Hip Replacement Surgery

Hip replacement surgery is a common operation where a damaged joint is replaced with an artificial one. Joint replacements are nearly always carried out because of pain that cannot be controlled by other methods such as painkillers, physiotherapy or other surgery. It is major surgery, therefore is only recommended when physiotherapy has not helped to reduce the pain and improve mobility and it is affecting the quality of life.

Hip replacements are either completed under general anaesthetic or, more frequently, an epidural injection (numbs from the waist down). The surgery usually takes 1-2 hours to complete.

There are different types of implants and materials that can be used, depending on your age and the condition of your joint, as well as differing techniques. Your surgeon will be able to best advise you on this ⁽³⁾.

Any surgery comes with risks and therefore the decision to follow through with surgery is not taken lightly. These are considered low risks due to how common the operation is and include: infection (less than 1%), risk of dislocation, deep vein thrombosis (DVT), leg length discrepancies and damage to the nerves/tissues ⁽²⁾.

The final decision to have an operation or not remains with the patient. It will be based on the risks and benefits of having a hip replacement or choosing not to; these choices should be made clear. It may be that other options are available including, but not limited to, medication, physiotherapy, weight loss or other lifestyle changes.

The most common reason for hip replacement surgery is a damaged hip joint through age-related changes called osteoarthritis. In 2016, osteoarthritis was recorded as the main indication for surgery in 90% of hip replacement patients. You are more likely to have the condition if there is a family history of it ⁽³⁾.

Estimates suggest that up to 8.5 million people in the UK are affected by joint pain that may be attributed to osteoarthritis. The second most common cause is rheumatoid arthritis (an autoimmune inflammatory disease that affects the synovial lining of joints). Around 400,000 people in the UK have rheumatoid arthritis ⁽⁶⁾.

Hip replacement surgery is a very common surgical procedure whereby 32,715 hip procedures were completed in the NHS alone in 2020. A total of 101,651 hip replacement operations were reported to the National Joint Registry in 2016 ⁽²⁾.

Although patients having total hip replacements are becoming younger, consultants are cautious of performing a hip replacement too early due to the risk of requiring further surgery later on in life. Over time, implants can wear and need to be revised, often due to loss of function or pain. The need to require a revision of implants for patients aged 50–54 years is estimated to be 29%, but only 5% in patients aged 70 years and above ⁽⁴⁾.

Other reasons for revision surgeries can be due to infection, fracture/dislocation and implant loosening ⁽¹⁰⁾.

Favourable outcomes can be expected with appropriate physiotherapy treatment both pre-operatively and post-operatively, positively influencing pain, physical function and quality of life ^{(6, 8, 9)}.

A physiotherapist can provide an accurate and timely diagnosis by obtaining a detailed history of symptoms. A series of physical tests might be performed as part of the assessment to rule out other potentially involved structures and gain a greater understanding of your physical abilities to help facilitate an accurate working diagnosis.

Your physiotherapist will want to know how your condition affects your day-to-day life so that treatment can be tailored to your needs and personalised goals can be established. Intermittent reassessment will ascertain if you are making progress towards your goals and will allow appropriate adjustments to your treatment to be made.

With mild symptoms, particularly in those with a more recent onset of symptoms, further investigations are not normally required as symptoms of hip osteoarthritis are often easily identifiable and can be managed well with good physiotherapy management and advice. Persistent cases that have not responded to appropriate physiotherapy input may require further investigations to confirm the diagnosis and severity with an X-ray and a referral for a surgical opinion to orthopaedics through your GP practice.

Condition-specific exercise forms a pivotal element of the treatment plan to ensure optimal recovery to improve mobility and strength around your hip. ^{(6, 8, 9)}.

There are certain things you can try to help you self-manage your condition, or whilst you await surgery. These may include the following:

• Medication to manage your pain and thereby impacting how much you are able to do.
• If you are overweight, losing weight might have a positive impact on your hip symptoms and your overall general health.
• Activity modification (avoiding or modifying activities of daily living, inclusive of work, that aggravates symptoms).
• If you work for an organisation that has an Occupational Health department and your symptoms are aggravated by work, it would be advisable to seek their input. They will be well placed to suggest work placed adaptations to facilitate continued working whilst best managing symptoms.
• Keeping active as much as you are able to, helps keep the joints strong and mobile.

For patients wanting to achieve a high level of function or return to sport, we would encourage a consultation with a physiotherapist as you might require advanced rehabilitation. As part of a comprehensive treatment approach, your physiotherapist may use a variety of other pain-relieving treatments to support symptom relief and recovery.

Whilst recovering, you might benefit from a further assessment to ensure you are making progress and to establish the appropriate progression of treatment. Ongoing support and advice will allow you to self-manage and return to full fitness. Your consultant will also advise you on when you are able to return to certain activities however, generally, you will be able to return to most sports from 3–6 months.

Alongside exercise and appropriate advice, your physiotherapist might utilise various forms of hands-on treatment skills in the form of joint mobilisations, soft tissue techniques and acupuncture. These techniques can be useful to restore function and alleviate symptoms whilst you continue to strengthen and mobilise the limb.

https://www.nhs.uk/conditions/hip-replacement/