Hip replacement surgery

The aim of hip replacement surgery

Hip replacement surgery is one of the most performed orthopedic operations, as hip joint wear (arthrosis) is affecting more and more people these days. In Hungary, the 12-15,000 hip replacements performed every year and the waiting list for hip replacements in the thousands show how this procedure is the way to improve quality of life for a significant number of people.

What are the causes of hip joint deterioration?

Some of the wear and tear on the hip joint is caused by previous developmental disorders (hip sprain, hip socket malformation), growth problems in children and adolescents, thigh head injuries, inflammatory diseases or joint surface disintegration due to injury. In other cases, however, wear and tear of the hip joint can develop without any identifiable predisposing factor, which is referred to in the medical literature as primary hip wear.

In both cases, gradual hip pain develops, which can radiate down to the thigh or even into the knee joint. The initial complaints associated with weight-bearing may progress over time to pain at rest and even severe pain at night. The range of motion gradually decreases, with rotational movements commonly being lost at first; it becomes difficult to lace up shoes, and in more severe cases, limping may develop.

In some cases, a limb length difference can develop, but this may also be due to an earlier hip condition. All these changes gradually limit walking, initially only on stairs or uphill, and later over horizontal ground.

In which cases is a hip replacement necessary?

Initial treatment methods may consist of a combination of exercise, swimming, physiotherapy and various cartilage-supporting medications. Later, in addition to anti-inflammatory, analgesic and relaxing medications, physiotherapy and balneotherapy options may help to alleviate symptoms.

If these treatment options are exhausted or do not provide the expected quality of life and physical performance, surgical treatment is considered. The anatomical peculiarities of the hip joint allow cartilage resurfacing, cartilage replacement, biomechanical correction, or arthroscopic resurfacing only in very limited cases, therefore surgical treatment in most cases means an endoprosthetic solution, hip prosthesis implantation.

The aim of these operations is to eliminate or reduce pain, to increase as far as possible the reduced range of motion, to reduce any difference in limb length and to improve the load-bearing capacity.

The average lifespan of a hip replacement is 15-20 years.

Artificial hip implantation

What happens during the operation?

The hip replacement is performed by replacing the hip joint’s inner surface (acetabulum) and the femoral head. During the operation, metal implants are inserted on both sides into the prepared receptive surfaces, with an ultra-hard polyethylene plastic insert on the socket side. The femoral head can be made from metal or ceramic.

Hip replacement fixation techniques

Implants are either fixed into the bone using bone cement, or so-called cementless or glue-free implants are used, which require good bone quality. In our hospital, we choose this latter type of implantation if it is possible - and in 95% of cases it is. In other cases, we use bone cement to ensure proper adhesion.

As far as the metal material of the implant is concerned, we use titanium-based implants at our hospital, as these have the best long-term results.

What improvement can I expect from the surgery?

Minimally invasive surgical techniques are now a basic requirement for rapid rehabilitation and better long-term results. This involves avoiding the dissection of muscles and tendons to spare the soft tissues as much as possible. This, combined with the initial stability of the implant, ensures that our patients can put their full weight on the operated limb the day after surgery.

Previous anatomical abnormalities that lead to wear (insufficient socket material, bone deformities, etc.) may slow the rate of load bearing on the limb in a small number of cases, but in the majority of cases such abnormalities can also be speedily rehabilitated.

Preparation and procedure for hip replacement surgery

Pre-operative period

The recommendation for surgery is based on the patient’s medical history, an outpatient physical examination, native x-rays and other scans (CT, MRI, bone scintigraphy) as necessary, and possibly additional tests. These will include planning the type of implant, the method of insertion and other important technical details of the surgery.

At the time of the proposal, we will explain the main elements of aftercare, the rehabilitation schedule and answer any questions you may have about the surgery during this consultation. You will then receive a written offer of surgery, together with details of your hospital stay. We will arrange the necessary pre-operative tests and subsequent anesthetic consultation.

If the offer of surgery is accepted, we will set a date for the planned operation.

