Hip Replacement

What’s involved?

Total hip replacement surgery is a common option for the treatment of hip arthritis. It involves replacing the entire hip joint; any remaining cartilage in the joint is removed and the femoral head (ball) and the socket are replaced. These materials are placed to mimic your original joint and cartilage.

“A total hip replacement is one of the most successful surgeries I do. It has the ability to drastically reduce your associated pain and greatly improve your freedom of movement,” says Dr Rhys Clark.

The two surgical options

There are two main surgical options when it comes to replacing your damaged hip joint: the direct anterior approach (DAA), and the posterior approach. With the anterior approach, the incision is made on the front of the leg, while the posterior approach means that the incision is made on the side, extending around to the buttocks. Rhys and his team are always happy to discuss either approach and the benefits and risks associated. And, regardless of whether you require an anterior or posterior approach, evidence suggests that there is no major difference between patient outcomes six to twelve months after surgery.

“The most important thing I consider when performing this surgery is to make sure the replacement joint is placed in the correct position. My general preference is to perform the minimally invasive anterior approach unless there are contra-indications or perceived technical difficulties that may mean a patient is not suitable for this approach. Regardless of whether I use an anterior or posterior approach to your surgery, I am focused on the best possible outcome for you.”

Returning to life with purpose

Hip replacement surgery is rated as one of the top five operations (out of elective surgeries) for improving people’s quality of life. Hip arthritis causes uncomfortable and lingering pain that can really limit your movement. The surgery will allow you to get back to your normal daily routine (including some sporting activities) knowing you can move freely without the fear of pain. Even patients that suffer from a limp due to osteoarthritis are typically able to walk normally again post-surgery.

“For severe arthritis this form of treatment can offer a lot of relief. Many of my patients opt for hip replacement surgery as a way to get back a life of pain-free movement.”

Are there any limits on age?

Your age is not a limiting factor when deciding on hip replacement surgery. So long as you are in reasonable health, surgery is still an option at an older age. In the rare case that something with your hip replacement goes wrong later in life, hip revision surgery may be necessary. In most cases, evidence does suggest that continued improvements in technology mean that modern hip replacements should last most patients’ lifetimes.

“Approximately 90% of hip replacements are still in place and working well 18 years post-surgery. No matter what surgical approach is best for you, my aim is to give you a long-term solution that shows results beyond your goals.”

Personalised total hip replacement surgery

Your hip joint plays a crucial role in supporting your body’s weight and enabling a wide range of movements, from simple walking to more complex activities like turning and driving. You might not think about it much until discomfort or stiffness sets in, but your hip is essential for your everyday tasks.

When hip arthritis persists despite non-operative treatments and significantly impacts your quality of life — causing pain or restricting your mobility — a total hip replacement might be the best option. This surgical procedure involves replacing the damaged or worn parts of your hip with artificial components. The goal is to reduce your discomfort, improve joint function, and facilitate smoother movement.

Recognising that each person’s anatomy and needs are unique, advanced imaging techniques and personalised technology are used during the planning phase of your hip replacement. This customised approach ensures that the hip implant aligns with your natural movement patterns, providing a tailored solution designed to enhance your joint performance and improve your overall well-being.

How do I know if I need a hip replacement?

To figure out whether hip replacement is a necessity or not, many relevant tests and symptoms must be assessed. Persistent hip pain, which continues despite non-operative treatments such as medications, physical therapy, and — more importantly — change of lifestyle, sometimes indicates the need for hip replacement.

Moreover, if you find it hard to perform basic activities such as walking, climbing stairs, bending, or getting in and out of chairs, then this could be an indication that your hip joint has suffered significant damage. Stiffness in your hips, especially after waking up from sleep or long periods of sitting, can also point towards an advanced arthritis condition.

When hip pain affects your ability to enjoy everyday activities, including work or hobbies, it could be time to think about having a new hip so as to enhance your quality of life. If conservative measures such as anti-inflammatory drugs, physiotherapy sessions, corticosteroid injections, and assistive devices no longer offer relief, then a hip replacement may be needed. An orthopaedic surgeon should be consulted to assess you carefully.

How successful is hip replacement surgery?

Hip replacement surgery stands out among orthopaedic procedures in terms of success rate and the frequency with which it is performed; it is known to bring about a lot of advantages, such as reducing pain, improving joint function, boosting patient satisfaction levels, and increasing how long the implants last. The primary aim of hip replacement surgery is to alleviate chronic pain caused by arthritis or other hip conditions.

It has been found that more than 90% of patients undergoing this surgery achieved significant pain relief after the procedure. This allows them to go back into their daily lives without feeling much discomfort. Another important metric for success is improved joint function — patients generally find that they have a wider range of motion, enabling them to perform their routines with more ease.

