What is a Hip Replacement?

In a hip replacement, a surgeon replaces a damaged or diseased hip joint with an artificial joint, also known as a prosthesis. The hip joint, which is a ball-and-socket joint responsible for smooth leg movement, may become painful, stiff, and limit mobility when the articular cartilage that cushions the bone ends in the joint gets damaged.

When non-surgical treatments such as physiotherapy or medication fail to provide adequate relief, doctors may recommend hip replacement surgery. Hip osteoarthritis, rheumatoid arthritis, post-traumatic arthritis, avascular necrosis, and childhood hip disease are the most common conditions that may necessitate a hip replacement.

Hip osteoarthritis is a common form of arthritis that occurs due to age-related wear and tear of the hip joint. Rheumatoid arthritis is an autoimmune disease that causes inflammation in the synovial membrane, leading to damage of the cartilage. Post-traumatic arthritis may develop after a severe hip injury or fracture, while avascular necrosis may occur due to limited blood supply to the femoral head. Childhood hip disease may also lead to premature hip arthritis later in life. In all these cases, hip replacement surgery may be recommended to improve mobility and reduce pain.

What are the Signs of Needing a Hip Replacement?

Hip pain that limits everyday activities may indicate need for hip replacement. Persistent hip pain, even at rest, may also be a sign. Stiffness in the hip joint that limits movement or lifting may suggest the need for surgery. Limited mobility due to hip pain and stiffness may indicate it’s time to consider hip replacement. If conservative treatments aren’t working, a doctor may recommend surgery. The decision to undergo surgery should be made in consultation with your healthcare provider based on your specific needs.

What Occurs in a Hip Replacement?

During a hip replacement, the surgical team removes the damaged bone and cartilage of the hip joint and replaces them with prosthetic components.

The procedure involves removing the damaged femoral head and replacing it with a metal stem that has a ceramic ball on the upper part. The surgeon places this stem into the hollow centre of the femur, either cementing or press-fitting it into the bone. They also remove the damaged cartilage surface of the socket, known as the acetabulum, and replace it with a metal socket. In some cases, screws or cement are used to secure the socket in place.

To create a smooth gliding surface for the hip joint, the surgeon inserts a plastic, ceramic, or metal spacer between the new ball and socket. The selection of the spacer is based on the patient’s age, level of activity, and other factors.

The surgery typically takes a few hours, and patients may require a few days of hospitalisation for recovery. After the surgery, patients undergo physiotherapy to help them regain strength and mobility in their hip joint.

While hip replacement surgery is a common and effective procedure, it also carries certain risks, including infection, blood clots, and implant failure. It is important for patients to discuss the risks and benefits of the procedure with their surgeon before deciding to undergo surgery.

Post-Hip Replacement – Immediate Priorities

Hip replacement surgery typically takes a few hours under general anaesthetic. After surgery, you will be monitored in the recovery room until you wake up safely. You will most likely stay in the hospital for 4 to 7 days, depending on your recovery.

Pain Management

Your orthopaedic team will provide you with pain medication to ensure you are as comfortable as possible. This may start before or after the surgery.

Wound Care

You may have stitches or staples on your wound, or a suture beneath your skin. Your doctor will remove them approximately 2 weeks after surgery. Avoid getting the wound wet until it has sealed and dried. You may continue to bandage the wound to prevent clothing irritation.

Blood Clots/Deep Vein Thrombosis (DVT)

Blood clots are a common complication after hip replacement surgery. Your orthopaedic team will outline a prevention program that may involve wearing compression stockings for several weeks, taking blood-thinning medications, using inflatable leg coverings, and doing ankle pump exercises.

Post-Hip Replacement Physiotherapy Rehabilitation

After hip replacement surgery, your physiotherapist will teach you how to walk, stand, and use assistive devices correctly. They’ll advise you on positions to avoid that may stress your hip joint, and help improve your balance, coordination, and fitness.

It’s vital to follow your physiotherapy program and attend appointments for the best results. Your exercises will gradually increase as your hip heals, challenging you without pushing too hard. Recovering lower limb muscle strength, balance and function are crucial for a safe and full return to your life.

Rehabilitation after hip replacement is a gradual process that requires patience and commitment. However, with the right guidance and support from your physiotherapist, you can achieve full recovery and resume your favourite activities.

