The hip is a large ball and socket joint that allows movement between the pelvis and the femur. If the cartilage and/or bone in your hip has been damaged, either through wear and tear or trauma, you are likely to experience hip pain and everyday movements such as sitting and walking may become difficult.
Common causes of hip pain
There are several causes of chronic hip pain but the most common are arthritis or trauma.
Osteoarthritis
Osteoarthritis normally occurs in people over the age of 50, as it relates to the ‘wear and tear’ of the cartilage. As this cartilage wears away over time, the bones rub against each other causing stiffness and pain.
Post-traumatic arthritis
Following a serious injury or fracture, the cartilage in the hip can wear down or become damaged, leading to stiffness and pain in the joint.
Rheumatoid arthritis
Rheumatoid arthritis is an autoimmune condition which results in the synovial membrane surrounding the hip joint to become thickened and inflamed. This can then result in the cartilage becoming damaged, leading to pain and stiffness in the hip.
Osteonecrosis
Also known as avascular necrosis, osteonecrosis can occur when an injury, such as a dislocation or fracture of the hip, limits the blood supply to the femoral head (the highest part of the thigh bone). The lack of blood flow may cause the surface of the femoral head to collapse, resulting in arthritis. Osteonecrosis can also be caused by some diseases.
Childhood hip conditions
If you had hip problems as a child, such as congenital hip dysplasia, it may affect the surface of your joints. Even if the condition was addressed and treated during your childhood, it can still cause arthritis and pain as you get older.
When is a hip replacement considered?
Hip replacement surgery may be recommended by your doctor and orthopaedic surgeon if your pain starts to interfere with your lifestyle and everyday activities. This includes:
- Hip pain that does not ease when you are resting, both during the day and at night
- Hip pain that affects your ability to undertake daily activities such as walking or bending
- Stiffness that affects your ability to lift or move your leg
- Pain that is not helped by non-surgical methods including anti-inflammatory medication, physiotherapy and walking aids such as walking sticks.
Preparing for hip replacement surgery
Once you have discussed all treatment options with your care team and decided to proceed with your hip replacement, there are several important steps to take to prepare for the surgery.
Medical preparations
You may be asked to complete a medical evaluation completed by your GP to make sure that there are no underlying health concerns that could impact your surgery or significantly increase your risk of complications. This may include tests such as blood tests, x-rays, urine samples and heart tests such as an electrocardiogram.
Your surgeon will work closely with your GP to manage your regular medications in the lead up to your surgery. They will advise which ones are safe to continue taking and which ones you will need to pause due to potential reactions.
At-home preparations
Following your surgery, there are some things that you will not be able to do on your own. For example, you may require assistance with activities including cooking, laundry and shopping for several weeks after the surgery. If possible, you should arrange for someone to stay with you to assist with these tasks. If you live alone, talk to your GP about arranging help for you at home.
What is involved in hip replacement surgery?
Hip replacement surgery is usually done under either general anesthesia (where you’re completely unconscious) or a spinal block (where you’re awake but have no feeling from the waist down).
A total hip replacement comprises of 4 main steps, where prosthetic components replace the damaged cartilage and bone. The prosthetic components may be made up of a combination of metal, ceramic and plastic materials, depending on your specific type of implant.
1. Removing the damaged ball joint
The worn or damaged femoral head is removed. Then we replace it with a metal ‘stem’, which is implanted into the hollow centre of the femur.
2. Replacing the ball joint
The next step is to place a new ball joint, made of either ceramic or metal, on the stem. This will serve as the new ball joint, replacing the femoral head.
3. Replacing the damaged socket
The surface of the socket containing the damaged cartilage is removed. A metal socket, sometimes secured with cement or screws, is put in its place.
4. Replacing the damaged cartilage
A spacer made of ceramic, plastic or metal is placed between the metal socket and the new femoral head. This replaces the damaged cartilage and allows the ball and socket to glide across each other, providing a smooth movement.
Possible complications of a hip replacement
Most hip replacements proceed smoothly but it is important to understand the potential complications.
Infection
Infection can occur any time after surgery, and can be superficial to the wound or deeper in the joint, around the prosthesis. Most minor infections can be treated with antibiotics and other such management, but in severe cases further surgery or removal of the prosthesis may be required.
Blood clots
Blood clots are one of the most common complications arising from hip replacements. The clots are most common in the legs or pelvis, but can become life-threatening if they travel to your lungs or heart. To prevent blood clots, your surgeon will suggest a prevention plan for you that may include blood thinning medications, early movement of the leg, and compression stockings.
Dislocation
As the muscles around the hip heal, it is possible that the joint may separate. In most cases, the ball can be returned to the socket without requiring further surgery. However in some cases, and if the hip keeps dislocating, surgery may be warranted.
Loosening and implant wear
In the years following your hip replacement, there is the possibility that the implant will begin to wear out or loosen. This can be due to biological factors, or wear and tear from everyday activities. Revision surgery may be required if this becomes painful.
Hip replacement recovery
While each person will have their own unique recovery journey, generally you will be encouraged to get back on your feet as soon as you can. You will most likely be discharged from the hospital within a matter of days, your recovery will continue at home.
Medications
Following your surgery you may be prescribed pain medications. The specific pain medications you will be prescribed varies depending on your pain, medical history and any other medications you are taking.
You may also be given blood thinners to prevent the formation of blood clots during your recovery.
It is important to continue talking to your GP and your surgeon about your regular medications to minimise interactions or side effects.
Wound care
To prevent infection, it is important that you follow the instructions your surgeon provides regarding the incision site. This will include keeping the area dry and clean, changing the dressing and any specific instructions about showering or bathing. If the wound becomes red or inflamed, you should notify your doctor immediately as it could be a sign of infection.
Activity
For several weeks, you may require the help of walking aids such as a walking stick, walking frame or crutches. During this time, make sure tripping hazards have been removed from your home, including rugs, pillows or electrical cables.
Your care team, including your physiotherapist and surgeon, will provide a rehabilitation plan with the aim of getting you back to resuming your usual activities as quickly as possible.
You will be prescribed specific exercises to complete several times a day in order to restore your movement and strengthen your hip. One of the most important activities you can do during this time is walking, as the movement in the joint may reduce stiffness.
Make sure that you follow the advice from your care team, and let them know if something is causing too much pain or you notice any abnormal bleeding, oozing, redness or swelling.
How the Victorian Orthopaedic Spine Service can help
Dr David Edis has over 15 years’ experience in orthopaedic surgery and has a special interest in reducing hip pain for his patients.
Dr Edis strongly believes in a multidisciplinary approach for the best possible outcomes, and as such works closely with your care team including your GP and physiotherapist.
Book an appointment today.
All information is general in nature. Patients should consider their own personal circumstances and seek a second opinion. Any surgical or invasive procedure carries risks.
