TOTAL HIP REPLACEMENT: PROS & CONS OF THE OPERATION / CONSENT
On the whole, total hip replacement is seen as one of the most successful operations that medicine has to offer. In the right patient, it can be an effective, safe, and durable way to treat many of the problems that come with severe arthritis of the hip.
Pain relief: This is the greatest benefit that the proceedure has to offer and the main reason for surgery. A hip replacement can provide a dramatic reduction in pain, with almost all patients getting complete or near complete relief from arthritic hip pain.
Improved mobility and hip function: After reduction in pain, increased mobility is the next major benefit. A hip replacement should allow you get back walking without restriction. Improved hip function should also help significantly with other common problems associated with hip arthritis, such as climbing stairs, putting on socks, getting out of chairs, etc.
Long lasting: A hip replacement is a durable way to treat the problems that come with severe hip arthritis. Current evidence shows that 80-85% of hip replacements are still working at 20 years after they were inserted.
RISKS AND COMPLICATIONS
While overall it is deemed to be a safe proceedure, there are associated risks that potential patients need to be made aware of.
Infection: A small number of people (around 1%) can get an infection around their hip replacement. This can be one of the most debilitating complications associated with total hip replacements, as it can require several further surgeries and prolonged courses of antibiotics to treat the infection.
Blood clots: For a period after the operation, people who have a hip replacement are at an increased risk of developing blood clots in the veins in their leg and pelvis. These can be dangerous because pieces of the clot can break off and travel to the lungs. You may be prescribed blood thinners for a period after the operation to help reduce the risk. Other measures such as compression stockings, and calf pump exercises may also be advised.
Blood loss: Significant blood loss can occur during the operation, and in the immediate period after. In the event that this happens, a blood transfusion may be required.
Dislocation: This occurs when the ball of the hip becomes dislodged from the socket. Dislocation occurs in less than 2% of patients. In most cases the hip can be put back into the socket while the patient is under sedation. In cases where the hip keeps dislocating, further surgery to stabilise the hip may be necessary. To reduce the risk of dislocation some patients are given instructions on certain positions to avoid. The specifics of these instructions depend on how your surgery was performed, and therefore should be discussed with your consultant.
Change in leg length: It can occur that after surgery one leg may feel longer or shorter than the other. While your consultant will make every effort to make leg lengths equal, slight differences may occur as a result of trying to maximise the stability of the hip. In cases where there is a significant difference in leg length, some people find that wearing a raised insole is helpful.
Loosening and wear: Over time, a hip replacement can begin to wear or loosen. This is the most common long-term problem associated with total hip replacements, and when severe, can cause significant hip pain. In such cases a second hip replacement surgery may be required. The rate at which wear and loosening occurs varies, however it usually only occurs many years after surgery.
Other complications: During the operation, injury can occur to surrounding nerves and blood vessels; likewise a fracture to either the femur or the pelvis can also occur. Most of these injuries can be treated during the operation but can affect rehab. Nerve injuries can cause weakness and numbness, which are generally temporary, but infrequently it can be permanent.
Finally, while they are very rare, there are life-threating complications like heart attack, stroke, and kidney failure associated with getting a hip replacement. While these can happen without surgery, the stress of the surgery can put you at increased risk during the post-operative period. The risk of these complications is very much associated with the general health of the patient prior to the surgery.
While not a complication, the recovery from a hip replacement can take some time and will impose some restrictions on daily activities; therefore it needs to be considered too.
Mobility: Early mobilisation is expected and encouraged, and most people are able to stand and walk (with the help of a frame) the day after surgery. It is expected that within the first month to two you will progress to using a stick, to hopefully nothing at all. The rate of your recovery is very much dependant on your general health before the operation. It can sometimes take a couple of weeks before you are safe to manage independently at home, and therefore discharge to a rehab facility, or temporary adjustments to your home may be required.
Driving: The rate at which someone can get back driving varies, but generally it not advisable to drive for 4-6 weeks after the surgery.
Work: Return to work very much depends on your general health before the operation, and the type of work that you do. As a rough outline, return to a sedentary desk based job would be 4-6 weeks; while for more physically demanding jobs it can take up to 3 months until you are fit to return.