Hip replacement and hip revision
- Mr Geza Kordas, Consultant Orthopaedic Surgeon
- Rachael Mayfield-Blake, Freelance Health Editor
Hip replacement surgery is a procedure to replace your hip joint with artificial parts when your joint is damaged.1 This will help to reduce pain and improve your movement.
A hip revision is a repeat hip replacement operation. It will replace your artificial hip joint if this:
- has become loose
- is worn out or infected
- keeps dislocating (loosen through wear and tear and come out of position)
About hip replacement
You may be offered a hip replacement if you have arthritis in your hip and have a lot of pain. Osteoarthritis is the most common cause of hip pain. It happens when the cartilage in your hip wears out, which causes pain and stiffness.
Artificial hips are usually made from either metal and plastic or ceramic and plastic. Your surgeon will speak to you about the best type of hip replacement for you.
Your hip joint is a ball-and-socket joint. During hip replacement surgery, the ball of your hip joint is removed. A metal stem is placed in your thighbone and a metal or ceramic head is attached at the top. The socket is replaced with a metal shell and a plastic or ceramic insert, or a plastic cup.
After a while, artificial hip joints can loosen or wear out and may need to be replaced. But for more than half of people who have a hip replaced, the joint will last for around 25 years.
Before deciding to have surgery, it’s important to think about if it’s right for you. Your doctor can discuss if there are any alternatives and help you to decide.
About hip revision
After many years, hip replacement joints can loosen through wear and tear and may come out of position (dislocate). Sometimes they can become infected. If any of this happens, you may need to have the joint replaced again. This is called a hip revision.
Hip revision surgery is more complicated than the original hip replacement surgery. Your surgeon will need to take out the existing artificial hip joint and may need to reconstruct some of your bone. This can make the operation and recovery longer and complications more likely.
Preparation for hip replacement and hip revision
Your surgeon will explain how to prepare for your operation. If you smoke, try to stop because smoking increases your risk of complications, and can also slow down healing and recovery.
Aim to follow a healthy lifestyle in the weeks and months before your operation. Be active, lose any extra weight and eat healthily; these actions will all help your recovery. Your hospital may give you some exercises to do before your hip replacement operation.
You may need to wear compression stockings before and after your operation to help prevent blood clots forming in the veins in your legs. You may also need to take tablets or have injections of an anticlotting medicine as well as or instead of compression stockings.
You should see an occupational therapist and/or a physiotherapist before your operation. They’ll help you with preparing for your recovery and how to manage at home afterwards.
Your surgeon or nurse will give you information about your hip replacement or revision operation and your recovery. It’s important to read this because it will help you prepare well and aid your recovery. Some hospitals have a ‘joint school’, either in person or online, where you can learn about what to expect from a hip replacement.
Your operation can be done under spinal or epidural anaesthesia. This completely blocks feeling from below your waist, but you’ll stay awake during the operation. But you can also have a sedative to help you feel relaxed and drowsy. Or you may be able to have the operation under general anaesthesia, which means you’ll be asleep during the operation.
An anaesthetic can make you sick so it's important that you don't eat or drink anything for a time before your operation. Follow your doctor's advice. If you have any questions, just ask.
Your surgeon will discuss with you what will happen before, during and after your surgery. If you’re unsure about anything, don’t be afraid to ask. No question is too small. It’s important that you feel fully informed, so you feel comfortable to give your consent for the operation to go ahead. You’ll be asked to sign a consent form.
Hip replacement and hip revision procedure
A hip replacement operation usually takes about an hour. Hip revision surgery takes longer. Hip replacements are usually big operations. Sometimes hip replacement can be done as what’s called ‘minimally invasive’ surgery through smaller cuts, but this isn’t suitable for everyone. This kind of operation potentially causes less damage to the surrounding muscles and tendons.
During open hip replacement surgery, your surgeon will make a cut (between 8 and 20cm long) over your hip and thigh. They’ll then divide your hip muscles and separate (dislocate) your ball-and-socket hip joint.
