Hip Replacement

Overview

A hip replacement is an operation that swaps a worn-out or damaged hip joint for a new one made of metal, plastic or ceramic parts. Your hip is a ball-and-socket joint: the round top of your thigh bone sits inside a hollow in your pelvis. When the smooth cartilage covering these surfaces wears away, bone rubs on bone, which causes pain and stiffness. During the operation, the surgeon removes the damaged parts and fits an artificial joint, called an implant or prosthesis. The aim is to ease pain and help you move more easily again.

Yes, it is very common. More than 100,000 hip replacements are carried out in the UK each year, and millions of people around the world have had one. It is one of the most reliable operations in medicine for improving quality of life.

It is most often done for people in their 60s, 70s and 80s, because wear-and-tear arthritis becomes more likely with age. But younger adults sometimes need one too, for example after a serious injury, hip disease in childhood, or arthritis that started early. The decision is based on how much pain and disability you have, not on your age alone.

Symptoms

Common symptoms

• Pain in the groin, front of the hip, or sometimes the outer hip or buttock
• Stiffness that makes it hard to put on socks, cut toenails or get out of a low chair
• Pain that gets worse with walking, standing or climbing stairs, and eases with rest
• Limping, or feeling that one leg is 'not working properly'
• Grinding, clicking or catching sensations in the hip
• Pain that wakes you at night or stops you lying on that side
• Feeling unsteady, or being less able to walk distances you used to manage

Symptoms in children

• Hip replacement is very rarely done in children, because a child's bones are still growing. Children with hip problems are usually treated in other ways first.
• Conditions that can lead to hip trouble later in life include hip dysplasia (a hip that did not form properly at birth), Perthes' disease and a slipped growth plate in the hip.
• A child with hip problems may limp, complain of knee or thigh pain, or walk on tiptoes, so it is worth having them checked.

Symptoms in older adults

• Pain that limits how far you can walk, or that makes you stop and rest often
• Needing to use a stick or hold on to furniture to get around
• Falls or near-falls, especially if the hip feels weak or gives way
• Pain at night that disturbs sleep
• Stiffness after sitting, which makes the first few steps difficult
• Less confidence going out, which can lead to feeling isolated

Causes

Main causes

• Osteoarthritis (wear-and-tear arthritis) of the hip, where the smooth cartilage covering the joint wears away over time
• A broken hip (hip fracture), usually after a fall, especially in older adults with thin bones
• Rheumatoid arthritis or other inflammatory joint diseases that damage the joint lining
• Hip dysplasia, where the hip joint did not form properly, which can lead to early wear
• Avascular necrosis, where the blood supply to the ball of the hip is lost and the bone collapses
• After-effects of a previous hip injury or hip surgery in childhood

Risk factors

• Getting older, because joints wear with age
• Being overweight, which puts extra load on the hip
• A family history of hip arthritis or hip replacement
• Previous injury or surgery to the hip
• Heavy physical work or high-impact sports over many years
• Conditions that affect the shape of the hip or how the bones develop
• Weaker bones (osteoporosis), which raise the chance of a hip fracture after a fall

When to see a doctor

See a doctor urgently if:

• You have hip pain after a fall or injury and cannot bear weight on the leg
• You have sudden severe hip pain with a leg that looks shortened or turned outwards
• You have pain in the calf with swelling or warmth, or any chest pain or breathlessness
• You have a wound from hip surgery that is red, hot, leaking, or you feel feverish and unwell

Book a routine appointment if:

• Hip pain or stiffness has been building up over weeks or months
• Pain is limiting how far you can walk, or waking you at night
• You are taking pain relief more often, or it no longer seems to help
• You feel unsteady on your feet, or you have had a fall
• You want to talk about whether surgery might be right for you

Diagnosis

A doctor will usually start by asking about your pain: where it is, when it started, what makes it better or worse, and how it affects your walking, sleep and daily activities. They will watch you walk and move your hip to see how far it moves and what is tender. If the pattern fits a hip problem, they may arrange an X-ray. Most people do not need complicated tests.

Tests that may be done

• A physical examination of your hip, leg, walking pattern and posture
• An X-ray of the hip, which shows joint damage, arthritis, or a fracture
• A blood test if the doctor suspects inflammation or infection
• An MRI or CT scan in some cases, for example if X-rays are not clear or a different problem is suspected
• Sometimes a referral to an orthopaedic specialist (a bone and joint surgeon) for an opinion about surgery

What to expect at your appointment

You may be referred to a specialist hip clinic, where a surgeon reviews your X-rays and examines you. The conversation is usually two-way: you will talk about how much pain you are in, what you can no longer do, what the operation involves, and what recovery will mean for your life. You do not have to decide straight away. It is a good idea to write down your questions beforehand, and you are welcome to bring someone with you.

Treatment

Treatment usually starts without surgery. Keeping active, staying at a healthy weight, physiotherapy and pain relief help many people manage for months or years. If pain and stiffness still get in the way of everyday life, an operation is the next step. Hip replacement is a planned operation, so you and your care team can take time to decide.