Precautions to Take During the Initial 3 Months Post-Hip Replacement:

Dislocation is a possible complication during the first few months after surgery while the tissues are healing. Although dislocation is not common, it is important to take the following precautions to reduce the risk of dislocation:

• Avoid sitting in low chairs or seats that are difficult to get in and out of.
• Keep your knees level with or below your hips when sitting.
• Avoid crossing your legs or bending forward from the waist to pick up objects.
• Sit with your knees apart to avoid twisting your hip joint.
• Do not lie on your operated side.
• When lying on your non-operated side, keep two pillows between your knees to prevent your operated leg from crossing over your body.
• Avoid squatting down to do up your shoes or socks, and use a shoehorn or a reacher to put them on.
• Avoid twisting your body while standing or bending down.

Following these precautions can help to minimise the risk of dislocation and promote a successful recovery after hip replacement surgery. Remember to always consult with your healthcare provider before resuming any physical activity or if you experience any discomfort or pain.

Home Planning

When you return home from the hospital, it is important to have a safe and comfortable environment that will support your recovery. Here are some modifications you can make to your home to help protect your new hip and ease your daily activities:

• A sturdy chair with a firm seat cushion, a straight back, and two arms can provide a stable surface for sitting and standing during your early recovery period. Make sure the chair is at the correct height so that your hips are level with or slightly higher than your knees when you sit.
• Consider installing a raised toilet seat to help reduce the amount of bending required when using the toilet. This can help to minimise stress on your hip joint during the healing process.
• A stable shower bench or chair can make bathing safer and more comfortable, especially during the early stages of your recovery. Use a long-handled sponge and a shower hose to avoid bending your hip excessively.
• A dressing stick, sock aid, and long-handled shoehorn can help you put on and take off your clothes and shoes without putting unnecessary strain on your hip joint.
• Use a reacher to pick up objects from the floor or other low surfaces without bending over. This can help to prevent excessive stress on your hip and reduce the risk of dislocation.
• Firm pillows can be placed on chairs, sofas, and car seats to help you maintain good posture and avoid excessive bending of your hip joint.
• Remove all loose carpets and electrical cords from the areas where you walk in your home to reduce the risk of falls.

By making these modifications to your home, you can create a safe and supportive environment that will help you to recover from your hip replacement surgery more quickly and comfortably. Remember to consult with your healthcare provider before making any changes to your home or resuming physical activities.

Sleeping Rules:

During the first month after being discharged, it is important to sleep with a pillow between your legs. If you lie on your non-operated leg side, make sure to place a pillow between your legs to keep them apart.

Sitting Rules:

You can start sitting within the first week after the surgery as long as your surgeon permits. However, avoid sitting for extended periods, especially during the first few days. Choose chairs with armrests and avoid low chairs. When sitting, keep your knees slightly apart to avoid excessive hip bending.

Walking Rules:

If you are using a stick, hold it in the opposite hand of your operated leg and move it forward with your operated leg. You should use the stick for about a month after discharge or longer if necessary.

If you are using crutches, remain partial weight-bearing on the crutches for six weeks after the surgery unless advised otherwise by your doctor or physiotherapist.

Stair Rules:

When walking up stairs with an injured leg, it’s important to use your good leg first, followed by your injured leg. This means stepping up with your good leg and then bringing your injured leg up to the same step. Repeat this process until you reach the top.

When walking down stairs with an injured leg, lead with your injured leg first, followed by your good leg. This means stepping down with your injured leg and then bringing your good leg down to the same step. Repeat this process until you reach the bottom.

It’s important to remember to take your time and use any necessary support, such as a handrail or crutches, to help you maintain balance and stability. If you experience pain or discomfort while going up or down stairs, take a break and rest until you feel comfortable to continue.

By following these rules, you can ensure a smoother recovery after your hip replacement surgery. Always consult with your healthcare provider before resuming any physical activity.

What to Expect from Your New Hip Replacement

After undergoing a hip replacement, many patients can enjoy a pain-free lifestyle with the help of proper care and rehabilitation. With time, patients can resume activities such as walking, hiking, bending, climbing stairs and ladders, kneeling, and even low-impact sports like golf, swimming, cycling, and social tennis. It’s important to avoid extreme positions and activities that may cause hip dislocation, but overall, patients find that they can engage in a wider range of activities that were previously limited by pain and limited mobility.

During the early stages of recovery, patients may experience numbness and stiffness, but these symptoms typically improve over time. Patients may also set off metal detectors in certain settings, but this is a minor inconvenience compared to the benefits of a pain-free and active lifestyle. To ensure the best possible outcome, it’s important to follow your healthcare provider’s instructions and attend all recommended follow-up appointments.

We wish you the best for a successful and satisfying recovery from your hip replacement.

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