Hip Replacement

Hip Replacement

Article by John Miller

What is a Hip Replacement?

Your hip is one of the body’s largest joints. It is a ball-and-socket joint. The bone surfaces of the hip joint are covered with articular cartilage, a smooth tissue that cushions the ends of the bones and enables them to move easily. When significant damage occurs to the hip joint, it may not naturally repair. When other conservative treatment forms such as physiotherapy fail to assist your hip pain, the hip joint itself may need to be replaced with a prosthetic hip joint, known as a hip replacement.

What Conditions Can Lead to a Hip Replacement?

The most common reasons for needing a hip replacement are:

Hip Osteoarthritis

  • This is an age-related “wear and tear” type of arthritis. The cartilage cushioning the bones of the hip wears away. The bones then rub against each other, causing hip pain and stiffness.

Rheumatoid Arthritis

  • This is an autoimmune disease in which the synovial membrane becomes inflamed and thickened. This chronic inflammation can damage the cartilage, leading to pain and stiffness.

Post-traumatic Arthritis

  • This can follow a serious hip injury or fracture. The cartilage may become damaged and lead to hip pain and stiffness over time.

Avascular Necrosis

  • An injury to the hip, such as a dislocation or fracture, may limit the blood supply to the femoral head. The lack of blood may cause the surface of the bone to collapse, and hip arthritis will result. Some diseases can also cause avascular necrosis, which normally requires prompt surgical attention.

Childhood Hip Disease

  • Some infants and children have hip problems. Even though the problems are successfully treated during childhood, they may still cause arthritis later on in life. This happens because the hip may not grow normally, and the joint surfaces are affected. Some conditions that can result in premature hip arthritis include Perthes diseaseSCFE and septic arthritis.

When is Hip Replacement Recommended?

There are several reasons why Your hip surgeon may recommend you a hip replacement. People who benefit from hip replacement surgery often have:

  • Investigations such as X-rays or MRI scans indicate significant injury, which requires surgery.
  • Hip pain that limits everyday activities, such as walking or bending.
  • Hip pain that continues while resting, either day or night.
  • Stiffness in a hip limits the ability to move or lift the leg.
  • Inadequate pain relief from anti-inflammatory drugs, physiotherapy, or walking supports.

What Occurs in a Hip Replacement?

In a hip replacement, the damaged bone and cartilage is surgically removed and replaced with prosthetic components.

  • The damaged femoral head is removed and replaced with a metal stem, which has a ceramic ball on the upper part of the stem and is placed into the hollow centre of the femur. The femoral stem may be either cemented or “press-fit” into the bone.
  • The damaged cartilage surface of the socket (acetabulum) is removed and replaced with a metal socket. Screws or cement are sometimes used to hold the socket in place.
  • A plastic, ceramic, or metal spacer is inserted between the new ball and the socket to smooth the gliding surface.

Post-Hip Replacement Treatment

The surgical procedure normally takes a couple of hours. Your anaesthetist will put you under general anaesthetic before your Orthopaedic Surgeon performs the surgery. After the surgery, you will be placed in recovery to safely ensure you come out of the anaesthetic. You will most likely be admitted to the hospital for 4 to 7 days, depending on your recovery.

After surgery, and in some cases before your surgery, your orthopaedic team will provide you with adequate pain medication to make you feel as comfortable as possible.

Early Priorities

Wound Care

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

Blood Clots/Deep Vein Thrombosis (DVT)

Blood clots in the leg veins or pelvis are among the most common complications of hip replacement surgery. Your orthopaedic team will outline a prevention program that will likely involve wearing compression stockings for several weeks. You may also be given blood-thinning medications, inflatable leg coverings and ankle pump exercises.

Leg-Length Difference

Sometimes after your hip replacement, one leg may feel longer or shorter than the other. Sometimes you’ll experience this leg length difference because your leg was actually shorter before the operation, which you were used to. Your Orthopaedic Surgeon will make every effort to make your leg lengths even but may lengthen or shorten your leg slightly to maximize the stability and biomechanics of the hip.