Your surgeon will replace both the ball and socket parts of your hip joint. They’ll remove the ball at the top of your thigh bone and put in a replacement on a long stem. This can either be fitted tightly into the inside of your thigh bone or sometimes it’s ‘glued’ in using a type of cement. Your surgeon will prepare the bony socket of your own hip to accept the hip replacement cup. Then your surgeon will then put your hip joint back together (they’ll fit the ball into the socket).
Finally, your surgeon will close the cut in your skin with stitches, staples or glue and cover it with a dressing.
If you’re having hip revision surgery, your surgeon will need to remove the old artificial hip joint before putting in the new one.
Aftercare for hip replacement and hip revision
After surgery, you may feel some discomfort or pain as the anaesthetic wears off. You'll be offered pain relief if you need it. You may not be able to feel or move your legs for several hours after a spinal or epidural anaesthetic.
You may have a pad or pillow between your legs to hold them apart and keep your hip joint in one position. This will help to stop your hip from moving out of position (dislocating).
Getting up and starting to walk early on is an important part of your recovery. A physiotherapist or occupational therapist will visit you quite soon after your operation and will see you regularly afterwards. They’ll get you up and out of bed and give you some exercises to do. They’ll give you a walking frame or crutches to help you walk.
You may need to take iron supplements to help your recovery because it’s normal to lose some blood during the operation.
You’ll need to stay in hospital until you're ready to go home. For some people, this can be just a day or two, but for others it may be four to eight days. When you're ready to go home, make sure someone can take you.
You’ll have a wound on your hip and thigh. If it’s closed with staples or stitches, you may need to keep your wound covered until these are taken out but check with your hospital. A nurse at your GP surgery will remove your stitches after about 10 days. If you have dissolvable stitches, they won’t need to be removed.
Recovery following hip replacement and hip revision
Everyone recovers differently from hip replacement or revision surgery. And it may also differ between sides if you need to have both hips replaced. Many people feel quite tired after a big operation like this, and you might feel like you want to just rest. The important thing is to keep moving but to pace yourself and build up activity gradually. Walk every day and keep doing the exercises you’re given to help you recover well. Full recovery from a hip replacement or revision can take up to a year, though most of the healing happens in the first three months.
- In the first week or so after the operation, you’re likely to have some pain and discomfort, as well as swelling and bruising. Try not to sit for long periods. Walk regularly then lie down to help any swelling go down. Take over-the-counter painkillers if and when you need them. Always read the patient information leaflet that comes with your medicine and if you have any questions about your medicines, ask a pharmacist.
- By the second week after your operation, you’ll probably feel a lot better, and you may be able to walk with just a stick. You may need to carry on with crutches for a while though. As time goes on, you’ll probably be able to do more and more. But to begin with, ask friends or family to help you with daily tasks like shopping.
- In the first eight to 12 weeks after surgery you’ll need to take extra care of your hip, to prevent it from dislocating. Don’t cross your legs, for example, and do put a pillow between your legs when you sleep on your side. Your physiotherapist or occupational therapist will tell you what you need to do.
- By around six to eight weeks, you should be able to walk as you usually would, as well as swim or cycle. If you do activities that involve twisting and turning, such as golf or dancing, wait until three months after surgery before you start them again.
It’s important to follow the advice your surgeon and physiotherapist give you because it will be specific to you.
Work and driving
If your job is office based or is physically light work, you can usually go back to work after a few weeks. If you can work from home, you may be able to return to work sooner. But if your work involves a lot of walking, standing or lifting, you may need to stay off for longer – perhaps up to three months. Ask your GP or occupational health advisor for advice.
You should be able to drive after about six weeks if you can do an emergency stop. If you had a left hip replacement and drive an automatic car, you may be able to drive within a few weeks. But check with your surgeon and car insurer. Don’t drive while taking any medicines that make you drowsy. Getting in and out of a car as a passenger can be difficult for the first few weeks. Your therapist may suggest you sit sideways on the seat and swing both your legs around together to get in and out.
