17102 Hip Replacement

Overview

A hip replacement is an operation to replace a worn-out or damaged hip joint with an artificial one, often called an implant or prosthesis. 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 surfaces that let it move easily become damaged, moving can become painful and stiff. In a hip replacement, the surgeon removes the damaged parts and fits new metal, plastic or ceramic parts so the joint can move smoothly again. Hip replacement is usually done when other treatments no longer keep the pain and stiffness manageable.

Yes. Hip replacement is one of the most frequently performed operations, with many thousands carried out every year in countries such as the UK. It is a routine procedure for most hospitals and surgical teams.

It is most often done for people in their 60s, 70s and 80s, because wear-and-tear arthritis becomes more common with age. However, younger adults sometimes need a hip replacement too — for example after a hip injury, or because of conditions such as hip dysplasia or a condition where the hip bone loses its blood supply. Children almost never have a full hip replacement, because their bones are still growing.

Symptoms

Common symptoms

• Pain in the groin, the front of the hip or the outer side of the hip, sometimes spreading to the thigh or knee
• Pain that is worse when walking, standing or going up and down stairs
• Stiffness, especially first thing in the morning or after sitting for a while
• A limp, or feeling that one leg is shorter than the other
• Being able to walk less far than before
• Pain that disturbs sleep or is there even when resting
• Trouble putting on socks and shoes, cutting toenails, or getting in and out of a low chair or car
• A grinding or catching feeling in the hip

Symptoms in children

• Hip problems in children are usually different from adult arthritis and are treated in their own ways
• A full hip replacement is rarely done in children because the bones are still growing; surgeons usually prefer other options until growth has finished
• Children with hip conditions may limp, complain of groin or knee pain, or walk in an unusual way — these should always be checked by a doctor

Symptoms in older adults

• The same pain and stiffness as above, often alongside reduced balance and a higher chance of falls
• Pain that makes it hard to keep active, which can lead to muscle weakness over time
• Sometimes a broken hip after a fall, which may need an operation
• Recovery after surgery can take a little longer, and planning for support at home before the operation helps a great deal

Causes

Main causes

• Osteoarthritis — wear and tear of the smooth cartilage that cushions the hip joint; this is by far the most common reason
• Inflammatory arthritis, where the body's immune system attacks the joint linings
• A hip fracture, or a break that has not healed properly
• A condition where the blood supply to the ball of the hip is lost, causing the bone to break down (often called avascular necrosis)
• Hip dysplasia, where the hip joint did not form normally in childhood
• Damage after an earlier injury or hip operation
• Less common causes such as certain bone diseases or growth problems

Risk factors

• Getting older — joint wear becomes more common with age
• A family history of hip problems or hip replacement
• Being overweight, which puts extra load on the hips
• A previous injury or operation on the hip
• Jobs or sports that involve a lot of heavy lifting, impact or twisting
• Smoking, which can slow healing and affect bone health
• Conditions such as diabetes or long-term inflammatory arthritis

When to see a doctor

See a doctor urgently if:

• Fever, shivering or feeling very unwell after hip surgery
• A wound that is red, hot, leaking fluid or opening up
• Sudden severe hip pain, or being unable to put weight on the leg
• Swelling, pain or redness in the calf
• Chest pain or breathing problems — call your local emergency number first

Book a routine appointment if:

• Hip pain or stiffness that has lasted more than a few weeks or keeps coming back
• Pain that is limiting your walking, work, sleep or everyday activities
• A limp, or a feeling that one leg is getting shorter
• You are finding it harder to get around or look after yourself
• You want to talk about treatment options, including whether surgery is right for you
• You have had a hip replacement and are worried about your progress, or your recovery feels slower than you expected

Diagnosis

A doctor will start by asking about your pain, how it affects your daily life, and your general health. They will then examine your hip — checking how far it moves, how you walk, and whether other areas such as your back or knee are causing the trouble. Based on this, they may arrange an X-ray. If you are considering surgery, you will also have a pre-operative assessment to make sure you are fit and ready for the operation.

Tests that may be done

• A physical examination of your hip, legs and walking pattern
• An X-ray of the hip, which usually shows how much the joint has worn
• Sometimes a scan such as an MRI or CT scan for more detail
• Blood tests to check your general health and look for inflammation or infection
• A pre-operative assessment before surgery, which may include heart and lung checks, a review of your medicines, and sometimes a wound swab test

What to expect at your appointment

None of the tests are usually painful. An X-ray takes only a few minutes. If surgery is being considered, you will be told what will happen, how long you may stay in hospital, and what help you may need at home afterwards. It is a good idea to bring a list of your medicines and any questions you have.

