Is Hip Replacement Major Surgery?

You may feel overwhelmed if you are told that you may need a hip replacement. You may wonder “is hip replacement considered major surgery?” To put it simply the answer is yes. Your damaged joint will need to be replaced which will require anaesthetic, a short stay in hospital and some weeks of rehabilitation.

However, although it is major, it is one of the most common operations within orthopaedics with around 370,000 hip replacements performed in the USA each year. Most patients will return to their previous strength levels within around 3 months.

Hip Replacement Surgery – Why is it Major?

An operation is considered major if it requires a large amount of anaesthetic, work on deep anatomy such as bones and a long recovery period. Hip replacement fits into all of these categories. Although joint replacement is often referred to as a major surgery, with improvements in technology and treatment it is now a safe and efficient operation.

Joint replacement – Your joint will be completely replaced. This means both the hip socket and the top of your thigh bone will be removed and replaced with smooth prosthetics. These can be made from metal, ceramic or plastic.

Anaesthetic – Almost all hip replacements will require spinal anaesthetic with sedation. Some patients will receive general anaesthetic.

Hospital stay – You will usually stay in hospital for between 3-5 days.

Rehabilitation – You will be encouraged to walk and undertake physical therapy exercises to speed up your recovery.

Hip Replacement Surgery - What Happens?
During your surgery your surgeon will replace your hip socket and top of your thigh bone with prosthetic parts. This is usually done with one or two incisions. The surgery can take between 1-2 hours, however this can vary depending on the patient and method used.

Osteoarthritis is the most common reason for hip replacement surgery. This occurs when the cartilage in your joint wears down over time. Usually surgery is considered once other treatments are no longer controlling your severe pain and lack of movement. Sometimes it can be carried out following a hip fracture.

Minimally Invasive Surgery - Is it Major?
Yes. Although minimally invasive techniques, such as anterior approach, can reduce the size of your incisions and speed up your initial recovery, it is still a joint replacement meaning it is considered major surgery.

Risks of Hip Replacement Surgery
Although most patients will have a successful recovery, all major operations carry some risks.

Common Risks:
There are several risks specific to joint replacement surgery. These include infection, dislocation, leg length discrepancy, nerve damage, loosening or wearing of the prosthesis over time, wound issues and bleeding. A review of research has shown that the most common cause of a poor outcome was dislocation, infection and osteolysis (loss of bone tissue around the prosthesis).
Dislocation:
Most dislocations occur within the first month of surgery. They are more common using the posterior approach. A review of research shows that 3.9% of about 332,000 hip replacements in 2010 had a dislocation. Due to this, patients having surgery from the side or back of their hip will have to follow hip precautions until their joint has healed.

Infection:
Infection is a feared risk. Long term antibiotics and staged revisions may be required. Patients will also be advised to inform their dentist or doctor that they have had a joint replacement.
Blood Clots:
A peer reviewed review of complications in hip arthroplasty shows that the incidence can vary greatly. Pulmonary embolism had a low rate of 1.1%, whereas Deep Vein Thrombosis below the knee had an incidence of over 70%. This paper was published in 2002 and prevention has improved since then. Be sure to check up-to-date sources.
At Risk Patients:
Patients at risk include females, elderly patients, obese patients, non-compliant patients, high ASA score (risk of anaesthetic) and previous hip surgery. These will be assessed by your surgeon.

Success Rates of Hip Replacement:
Generally hip replacement has very good success rates. One review written by a surgeon states that around 95% of patients will experience complete pain relief with an increase in mobility and independence. Around 90% of replacements will still be working after 20 years. Individual results will depend on your health, age and how well you follow your rehabilitation.

Recovery After Hip Replacement:
You will be encouraged to start moving as soon as possible. Often this will be on the same day as your surgery.

Recovery Timeline:

• Surgery Day

To take your first steps with support, pain relief and early mobilisation.

• 1-3 Months

Fast improvement. Most patients regain their previous strength and stamina within around 3 months.

• 6-12 Months

Most people will achieve maximum recovery within this timeframe.
Your hip may feel stiff when you start to move. Full mobility will take some time to return. As you age recovery times are usually longer and there are increased risks. Timescales are estimated and should be discussed with your surgeon.

When to Consider Hip Replacement:
If your hip pain is affecting your sleep, walking or daily activities and you are not receiving sufficient relief from medication, injections and physiotherapy then you may want to consider hip replacement. Speak to an orthopaedic surgeon to discuss your options.

Frequently Asked Questions

1. Is hip replacement high risk?

No. It is major surgery but serious complications are rare. Your risk will depend on your age and general health.

2. Is hip replacement serious for elderly people?

Many patients will be over the age of 65. Age is not necessarily a barrier but elderly patients may have increased risks and longer recovery. A thorough health assessment will be important.

3. How long does hip replacement take?

Usually around 1-2 hours but can be longer for more complex cases.

4. Can hip replacement be done as a day case?

Some centres will offer a day case for select healthy patients. However most will still require you to stay for a few nights.

5. How long does a hip replacement last?

Around 90% of replacements are still working after 20 years. This will vary depending on your age, weight and activity levels.

Conclusion:
Hip replacement is major surgery but is one of the most established and effective operations within orthopaedics. Knowing what will happen during the operation, risks involved and recovery plan will help prepare you for surgery. If you are experiencing hip pain that is affecting your life, speak to an orthopaedic specialist to see if surgery is right for you.
References:
[1] Mercy. (n.d.). Hip Replacement Surgery: Frequently Asked Questions. Retrieved from https://www.mercy.net/service/joint-replacement/hip-replacement-surgery-frequently-asked-questions/
[2] Top Doctors UK. (n.d.). What are the risks associated with a total hip replacement? Retrieved from https://topdoctors.co.uk/medical-articles/what-are-the-risks-associated-with-a-total-hip-replacement
[3] Top Doctors. (n.d.). Hip replacement surgery: Benefits, risks and recovery. Retrieved from https://topdoctors.co.uk/it/medical-articles/hip-replacement-surgery-benefits-risks-and-recovery
[4] Columbia Doctors. (n.d.). Total Hip Replacement Surgery. Retrieved from https://www.columbiadoctors.org/health-library/surgery/total-hip-replacement-surgery/
[5] North Central Surgical. (n.d.). Hip Replacement Surgery: Frequently Asked Questions. Retrieved from https://northcentralsurgical.com/hip-replacement-surgery-frequently-asked-questions/
[6] Primrose Retirement. (n.d.). Hip Replacement 101. Retrieved from https://primroseretirement.com/senior-living/hip-replacement-101
[7] Louisville Bone & Joint. (n.d.). Common Complications after Total Hip Replacement that Lead to Patient Dissatisfaction. Retrieved from https://louisvillebones.com/common-complications-after-total-hip-replacement/
[8] Saleh K. et al., (2002). Complications of total hip arthroplasty. American Journal of Orthopedics, 31(8), 485-488. https://experts.umn.edu/en/publications/complications-of-total-hip-arthroplasty/
[9] cortho.org. (n.d.). Hip Replacement Complications & Risks. Retrieved from https://www.cortho.org/?p=13307