Side-effects of hip replacement and hip revision
Side-effects of hip replacement surgery include:
- bruising around your hip, which may spread to your calf or foot
- pain around your scar for the first few days
- a sore hip and leg for a few weeks – if this gets worse speak to your doctor because it can be a sign of a blood clot in your leg (deep vein thrombosis)
- swelling in your leg – this might last for several weeks
- constipation for a few days after surgery caused by painkiller medicines – some people don’t have a poo for two to four days afterwards
- tiredness, which can take a few weeks to get better
Complications of hip replacement and hip revision
As with any surgery, there are some risks involved and complications from the operation are possible. But most people don’t get serious complications after hip replacement surgery. You’re more likely to have complications after a hip revision than if you’re having the joint replaced for the first time.
The main hip replacement complications include the following.
- The joint can move out of position (dislocate). If this happens, you may need another operation to put it back in place.1 A dislocation is more likely to happen after hip revision.
- A blood clot in your lower leg or in your lungs.
- Damage to nearby nerves or blood vessels.
- An infection around the new joint. Although this is unusual, it can be serious and your new hip may need to come out. It’s more likely to happen after hip revision surgery. Your surgeon may prescribe antibiotics during and after surgery to help prevent this.
- Difference in leg length. One leg may be slightly longer than the other after surgery.
- Loosening of the joint and hip fracture. The artificial joint can become loose over many years, which can cause the bone around it to become thin and break.
- A limp after hip revision surgery. This can get better over time, but sometimes it’s permanent.
- Ongoing pain. But this is rare.
Alternatives to hip replacement
Your surgeon will only recommend a hip replacement if other treatments – for example, changes to your lifestyle, physiotherapy and taking painkillers – haven’t worked.
It’s possible you could have a hip resurfacing operation rather than a conventional hip replacement. This involves removing the damaged bone and covering the surfaces of the ball and socket of your joint with metal caps. Ask your surgeon if this is an option for you.
Physiotherapy services
Our evidence-based physiotherapy services are designed to address a wide range of musculoskeletal conditions, promote recovery, and enhance overall quality of life. Our physiotherapists are specialised in treating orthopaedic, rheumatological, musculoskeletal conditions and sports-related injury by using tools including education and advice, pain management strategies, exercise therapy and manual therapy techniques.
To book or to make an enquiry, call us on 0330 127 7805
You’re likely to need a hip replacement if you have severe hip pain, stiffness, and limited movement – and other treatments haven’t worked. These might include physiotherapy, making lifestyle changes and taking painkillers.
For more information, see our sections about hip replacement and about hip revision.
It usually takes about three months to recover from hip replacement operation. You’ll probably be back to your usual activities by then. But you may find it takes longer, especially if you have a physically demanding job. For some people, a full recovery can take up to a year.
For more information, see our section on recovery following hip replacement and hip revision.
How long it takes to recover from hip revision surgery varies widely depending on the extent of your operation. Revision surgery is usually more complicated than a hip replacement, so you’ll probably be in hospital for longer than you were for the first operation. Sometimes recovery time can be similar to a primary hip replacement operation (see above). But for major hip revision operations, it may take over a year and a half to recover. You’re also more likely to have complications.
For more information, see our section on recovery following hip replacement and hip revision.
Yes, it can be. It’s takes about an hour to do the operation1 and you’ll need to be in hospital for several days. Afterwards, it will take weeks to a few months to get back to your usual activities such as driving and going back to work. You’ll need someone to help you when you’re at home recovering.
For more information, see our section on recovery following hip replacement and hip revision.
In the first week or so after the operation, you’re likely to have some pain and discomfort. You may also have some swelling and bruising which can take a while to get better. The arthritic pain you had before surgery will quickly go after the operation, but you can have pain from the operation itself. Take over-the-counter pain killers if you need them and try not to sit for long periods. Some people feel very little pain while others need to take pain-relief medicines for several weeks.
For more information, see our section on recovery following hip replacement and hip revision.
Rheumatoid arthritis
Osteoarthritis
Osteoarthritis is the most common form of arthritis, affecting over eight million people in the UK. It affects your joints, making them stiff and painful.
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