Treatment

Treatment usually starts with non-surgical options, and surgery is considered when pain and stiffness are seriously affecting your quality of life. The best plan depends on your age, general health, how much the joint is worn, and what matters most to you. Your healthcare team will help you decide.

Self-care at home

• Stay as active as you can — short, regular walks and gentle hip and thigh exercises help keep muscles strong
• Keep to a healthy weight to reduce strain on the hips; even modest weight loss can help
• Use a walking stick or aids if they help you get around more comfortably
• Try warm or cold packs on the hip for comfort
• Pace your activities and build in rests, rather than doing everything in one go
• Change position regularly and avoid sitting for long stretches
• Wear supportive, comfortable shoes
• Practise the exercises your physiotherapist gives you — they are a key part of both preparing for and recovering from surgery

Medical treatments

Doctors may suggest pain-relieving medicines, given in the lowest dose that helps, along with advice on how to use them safely. A physiotherapist can teach strengthening and movement exercises and suggest aids such as a stick or walking frame. Some people are offered an injection into the hip joint to ease pain for a while. For some, a referral to a specialist hip team is the next step to discuss surgery. Your doctor or pharmacist can explain the options and their pros and cons in detail.

When is surgery considered?

A hip replacement is usually considered when hip pain and stiffness are significantly affecting your sleep, walking, work or independence, and other treatments have not helped enough. It may also be needed sooner after a hip fracture. The decision is made together with your surgical team, weighing up the likely benefits against the risks, and what matters most to you.

Living with this condition

Before surgery, many people find day-to-day life easier with simple changes — a raised chair, a grabber to pick things up, a shower stool, and help with heavier chores. After surgery, you will usually be up and walking with help within a day or so. You may need crutches or a frame for a few weeks. Most people need a little help at home for the first couple of weeks. Follow the movement advice your team gives you — for example, how to sit, bend and get in and out of bed — to protect the new joint.

Lifestyle tips

• Build gentle activity into each day and increase gradually
• Avoid heavy lifting, twisting and high-impact sports until your team says it is safe
• Low-impact activities such as walking, swimming and cycling are often encouraged once you have recovered
• Keep up your physiotherapy exercises even when you feel better
• Plan for help with shopping, housework and transport in the early weeks
• Ask about when you can return to work, sport and driving — it varies from person to person

Diet and exercise

Eating a balanced diet with enough protein, calcium and vitamin D supports healing and bone health. Fibre and plenty of fluids help prevent constipation, which is common after surgery. Gentle movement is just as important: short, frequent walks and the exercises from your physiotherapist help keep muscles strong and reduce the risk of blood clots. Build up slowly and stop if something causes sharp pain — and check with your team if you are unsure.

Mental health and emotional wellbeing

It is very normal to feel anxious before surgery, and to feel frustrated or low during recovery. Some people have a dip in mood a few weeks in, when progress feels slow. Talk to your doctor or nurse about how you feel — this is part of your care, not a sign of weakness. If you ever feel you cannot keep yourself safe, contact your local emergency number or a crisis helpline in your country straight away.

Prevention

You cannot always prevent the joint wear that leads to hip replacement, since age, genes and some conditions are outside your control. But you can lower your risk and protect your hips: keep to a healthy weight, stay physically active with low-impact exercise, build strong muscles around the hips, avoid smoking, and warm up properly if you do heavy or high-impact activity. If you already have hip pain, getting advice early can help you stay active for longer.

Screening programmes

There is no routine screening test for hip arthritis. X-rays are only used when you have symptoms and your doctor thinks they are needed.

Complications

If left untreated

• Pain and stiffness that gradually get worse
• Reduced walking distance and difficulty with stairs, shopping or housework
• Muscle weakness around the hip, and a more pronounced limp
• A higher risk of falls
• Loss of independence, and needing more help from others
• Disrupted sleep and low mood
• Weight gain as activity becomes harder

Long-term outlook

Most people who have a hip replacement get good relief from pain and find it easier to move around. Like any operation, it carries some risks, such as infection, blood clots, bleeding, a joint that comes out of place, or wear of the implant over many years — your surgical team will explain these in full. Recovery takes time and patience, and many people notice steady improvement over weeks and months, with a good quality of life afterwards.

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