The hip joint, a ball-and-socket joint, is one of the body’s largest and most vital joints.

The ball, or femoral head, fits into the socket, known as the acetabulum, which is part of the pelvis. This joint is responsible for bearing the body’s weight and allowing a wide range of movement.

Several conditions can lead to hip damage, including:

Osteoarthritis: The most common cause of hip damage. It occurs when the cartilage that cushions the hip joint wears away, leading to bone-on-bone contact, pain and inflammation.
Rheumatoid Arthritis: An autoimmune disorder that causes chronic inflammation of the joints, including the hip, leading to pain, swelling and joint destruction.
Avascular Necrosis: This condition occurs when the blood supply to the femoral head is disrupted, causing the bone to die and collapse. Secondary Osteoarthritis and pain result from this.
Hip Fractures: Displaced intra-capsular fractures, particularly in older adults, can damage the hip joint, sometimes necessitating total hip[ replacement.
Hip Dysplasia: A congenital condition where the hip joint does not develop properly, leading to increased wear and tear on the joint and secondary osteoarthritis and pain.
Trauma: Injuries from accidents or sports can lead to hip damage, sometimes requiring surgical intervention.

5 Deciding Factors for Hip Replacement Surgery

Hip replacement surgery is usually considered when conservative treatments, such as physiotherapy, pain relieving medications or steroid injections are no longer effective in relieving pain and maintaining function.

Several factors influence the decision to undergo hip surgery:

Severity of Pain: Persistent, severe pain that limits daily activities and affects quality of life.
Mobility Limitations: Difficulty walking, climbing stairs or performing routine tasks.
Joint Deformity: Visible deformities or stiffness that impede movement.
Age and Activity Level: While there is no specific age limit, younger patients may need to consider the longevity of the artificial joint, as it may wear out over time.
Overall Health: Patients must be in good enough health to undergo surgery and anaesthesia. Chronic conditions such as heart disease or diabetes may require special consideration.

How Hip Surgery Is Performed in 5 Key Steps

Total hip replacement surgery typically lasts 1 to 2 hours and involves several key steps:

Anaesthesia: The patient is given either general anaesthesia (put to sleep) or spinal anaesthesia (numbing the lower body).
Incision: A surgical incision is made on the side of the hip to access the joint.
Removing the Damaged Joint: Mr Stitson removes the damaged femoral head and prepares the acetabulum by removing the worn cartilage and any bone spurs using specialist instruments.
Implanting the Prosthetic Joint: The acetabulum is fitted with a metal socket and a plastic or ceramic liner is placed inside it. The femoral component, a metal stem with a ball on top, is inserted into the femur. The ball fits into the socket, recreating the joint. The components may be cemented or un-cemented. In the latter case, the patient’s own bone grows into the component creating ‘biological’ fixation. Mr Stitson will discuss which is most suited to your situation.
Closing the Incision: Mr Stitson closes the incision with stitches or staples and applies a dressing.

Hip Surgery Recovery Recommendations

Post-surgery recovery is crucial for a successful outcome. Here are some general recommendations:

Hospital Stay: Patients typically stay in the hospital for 1-2 days, during which time they begin physio.
Pain Management: Pain and swelling are managed with medications, ice and compression. Patients will be prescribed blood thinners to prevent clots. You will also have calf or foot pumps to promote venous circulation while in bed in hospital.
Physiotherapy: Starting on the day of surgery, or the day after, physio is essential to restore function, mobility and muscle strength around the hip. Patients will learn exercises to continue the process once at home
Mobility Aids: Crutches, a walking frame or sticks may be needed for the first 6 weeks post-hip replacement.
Home Care: Modifications such as installing grab bars, using a raised toilet seat and removing trip hazards are often necessary and advice will be provided.
Follow-Up Visits: Regular follow-up appointments ensure the hip is healing properly and allow Mr Stitson to monitor for complications. The first follow-up is usually at 6-weeks.

Essential Post-Hip Surgery Exercises

Hip rehabilitation exercises play a key role in recovery. Here are some common exercises recommended after hip replacement surgery:

Ankle Pumps: Moving the foot up and down helps improve circulation and prevent blood clots.
Quadriceps Sets: Tightening the thigh muscles without moving the leg helps maintain muscle tone.
Gluteal Squeezes: Contracting the buttock muscles helps strengthen the hip area.
Heel Slides: Sliding the heel towards the buttocks while lying down aids in restoring knee and hip mobility.
Leg Raises: Lifting the leg while keeping the knee straight helps build strength in the hip and thigh muscles.
Standing Hip Abductions: Standing and lifting the leg to the side without rotating the hip helps improve balance and muscle strength.

It is essential to discuss all your options with Mr Stitson, who can guide you through the treatment process and advise on how you can achieve the best possible outcome.

Risks of Hip Replacement Surgery

While hip replacement surgery is generally safe, it does carry some risks:

Infection: Post-operative infections can occur around the incision or deep within the joint (approx 1%).
Blood Clots: Clots can form in the leg veins (deep vein thrombosis) and potentially travel to the lungs (pulmonary embolism). Blood thinners are prescribed for approximately 35 days post-op top reduce the risk.
Dislocation: The new joint can become dislocated, particularly in the early stages of recovery ( approx. 1%) risk. Hip precautions will be explained by the physio to help reduce the risk.
Injury to Vessels and Nerves: The risk is small and will be explained pre-operatively.
Leg Length Discrepancy: Occasionally, the operated leg may become slightly longer or shorter than the other.
Bleeding and Fracture. Can occasionally occur during THR surgery
Death: There is a slight increase in mortality from all causes within the first 90 days of joint replacement surgery. Risk varies with age and the presence of additional health conditions.
Prosthesis Wear and Loosening: Over time, the artificial joint may wear out or become loose, requiring revision hip surgery.

About Hip Surgery

Hip replacement surgery replaces the worn-out, painful and stiff hip joint with a new prosthetic joint. This procedure is normally performed under spinal anaesthesia and is commonly followed by a night or two in the hospital. Day-case hip replacement surgery may be an appropriate option for you.

The Nuffield Plymouth CQC Rating

The Nuffield Hospital has a history that spans over half a century and has built a reputation for high standards of care, professionalism and expertise in delivering health services. They aim for continuous quality improvement in everything they do.

Active Quality and Governance programmes are in place at the Nuffield Hospital Plymouth. As part of this, the hospital is inspected by independent healthcare regulators to ensure it meets the fundamental standards of quality and safety as determined by the regulating body (CQC).

In the most recent inspection, Plymouth Nuffield Hospital was rated as ‘Good’ overall, however, the surgical element of the inspection was rated as ‘Outstanding’. The hospital was referred to as:

“Outstanding in effective and caring, and
Good in safe, responsive and well-led.”

Total Hip Replacement Surgery – 5 Deciding Factors [+ Recovery Recommendations]

The hip joint, a ball-and-socket joint, is one of the body’s largest and most vital joints.

5 Deciding Factors for Hip Replacement Surgery

David Stitson, Consultant Orthopaedic Surgeon in Plymouth

How Hip Surgery Is Performed in 5 Key Steps

Total hip replacement surgery typically lasts 1 to 2 hours and involves several key steps:

Anaesthesia: The patient is given either general anaesthesia (put to sleep) or spinal anaesthesia (numbing the lower body).

Incision: A surgical incision is made on the side of the hip to access the joint.

Removing the Damaged Joint: Mr Stitson removes the damaged femoral head and prepares the acetabulum by removing the worn cartilage and any bone spurs using specialist instruments.

Closing the Incision: Mr Stitson closes the incision with stitches or staples and applies a dressing.