Some patients may feel more comfortable with a shoe lift after surgery. Your physiotherapist will be able to assess you after your surgery and advise you on the appropriate action required.

Precautions for Your Initial 3 Months Post-Hip Replacement

Dislocation

Your risk of hip dislocation is greatest in the first few months after surgery while the tissues are healing. Luckily, dislocation is uncommon. To decrease the risk of dislocation, the following is advised:

  • Do not sit in low chairs.
  • Keep your knees level with or below your knees.
  • Sit with your knees apart.
  • Do not squat down to do up your shoes, etc.
  • Do not bend from your hips to pick up anything.
  • Do not cross your legs.
  • Do not lie on your operated side.
  • When lying on your non-operated side, always have 2 pillows between your knees.

Home Planning

Several modifications to your home can help protect your hip in the early stages following your surgery and support your recovery. The following items may help with daily activities:

  • A stable chair for your early recovery with a firm seat cushion, a firm back, and two arms
  • A raised toilet seat
  • A stable shower bench or chair for bathing
  • A long-handled sponge and shower hose
  • A dressing stick, a sock aid, and a long-handled shoehorn for putting on and taking off shoes and socks without excessively bending your new hip
  • A reacher that will allow you to grab objects without excessive bending of your hips
  • Firm pillows for your chairs, sofas, and car enable you to sit with your knees lower than your hips.
  • Removal of all loose carpets and electrical cords from the areas where you walk in your home

Post-Hip Replacement Physiotherapy

Rehabilitation post-hip replacement starts immediately after your surgery. Sometimes even just a few hours after your operation. Your hospital physiotherapist will ensure that you are doing some early bed exercises to promote your recovery and get you back on your feet ASAP. This will ensure that you have a safe and efficient hospital discharge.

The whole rehabilitation period for a hip replacement can take between 3 to 6 months, but in some cases, it may last longer depending on your progress.

During this time, your Physiotherapist will:

  • Monitor your progress closely in the early stages.
  • Give you all the necessary advice and contraindications of your surgery.
  • Teach you specific exercises to strengthen your hip and restore movement at different stages of your hip healing.
  • Help you manage any pain you may be experiencing.
  • Help you return to walking and other normal daily activities.

Rules for Sleeping

Use an ordinary pillow between your legs for sleeping for approximately one month after discharge. You may lie on your non-operated leg side as long as you have a pillow between your legs to keep them apart.

Rules for Sitting

You are allowed to sit in the first week after the operation when your surgeon allows. The length of time you sit is determined by comfort. However, it is advisable not to sit for too long in the first few days. Remember, you must not sit in low chairs, and the chair should preferably have arms. Avoid excessive hip bend and sit with your knees slightly apart.

Rules for Walking

If you use a stick, always use your stick in hand opposite your operated leg and move your stick forward with your operated leg. The stick should be used for approximately one month after discharge or longer if necessary.

If you use crutches, you should remain partial weight bearing on crutches for six weeks after the operation unless otherwise instructed by your doctor or physiotherapist.

Rules for Stairs

You recommended that you walk upstairs on your non-operated leg first, then operated leg, then stick or crutches.

Going downstairs, lead with your stick/crutches first, then operated leg, and finally, your non-operated leg.

Tip: Good legs go UP first – Bad legs go DOWN first.

What to Expect from Your New Hip Replacement

The majority of patients achieve pain-free walking, hiking, bending, stair & ladder climbing, kneeling, crawling and return to low-impact sports such as golf, swimming, cycling, social tennis, and most gym exercises. Some activities requiring extreme flexibility (such as some yoga positions) may not be possible as it is best to avoid extreme positions and prevent dislocation of the hip.

Many younger patients can jog (at least a short distance), although this is generally not advised, as it is an activity that involves impact loads to the joint. Sexual activity can be resumed when comfortable, although not recommended in the first six weeks postoperatively.

You may feel some numbness in the skin around your incision. You also may feel some stiffness, particularly with excessive bending. These differences often diminish with time, and most patients find these are minor compared with the pain and limited function they experienced before surgery.

Your new hip may activate metal detectors required for security in airports and some buildings.

