How successful will my hip replacement be?
The simple answer is likely to be very! There is lots of research that shows that patients who have a hip replacement are relieved of pain and disability. This has often had a huge effect on their quality of life and their ability to live independently.
There is less research on the outcome of metal-on-metal hip replacements (MOMR) as the studies aren't very long. It seems to be effective in young men but it is not known if it is as effective in young women. By young, this generally means people under the age of 50 years.
Will I need to be seen again after my hip replacement operation?
Within about eight weeks of your operation, you will be followed up by the hospital where you had your surgery. You should be reviewed again at least after seven years and then every three years. You may not have to go back to the hospital for these review appointments, as they may just involve having an X-ray at your local hospital and then a telephone conversation with someone from the team who did your operation.
What are the possible immediate complications following hip replacement?
Blood transfusion may be needed.
- This can be reduced by different anaesthetic techniques used at the time of your operation.
- It is important to make sure that you get adequate pain relief. You need to be able to move about and then start to walk as soon as you are able after your operation.
- A venous thromboembolism (VTE) is a blood clot inside a vein.
- All patients are given measures to prevent this happening, where it is safe to do so. This usually includes: medication, foot pumps and below-knee compression stockings.
- The most severe (but rare) form of thromboembolism is a pulmonary embolism (PE). The prevention measures reduce the risk of dying from a PE by 70%.
- Certain factors make it more likely that you may have a VTE. These include: you have already had a VTE; you are closely related to someone who has; you have cancer; you are having chemotherapy; you are obese.
Dislocation of the hip
- This can occur at any stage but is most likely in the early days and weeks after a hip replacement.
- It is important to follow the advice you will be given by your physiotherapist about the strengthening exercises you need to do and how to do certain movements - for example, how to get in and out of a car - to reduce the chance of this happening.
- A urinary tract infection often occurs when people have had a tube (catheter) put in their bladder during the operation.
- Constipation can be caused by certain painkillers and being immobile.
- Chest infections are more likely following a general anaesthetic and in people who already have a lung condition, such as chronic obstructive pulmonary disease (COPD).
- Wound infection and wound breakdown (also hip joint infection - see below).
- Breakage of a prosthesis.
- Fracture - of the thighbone (femur) or the acetabulum.
What are the possible later complications following hip replacement?
Long-term complications include the hip replacement 'failing' and infection of the hip joint.
Hip replacements can wear out and when they do so they become loose or break - this is often referred to as hip replacement failure. You may then need a further operation (a 'revision') to correct this. It is often a much more complex operation. Needing to have your hip replacement revised is more likely the younger you are when you have it done in the first place.
90% of people who have their hip replaced in their 70s never need any further surgery on that hip. In contrast, 90% of people who have their hip replaced under the age of 50 will need to have it re-done. For people who have to have their hip replacement done again, most have run into problems around seven years after the original operation. The hip may start to hurt again, but it doesn't always, which is why it is important that you are followed up regularly (see above).
Infection of a hip replacement can be catastrophic. You are 18 times less likely to get an infection if the following are carried out (compared with conventional care):
- The operation taking place in an 'ultra-clean' theatre.
- The patient being given antibiotics at the start of the operation (and the use of antibiotic impregnated cement, if cement is used).
- Theatre staff wearing specially designed body exhaust suits or occlusive theatre clothing.
An infected hip prosthesis may need to be removed and it may not be safe or possible to replace it.
Further reading and references
Primary Total Hip Replacement: A Guide to Best Practice; British Orthopaedic Association (2012)
Arthritis of the hip (end stage) - hip replacement (total) and resurfacing arthroplasty; NICE Technology Appraisal Guidance, February 2014
Tired of the pain, can't wait for the 20th!john56733
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