can improve the outcome by getting as healthy as possible (exercise, healthy eating, limit alcohol, stop smoking) before your surgery.

Nurse smiles at older woman with walking stick

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Hip replacement surgery is carried out if pain from severe arthritis or another injury to your hip stops you from doing your day-to-day activities, and there are clear changes to the joint that surgery will correct.
It is only offered when other treatments such as physiotherapy and occupational therapy haven’t helped with pain and mobility.
People who actively participate in their care before and after surgery are likely to have a better recovery.
There are many things you can do to take part in your care, starting from before your operation, during your stay in hospital and when you get home after discharge.
You can improve the outcome of your surgery by getting yourself as fit and healthy as possible beforehand. This may include stopping smoking, exercising, eating a balanced diet and limiting or avoiding alcohol.
If you are overweight, weight loss is especially helpful and may mean you no longer need surgery.

A total hip joint replacement is an operation to replace a damaged or diseased hip joint. Your hip joint is made up of the head of the femur (ball) and the acetabulum (socket). In the majority of hip replacements, both the ball and the socket are replaced with metal and plastic components.

(external link)

(WebMD, US, 2019)

Hip replacement surgery is usually only offered when alternatives to it have not worked for you. These include regular exercise, losing weight, physiotherapy or occupational therapy, and pain relief medicines.

Learn more about the alternatives to hip replacement surgery.

Hip replacement surgery is usually recommended if you have severe arthritis of your hip that causes disabling pain and when other treatments, such as physiotherapy haven't helped reduce pain or improve mobility. 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 mobility 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 the pain and lack of mobility
you can't work or have a normal social life.

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

To decide whether a hip replacement is right for you, talk with your doctor about the risks and benefits of the surgery. Also, find out what you can do if you choose not to have surgery. The following summary is a guide.

What are the benefits of having hip surgery?

The aim of hip 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 joint and more than 90% of hip replacements last beyond 10 years.

Are there any risks to having hip surgery?

As with all surgeries, complications sometimes occur with hip replacement surgery. Smoking, obesity or 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 and bone fracture during or after the operation. Though uncommon, when these occur they may delay or limit your full recovery.

This series of videos provides an overview of preparing for, undergoing and recovering from hip replacement surgery. The first one is provided below.

Video: Your guide to hip replacement surgery - 01 - Welcome

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(Ministry of Health, NZ, 2015)

You can watch the other videos in the series by clicking on the following link. 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)

Many district health boards (DHBs) have introduced a new way of caring for people who need a hip or knee joint replacement. This is called ERAS – Enhanced Recovery After Surgery. The ERAS pathway of care starts when you and your doctor decide that you need surgery and continues through to your rehabilitation at home or in the community. The approach covers a number of evidence-based interventions that aim to ensure you:

are in the best possible condition for surgery
have the best possible management during and after your surgery
participate in the best possible rehabilitation after surgery.

You are 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. You return home earlier to your normal life, work and play. All going well, you are likely to return home after 2 to 4 nights in hospital. Read more about ERAS(external link).

Research has shown that people who actively participate in their own care before and after surgery are likely to have a better recovery. There are many things you can do to take part in your care, starting from before your operation, during your stay in hospital and when you get home after discharge. Your ERAS booklet(external link) will give you more details but here is a summary of what to expect and the sorts of things you can do.

Hip surgery	What to expect and things you can do
Before your 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 typically takes place about 4 to 6 weeks before admission. Things 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 is happening and can support you. The more you inform family/whānau and friends about your health, the more helpful they can be. 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. Consent for your anaesthetic will also be sought 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 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 in hospital	What to expect Before your operation, you will 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 will review and confirm your operation details and will mark the operation area with a marker pen. Your anaesthetist will also explain the anaesthetic options available to you. You will 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 are not mobile. Your blood pressure, temperature and heart rate will be taken. You will be washed with a disinfecting solution. After your operation, you will be encouraged to get up and move as soon as it is 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 will be shown simple exercises that you can do in bed and you will be assisted to sit in a chair for all your meals. You will be assisted by staff to walk short distances with crutches or a walking frame, once your anaesthetic has worn off and staff have assessed that you are safe to move. Your rehabilitation and mobilisation will be supervised by a physiotherapist. Things 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.
Discharge	What to expect You will 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. You will be given advice about looking after your hip at home. Things 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 family/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. Take precautions to reduce your chance of dislocating your hip, such as: don't bend your hip more than 90 degrees – for example don't bend forward to your toes or bring your knee up towards your body don't cross your legs at the knees or ankles when sitting or standing don't rotate or twist your hip make sure your operated leg doesn't cross the midline of your body – keep your feet pointing forward. If you have any concerns about your health after you are discharged from hospital, seek advice from your GP or an after-hours clinic or the emergency department at your nearest hospital.