Hip Pain Treatment

A thorough analysis of WHY you are suffering hip pain from a movement, posture, or a control aspect, is vital to solving your hip pain.

Only an accurate diagnosis of the source of your hip pain can solve the pain, quickly improve your day to day function, prevent a future recurrence,  or improve your athletic performance.

The first choice of short-term therapy has been symptomatic hip treatment. This approach could include local chemical modalities such as cortisone injections or painkillers. Ice or heat could also assist along with some gentle stretching or exercise.

However, persisting hip problems will require additional investigations to assess your joint integrity or range of motion, muscle length, strength, endurance, power, contraction timing and dynamic stability control.

You should consult a healthcare practitioner who has a particular interest in hip pain and injury management to thoroughly assess your hip, groin, pelvis, lower limb and spine. Due to the kinetic chain, they all impact, especially at the high athletic performance end. A quality practitioner will educate you on your condition and combine it with exercise and manual therapy as per the Clinical Practice Guidelines. (Cibulka et al., 2017) Hip pain education should also include teaching you specific activity modification, individualised exercises, weight-loss advice (if required), and methods to unload any arthritic joints.

Recent research evidence-backed approaches have modernised physiotherapy treatment approaches to effectively managing hip pain. Together with a thorough hip assessment, your hip treatment can progress quickly to restore you to a pain-free hip and perform your regular sport or daily activities in the shortest time possible.

For specific rehabilitation advice regarding your hip pain, seek the professional advice of high quality and up-to-date physiotherapists experienced in the assessment, treatment, prevention and optimisation of hip pain and related conditions. After assessing you, they will individually prescribe therapeutic activities based on your specific needs for daily living, values, and functional activities or point you in the direction of the most suitable healthcare practitioner for you and your hip condition.

Hip Pain Treatment Options

Your hip physiotherapist may consider an extensive range of treatment options, including manual joint therapy to improve your joint mobility, muscle stretches or supportive taping. Your physiotherapist is also likely to add strengthening and hip joint control exercises as they deem appropriate for your specific functional and sporting needs. Please consult with them for advice.

Acute Injury Signs

Acute Injury Management.

Here are some warning signs that you have an injury. While some injuries are immediately evident, others can creep up slowly and progressively get worse. If you don't pay attention to both types of injuries, chronic problems can develop.

For detailed information on specific injuries, check out the injury by body part section.

Don't Ignore these Injury Warning Signs

Joint Pain

Joint pain, particularly in the knee, ankle, elbow, and wrist joints, should never be ignored. Because these joints are not covered by muscle, pain here is rarely of muscular origin. Joint pain that lasts more than 48 hours requires a professional diagnosis.

Tenderness

If you can elicit pain at a specific point in a bone, muscle, or joint, you may have a significant injury by pressing your finger into it. If the same spot on the other side of the body does not produce the same pain, you should probably see your health professional.  

Swelling

Nearly all sports or musculoskeletal injuries cause swelling. Swelling is usually quite obvious and can be seen, but occasionally you may feel as though something is swollen or "full" even though it looks normal. Swelling usually goes along with pain, redness and heat.

Reduced Range of Motion

If the swelling isn't obvious, you can usually find it by checking for a reduced range of motion in a joint. If there is significant swelling within a joint, you will lose range of motion. Compare one side of the body with the other to identify major differences. If there are any, you probably have an injury that needs attention.

Weakness

Compare sides for weakness by performing the same task. One way to tell is to lift the same weight with the right and left sides and look at the result. Or try to place body weight on one leg and then the other. A difference in your ability to support your weight is another suggestion of an injury that requires attention.

Immediate Injury Treatment: Step-by-Step Guidelines

  • Stop the activity immediately.
  • Wrap the injured part in a compression bandage.
  • Apply ice to the injured part (use a bag of crushed ice or a bag of frozen vegetables).
  • Elevate the injured part to reduce swelling.
  • Consult your health practitioner for a proper diagnosis of any serious injury.
  • Rehabilitate your injury under professional guidance.
  • Seek a second opinion if you are not improving.