Consequently, many are able to return to simple activities like walking and cycling, which can enhance their overall quality of life and enable them to engage in social or recreational activities that used to be beyond reach. About 90–95% of all those who have undergone hip replacement surgery report being satisfied with the outcome, and a significant number would do it again if faced by similar conditions.

Implant lifetimes are also essential. Modern hip implants are intended to last many years; usually around 15 to 20, and some may even go beyond that. Approximately 85–90% of hip replacements function correctly for 15–20 years after the operation. These results are further improved by advances in surgical techniques and implant materials.

There are several factors determining success with hip replacement surgery. The surgeon’s skill and experience matter most, because precise alignment and positioning of the prosthesis directly impact the results. Minimally invasive methods can also boost success rates, as patients recover faster, experience less pain after surgery, and have fewer scars. Contemporary implants manufactured from strong materials like titanium, ceramic, and highly cross-linked polyethylene ensure extended lifespan and high performance. Patient-Specific Instrumentation (PSI) is an example of a customised solution that provides individualised surgical guides based on the unique anatomy of a patient, improving implant position accuracy as well as overall results.

What is a hip replacement made of?

In a hip replacement, the artificial joint is made from a prosthetic implant consisting of three parts: the acetabular component, the femoral component, and the articular interface. All these elements are critical to restoring hip movement and reducing pain levels.

The damaged hip socket is replaced by a new cup-shaped structure known as the acetabular component (or acetabular cup). This is durable and can be built from metal alone or in combination with other materials, depending on their endurance against wear and tear.

The femoral component, or stem, is inserted into the thigh bone. For younger patients undergoing anterior approach procedures, a specific stem designed for their needs is often used. For elderly patients or those with poor bone quality, a different type of stem may be preferred, as it provides an easy option for cementing if required. Both ceramic and metal femoral heads are available, providing options to best suit the patient’s needs.

The articular interface allows for smooth movement between the components and includes a liner made from materials such as polyethylene, ceramic, or metal. This liner is chosen for its compatibility and performance.

Selecting the right prosthetic implant is essential for ensuring optimal outcomes for each patient. These implants have a proven track record of durability and long-term success, helping patients regain their mobility and significantly improve their quality of life.

How long does hip replacement surgery take?

Hip replacement surgery takes about one to two hours. In most cases, advanced technology is used for greater precision and accuracy, with navigation tools enabling optimal positioning and alignment of the implants. Patient-specific instrumentation may also be used to customise the surgery based on individual anatomy.

As part of the surgical process, X-rays are used to ensure that the components are in exactly the right position before the operation finishes. If small adjustments need to be made, Dr Rhys Clark can do them then and there to ensure everything is correctly aligned.

Following the surgery, your hospital stay usually lasts one to two days, though this can vary based on your individual health and circumstances. This period allows for initial recovery and monitoring to ensure a smooth transition to the next phase of your rehabilitation.

How do I prepare for hip replacement surgery?

The pathway to a personalised total hip replacement includes several essential steps that help guarantee the best possible result:

• Undergo a comprehensive medical evaluation to ensure you are healthy enough for surgery. This may include a physical examination, blood tests, and a review of your medical history.
• Diagnostic imaging, such as X-rays, CT scans, or MRI scans, will be performed to assess the condition of your hip joint and surrounding structures. These images provide crucial information for surgical planning.
• Participate in pre-operative education sessions to learn what to expect before, during, and after surgery, including pain management, the rehabilitation process, and any lifestyle adjustments you may need to make.
• Review your current medications with your healthcare team to ensure you are taking the appropriate medications before and after surgery.
• Engage in pre-surgical exercises to strengthen the muscles around your hip joint and improve your range of motion, which can enhance your recovery and help you regain mobility more quickly.

What should I expect after hip replacement surgery?

After total hip replacement surgery, you can expect to spend one to two days in hospital before being discharged home. Pain management is a crucial part of the recovery process, and your healthcare team will work with you to ensure your comfort during healing.

Rehabilitation and physiotherapy play a vital role in your recovery. Physiotherapists will guide you through personalised exercises and mobility training to gradually regain strength, range of motion, and function in your new hip joint.

Many people make a good recovery and return to normal activities within six weeks of their procedure, although full recovery can take six to twelve months. Early and gentle physiotherapy, combined with early mobilisation, is essential — gradual movement helps prevent stiffness and promotes healing. Ice therapy may be used to reduce inflammation and provide local pain relief, and continuous monitoring allows the healthcare team to adjust your recovery plan as needed.

Regular postoperative follow-up includes assessments of your recovery progress, monitoring for any signs of complications, and adjusting your rehabilitation strategies as you progress. Communicating openly with your healthcare team about any concerns you may have is crucial to ensuring the best possible recovery experience.