Self-care at home

• Keep moving: short, regular walks and gentle hip exercises can keep muscles stronger and reduce stiffness
• Stay at a healthy weight to take some of the load off the joint
• Use a stick, walking pole or handrail if it helps you stay steady and walk further
• Try low-impact activity such as swimming, cycling or using an exercise bike
• Adapt your home to make life easier, such as a raised chair or a seat in the shower
• Spread activity through the day and rest before you get too tired
• Ask your pharmacist or GP about suitable pain relief and whether it is safe for you

Medical treatments

Your care team may suggest several approaches before considering surgery. These can include physiotherapy to strengthen the muscles around the hip and improve movement, pain relief from your GP or pharmacist, weight management support, and walking aids. Some people are offered an injection into the joint to calm inflammation and give temporary relief. Stronger pain medicines are sometimes used for a short time, but they are not a long-term answer for most people. Your doctor will discuss what is safe for you, taking your other health conditions into account.

When is surgery considered?

Surgery may be recommended when hip pain is severe, keeps you awake at night, makes walking difficult, or stops you doing the things you need or enjoy, and other treatments have not helped enough. There are different types of operation, such as replacing the whole hip or only part of it. The surgeon will explain the options, the risks and what recovery will involve. You will usually be asked to prepare beforehand: a check-up, sometimes blood tests, advice on medicines, and exercises to do before and after the operation. Most people go home a few days after surgery and use crutches or a walking frame while they heal.

Living with this condition

In the first weeks after surgery you will need help with everyday tasks such as shopping, cooking and housework. You may be given rules for a while about how far to bend and turn the new hip, and advice on how to sit, stand and get in and out of bed safely. Most people use a stick, crutches or a frame at first and gradually need less support. Many people are back to gentle daily activities within a few weeks, but full recovery - including strength and stamina - commonly takes three to six months and sometimes longer. Before surgery, many people find that planning ahead and pacing themselves makes daily life easier.

Lifestyle tips

• Follow your physiotherapy exercises, even on days when you feel well - they are what build strength back up
• Build activity up gradually, and avoid heavy lifting or twisting for as long as your team advises
• Ask your team when you can drive again; most people need to wait several weeks and check they can do an emergency stop comfortably
• Talk to your employer about a phased return to work; desk-based jobs are often easier to return to than manual work
• Keep your home clear of tripping hazards, especially in the early weeks
• See your dentist and take care of your teeth, and tell any dentist or doctor that you have a joint implant
• Attend your follow-up appointments so your recovery can be checked

Diet and exercise

There is no special diet that repairs a hip joint, but eating well supports healing and helps you keep a healthy weight. Aim for plenty of fruit and vegetables, protein such as beans, eggs, fish or lean meat, and enough calcium and vitamin D for bone health - your GP or pharmacist can advise on supplements if needed. Keep hydrated and eat enough fibre, as pain relief and reduced activity can cause constipation. For exercise, walking is one of the best things you can do, alongside the specific exercises your physiotherapist gives you. Swimming and cycling are friendly to the hip. Build up slowly and stop if something causes sharp pain.

Mental health and emotional wellbeing

Long-term hip pain can wear you down, and it is very common to feel low, frustrated or anxious when pain limits what you can do. Waiting for surgery, and recovering from it, can also test your patience. These feelings are normal and worth mentioning - to your GP, your care team or someone you trust. Getting good sleep, staying in touch with friends and family, and setting small goals can help. If you are struggling with your mood, support is available, and asking for it is a sign of strength.

Prevention

Not all hip replacements can be prevented - some are needed because of a fracture or a hip that never formed normally. But you can lower your chance of hip arthritis getting worse. Keeping active, staying at a healthy weight, strengthening the muscles around the hip, and protecting your bones all help. If you have hip pain, getting advice early can help you manage it well for longer.

Vaccines

There is no vaccine that prevents hip arthritis or hip damage. Your care team may suggest routine vaccinations before surgery, or an annual flu vaccination, because staying well matters if you are preparing for an operation. Ask your GP or pharmacist what is recommended for you.

Screening programmes

There is no national screening programme for hip arthritis. Hip problems are found when you see a doctor about pain, stiffness or trouble walking, and an X-ray can be arranged if needed. If you have weaker bones, your doctor may assess your bone health and talk about ways to reduce your risk of a fracture.

Complications

If left untreated

• Pain that gradually gets worse and starts to limit walking, sleep and everyday tasks
• Increasing stiffness, so the hip moves less and daily activities become harder
• Muscle weakness and a lasting limp
• More reliance on walking aids, and less confidence going out
• A higher chance of falls, which can lead to a broken hip
• Strain on the other hip, knees and back as you change how you walk
• Effects on mood, sleep and social life as activities drop away

Long-term outlook

Hip replacement is one of the most successful operations there is. Most people get a big reduction in pain and find walking, sleeping and daily life much easier. Recovery takes time and effort, and the first few weeks can feel slow, but steady progress is normal. Modern implants commonly last 15 to 25 years or more. Like any operation there are risks, and your surgical team will talk them through with you so you can decide together what is right. Whatever stage you are at, there is good help available - and plenty of reason to feel hopeful.

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