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A hip replacement is an artificial joint made up of two parts (called prostheses), which will replace or resurface your arthritic hip joint. The two parts being a ball shaped femoral component (head) which fits into a cup shaped socket within the pelvis.

The Orthopaedic and Therapy staff at The Royal Liverpool and Broadgreen University Hospitals NHS Trust have written this booklet. It has been designed to give you and your family / friends guidelines to understand your operation and your rehabilitation afterwards.

Remember, each person is an individual and particular instructions and details may vary from one person to another - your rehabilitation will be aimed at your individual needs.

Arthritic hip		New hip replacement

What are the benefits of having a total hip replacement?

You should experience one or more of the following benefits:

• Reduced hip pain

• Improved walking ability

• Improved quality of life

What are the risks of having a total hip replacement?

This hospital uses a number of modern techniques to keep operative complications to a minimum. If you wish to know more about them your surgeon will be happy to explain. Despite using such techniques however, complications still happen. They are listed below and are accompanied by percentage figures, which show the number of patients per 100 who would be expected to develop the problem.

It is important that you carefully read this list. When you sign your operation consent form it means that you are aware of the possible complications and the consequences of them.

These include:

1. Deep vein thrombosis

Blood clots can form in the veins of the legs. Minor clots form in up to 50% of patients. In a much smaller percentage of patients the clots cause leg pain and swelling. This usually fully recovers, but 1% of patients are left with persistent leg swelling and discomfort.

2. Pulmonary embolus (PE)

Some leg clots are large and can pass from the legs to the lungs. This is called a pulmonary embolus and can result in sudden death. Most patients however, who develop this condition while in hospital do survive after emergency treatment. This is the condition widely reported recently in the press and TV as occurring after long airplane journeys. Less than 1% of patients develop a pulmonary embolus.

3. Infection

Infections after hip replacements are of two types. The first is the so-called superficial infection, which happens in 15% of cases. The wound becomes painful and inflamed after surgery but usually responds to antibiotics and a longer than average stay in hospital. Occasionally, an operation to clear the infection is needed.

Some infections can involve the hip joint replacement itself, this is known as a deep infection. These infections occur when bacteria infect the joint replacement from the patient’s own bloodstream. This can happen after procedures such as passing a catheter into the bladder when a patient has difficulty passing urine after the operation. Infection can also occur after dental abscesses, chest infections or skin infections. Overall the deep infection rate resulting in failure of the hip replacement is approximately 2%. If deep infection occurs, a second joint replacement is then needed, this is known as a revision procedure. Revision surgery is much more difficult than the original operation and has a higher complication rate. Occasionally it may not be possible to revise the hip joint and in that instance a different operation is performed known as a Girdlestone procedure. When a Girdlestone procedure has been performed, patients are left with a shortened leg on the operated side and are likely to need a raised shoe permanently.

It should be noted that both types of wound infection are more common in patients who are overweight or obese and in those with diabetes and general skin conditions such as psoriasis.

Most bacteria that cause infections are those that live on normal skin. Hospital ‘super bugs’ such as MRSA very rarely infect hip replacements.

4. Nerve and artery damage

The two main nerves supplying the leg, the femoral and sciatic, can be damaged resulting in weakness and loss of feeling in the leg. Damage to the main artery to the leg needs emergency surgery at the time of the hip replacement involving the vascular surgery team. Damage to nerves and arteries are fortunately very rare and happen in well under 2% of cases.

5. Dislocation

Dislocation of the new joint happens in up to 2% of cases. The 2 main parts of the replacement lose contact, this means that the ball and socket come apart from each other. This then needs repositioning under general anaesthetic. In most cases this problem happens within a short time of the surgery when complete healing has not taken place. After the hip is put back in place, usually there is no further problem with dislocation. Occasionally however, you may need to wear a leg splint for two to three months. When your splint is fitted you will also start an exercise programme to improve the tone of the muscles around your hip. Occasionally, dislocation can keep occurring and revision surgery is then needed.

6. Limb length discrepancy

Occasionally, after surgery the legs are not the same length. It may be slightly longer or shorter. It may improve during the first few months after surgery as the muscles regain their normal function. This does not usually result in any major problems. However, sometimes a shoe raise may be needed, which will be arranged for you by the hospital.

7. Limping

Limping after surgery is common but usually settles after six weeks if the patient works hard to rehabilitate.

8.Variations in the operation

The procedure used to carry out the operation varies from surgeon to surgeon and each procedure has benefits and disadvantages.

Some surgeons remove a piece of bone from the top of the femur to gain access to the hip (a trochanteric osteotomy). This piece of bone has to be re-attached with special wires at the end of the operation. Occasionally they break and cause minor discomfort. Very occasionally they have to be removed.

9. Death - occurs in one in every 400 of these operations due to pulmonary embolus (PE) or anaesthetic complications.

If you are worried about any of these risks, please speak to your consultant or a member of their team.

Are there any alternative treatments available?

The only alternative to surgery would be to continue to manage your symptoms with appropriate analgesia (pain relief) and advice from therapy staff.

What would happen if I had no treatment?

Your mobility would not improve and would possibly worsen.

What sort of anaesthetic will be given to me?

The anaesthetic for your operation will either be a general or a spinal anaesthetic. Those people having spinal anaesthesia may be able to choose to be awake during the operation if they want to be. Some general anaesthetics will include nerve blocks, which numbs your leg, so that you are more comfortable when you wake up.

What are the risks of having an anaesthetic?

All types of anaesthetic have side effects and complications. Minor side effects of general anaesthetics include feeling sick, drowsy or having a sore throat when you wake up. Spinal anaesthesia can give you a headache. More serious complications of anaesthetics include death, and permanent nerve damage. The chance of one of these serious complications is very small.

Doctors who specialise in anaesthesia give all the anaesthetics and they will take into account your health, the type of operation and your wishes, when deciding what type of anaesthetic to give. They will be happy to explain more about your anaesthetic and answer any questions that you have.

If you want more information please ask your nurse for the patient information leaflet - You and Your Anaesthetic (PIF 344).