During the anesthetic consultation, we will decide on the planned anesthetic method. Hip replacement procedures can be performed under regional spinal anesthesia or general anesthesia. The choice of the type of anesthesia and the determination/modification of any medication required prior to surgery (e.g., switching blood-thinning drugs) is made in consultation with an anesthetist, based on the patient's medical condition and prior tests.

The surgery is performed after adequate preparation on the day of admission.

The operation

Before, during and after the procedure, we use both medication and physical preventive measures to control the most common complications. These include antibiotic prophylaxis to reduce the risk of infection and prophylactic treatment against blood clots (blood thinners, surgical stockings).

Appropriate analgesic and anti-inflammatory treatment commences in the operating theater and is continued in your recovery room. Our nursing staff is always available via the nurse-call facility for both pain relief and all other care and comfort issues.

During the operation, a suction drain may need to be inserted to remove post-operative bleeding, which will be removed the day after surgery. The urinary catheter inserted during surgery is also removed the following day.

What to do after surgery

The day after surgery, we will start mobilization with the help of the physiotherapist. Although in most hip replacement operations the patient can immediately step onto the operated limb with their full bodyweight, the physiotherapist will provide a walking aid to assure walking safety during the initial period. The type of aid (elbow or underarm crutches, walking frame) is determined together with the patient, taking into account their physical parameters.

During the three days of the hospital stay, the physiotherapist will teach the patient how to walk and climb stairs safely, and demonstrate the home exercises to be carried out, as well as movements to avoid, in the initial post-operative period.

The first weeks after surgery

The majority of our patients leave hospital on the third day after surgery, able to walk and climb stairs, however the ability to climb stairs depends on the condition of other joints.

We usually recommend travelling home in a reclined position or with the car seat reclined significantly, as bending the hip joint beyond 90 degrees during the first four weeks can cause dislocation.

During the first few weeks, the prohibition of bending over 90 degrees may require raising the height of the bed and chairs at home, and for the use of a raised toilet seat, which we provide for our patients. At the time of discharge, we provide prescriptions for any necessary medications (blood thinners, anti-inflammatories, pain relievers, gastroprotective medicine, etc.) and a final report will recommend physical therapy in the home care setting.

After a three-day hospital stay, our post-operative patients are usually discharged in a physical condition that does not require ongoing home monitoring. However, for a few weeks they may still need the support of a family member or friend to do their shopping or run errands outside the home.

What to look out for after hip replacement surgery?

Rehabilitation after hip replacement surgery

It is not usually necessary to change the dressing that was applied in hospital while recovering at home. The wound should not be exposed to water until the stitches are removed. If the dressing is damaged or bleeds through, it can be replaced with a dry top dressing.

In most cases, no special physiotherapy is needed in the first few weeks; it is sufficient to repeat the exercises learned in hospital at home, as agreed. Some patients soon develop a degree of walking security that allows them to leave the home without the use of a walking aid.

Postoperative check-ups

First check-up

The first postoperative check-up comes after around 10-14 days, when the sutures or surgical staples are removed. The dressing applied at this time can be removed within 1-2 days and showering can be continued without wound protection. Anti-inflammatory therapy and thromboprophylaxis with tablets or injections should be continued for the period prescribed at discharge.

Most of our patients are usually able to resume manageable walks outside the home at the time of the first check-up. It is not advisable to start driving in the first four weeks after surgery.

Second check-up

The second check-up is due in 4-6 weeks, when an x-ray will be taken to check that the implant is in the correct position and is properly fixed. After assessing the range of motion, walking ability and muscle strength, we will determine whether additional physical therapy is needed in our hospital or elsewhere.

Most of our patients are already functioning well at this stage and do not require organized physiotherapy. Performing the exercises they have learnt or doing physiotherapy in the context of home care is sufficient to achieve good daily physical activity. At this stage, restrictions on hip flexion, bending, sitting too low, and crossed-leg sitting should be relaxed, because by this time the soft tissues around the hip joint are already properly stabilized and can accommodate different positions.

Third check-up

The third check-up comes between 2 and 3 months post-op. By this time, we expect that everyday activities are functioning at the desired level and that our patients with an artificial hip can attempt more demanding sports activities. If function is adequate during this period and the prosthetic joint is comfortable and performing well, a follow-up check is only necessary at the end of the first year after surgery. At that time, the implant and the function of the operated joint are again checked by x-ray.

Further follow-up tests

Even in the absence of any complaint, we consider it necessary to continue to x-ray the operated hip every two years.

Possible complications

The outcome of a hip replacement depends on several factors, of which the general musculoskeletal condition of the patient, the limitation of other joint functions and the level of previous physical activity play a significant role in the outcome.

Swimming, cycling, hiking and training on gym machines are strongly recommended, but running, tennis, cross-country skiing and similar sports are not prohibited if the patient is in good physical condition. However, we recommend avoiding so-called contact sports which involve jumping and collisions.

Sauna and spa use is allowed three months after surgery, but it is advisable to limit the time spent in water warmer than body temperature to 10-15 minutes.

Longer term, there may be symptoms of an inflamed hip replacement or signs of the prosthetic joint loosening, in which case it will be replaced during a new operation. Generally speaking, the vast majority of today’s implants can be expected to last at least 20 years and a significant proportion do not loosen after this time. X-ray examinations every two years or when complaints occur are intended to detect any signs of loosening developing and to treat them in time.

Frequently asked questions about hip replacement

What movements are forbidden?

In the first weeks after surgery, the healing of the soft tissues around the implant requires avoidance both of lifting heavy loads and of adopting extreme postures. These will be duly explained by the doctor, physiotherapist and nursing staff treating you while you are in hospital. In general, patients are advised against hip bends beyond 90 degrees, twisting outwards or crossing their legs, for 4-6 weeks.

What medical aids are needed for physiotherapy at home?

During rehabilitation in our hospital, we provide all the medical aids that may be required when our patients leave for home. These include compression stockings to protect against blood clots, walking aids (elbow or underarm crutches, walking frames or walking sticks), and a toilet booster seat.

Can I have an MRI scan with the implant?

Implant metals are generally MRI-compatible and titanium implants can be MRI scanned without restrictions. The hip prosthesis we use is titanium-based, except for the femoral head, which is made of stainless-steel alloy or ceramic. As medical metals can heat up slightly in a magnetic field, we do not recommend an MRI scan in the first six weeks after surgery. 

How does the implant behave at the airport or other metal detector gates?

The implant can be detected by a metal detector. Neither the hospital discharge report nor any other certificate will exempt you from being screened with a handheld metal detector, as the purpose of these checkpoints is essentially to detect metal weapons.

When can I start driving a car with a hip replacement?

After a problem-free implant, it is usually 4-6 weeks after surgery before we recommend that you resume driving, and this applies to automatic cars too.

What sports activities can I do after a hip replacement?

Hip replacement surgery does not rule out subsequent sporting activity. On the contrary, the aim of the operation is to enable the patient to lead as full and active a life as possible, free from pain and regaining their previous mobility. The pace of the gradual return to sporting activity is decided by the surgeon and the physiotherapist and is determined not only by the function of the operated joint, but also by the patient's other parameters and general musculoskeletal condition.

In general, swimming and cycling are recommended after 4-6 weeks, and sports activities involving rotational movements and running after 8 weeks. In the long term, we discourage our patients from contact sports and activities involving impact.

Why choose Dr. Rose Private Hospital?

• We offer a full range of orthopedic services. At our specialist orthopedic clinic, we provide the necessary tests (MRI, CT, x-ray, ultrasound, laboratory tests) to make an accurate diagnosis. Hip replacement surgery is performed without a waiting list. After the operation, our physiotherapist and sports rehabilitation staff will help you to regain your mobility as quickly as possible.
• A highly trained team of specialists. Our specialists use state-of-the-art, minimally invasive techniques to speed recovery, complemented by our physiotherapists, physical therapists and sports rehabilitation staff. In the case of complex problems, we decide on the appropriate course of treatment, necessary tests and therapies in a consultation.
• Exclusive environment. Our premium in-patient department has 3 operating theaters and 24 patient rooms with 33 beds to meet all your needs. The highest professional standards together with a unique healing environment mean you can recover in safety and with complete peace of mind.

If you suffer any complaints related to hip joint wear and tear, please contact the doctors at Dr. Rose Private Hospital.