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Hip replacement



NHS Choices Syndication

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Hip replacement

'It's amazing what your body can do'

Builder Norman Lane, 63, hasn’t stopped running since he had a double hip replacement

“I used to be a keen footballer and ran around 80 miles a week until I started to have problems with my hips when I was around 40. The doctor diagnosed osteoarthritis.

“At first it wasn’t too bad, but gradually things got so painful that I couldn’t turn over in bed at night, let alone run. The surgeon said both my hips were ‘shot’ and suggested a double hip replacement, which I had done in 1998. 

“The operation lasted eight hours. The day after, it took me 20 minutes to walk to the end of the bed and back. It seemed impossible that I would ever run again, but I was determined. I didn’t want to die with my new hips unused! 

“I was in hospital for a week. It was painful at first but I stopped taking painkillers after two days and the pain gradually went away over the course of about a month. My attitude was, ‘It’s only pain and it will get better’.

“After a month, I was riding a bike. After six months, I started to do some gentle running and very gradually built it up over the course of a year. After 18 months, I ran the Majorca marathon in 3 hours and 14 minutes, winning the international over-50 category. I did the New York and London marathons the next year and, three years ago, I ran from John O’Groats to Land’s End, raising more than £25,000. It took me 28 days and my wife had to pull me off the road at the end. I just got fitter and fitter over the course of it. It’s amazing what your body can do.

“There are some things I still can’t do. I don’t play football now and I would never jump off a scaffold. I run an average of 40 to 50 miles a week. I’m really pleased I had the operation and would advise anyone to go for it.”

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Published Date
2014-07-24 14:24:11Z
Last Review Date
2014-07-19 00:00:00Z
Next Review Date
2016-07-19 00:00:00Z
Classification
Hip replacement


NHS Choices Syndication

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Hip replacement

Alternatives to hip replacement

Before being considered for a hip replacement you will probably be given a number of non-surgical treatments to see if they are effective in relieving hip pain and stiffness.

Non-surgical treatments can also be used if you are unable or unwilling to have hip replacement surgery.

These may include:

  • Painkillers, including non-steroidal anti-inflammatory drugs (NSAIDs), if your hip joint is also inflamed.
  • Steroid injections can help in some cases, although their results are unpredictable in the hip so not generally recommended.
  • Pain-relieving creams, gels and rubs are available over the counter or on prescription. It is not known how these compare with more conventional ways of taking painkillers.
  • Disease-modifying medications – these medications alter the working of the immune system to block the underlying processes involved in certain forms of inflammatory arthritis.

For more detailed information on treatment options for the most common causes of hip pain see:

Hip resurfacing

Hip resurfacing involves removing the upper surface of the femur (thigh bone) as well as the surface of the cavity in the pelvis in which the femur sits.

Both of these surfaces are then covered with a metal surfacing (metal-on-metal). This helps correct a damaged joint into a correct position. An advantage of hip resurfacing is that less bone is removed than in a hip replacement.

Hip resurfacing requires that a person has relatively strong bones so it is usually only suitable for younger adults and it may not be suitable for:

  • adults over the age of 65 years – bones tend to weaken as a person becomes older
  • women who have gone through the menopause – one of the side effects of the menopause is that the bones can become weakened and brittle (osteoporosis)

Your surgeon should be able to tell you if you could be a suitable candidate for hip resurfacing.

Published Date
2014-07-24 14:22:35Z
Last Review Date
2014-07-19 00:00:00Z
Next Review Date
2016-07-19 00:00:00Z
Classification

Hip replacement – NHS Choices

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Hip replacement 

Introduction 

Hip operation: animation

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This detailed animation explains how a hip replacement is done and why it would be needed.

Media last reviewed: 11/07/2013

Next review due: 11/07/2015

How common are hip replacements?

Hip replacements are a very common procedure.

In 2013, the NHS performed just over 66,000 hip procedures in England and Wales.

Worries over metal-on-metal implants

There have been cases of some metal-on-metal hip replacements wearing sooner than would be expected, causing deterioration in the bone and tissue around the hip. There are also concerns that they could leak traces of metal into the bloodstream.

The Medicines and Healthcare products Regulatory Agency (MHRA) has issued new guidelines that certain types of metal-on-metal (MoM) devices should be checked every year while the implant is in place. This is so that any potential complications can be picked up early.

If you are concerned about your hip replacement contact your GP or orthopaedic surgeon. They can give you a record of the type of hip replacement you have and tell you if any follow-up is required.

You should also see your doctor if you have:

  • pain in the groin, hip or leg
  • swelling at or near the hip joint
  • a limp, or problems walking
  • grinding or clunking from the hip

These symptoms do not necessarily mean that your device is failing, but they do need investigating.

Any changes in your general health should also be reported, including:

  • chest pain or shortness of breath
  • numbness, weakness, change in vision or hearing
  • fatigue, feeling cold, weight gain
  • change in urination habits

For more information read our metal-on-metal implant advice Q&A.

A hip replacement is a common type of surgery where a damaged hip joint is replaced with an artificial one (known as a prosthesis).

The hips

The hip joint is one of the largest joints in the human body and is what is known as a “ball and socket joint”.

In a healthy hip joint, the bones are connected to each other with bands of tissue known as ligaments. These ligaments are lubricated with fluid to reduce friction.

Joints are also surrounded by a type of tissue called cartilage that is designed to help support the joints and prevent bones from rubbing against each other.

The main purpose of the hip joints is to support the upper body when a person is standing, walking and running, and to help with certain movements, such as bending and stretching.

Why do I need a hip replacement?

It might be necessary for you to have a hip replacement if one (or both) of your hip joints becomes damaged and causes you persistent pain or problems with everyday activities such as walking, driving and getting dressed.

Some common reasons why a hip joint can become damaged include:

  • osteoarthritis – so-called “wear and tear arthritis”, where the cartilage inside a hip joint becomes worn away, leading to the bones rubbing against each other
  • rheumatoid arthritis – this is caused by the immune system (the body’s defence against infection) mistakenly attacking the lining of the joint, resulting in pain and stiffness
  • hip fracture – if a hip joint becomes severely damaged during a fall or similar accident it may be necessary to replace it

Many of the conditions treated with a hip replacement are age-related so hip replacements are usually carried out in older adults aged between 60 and 80.

However, a hip replacement may occasionally be performed in younger people.

The purpose of a new hip joint is to:

  • relieve pain
  • improve the function of your hip
  • improve your ability to move around
  • improve your quality of life

Read more about why a hip replacement may be necessary.

What happens during hip replacement surgery?

A hip replacement can be carried out under a general anaesthetic (where you are asleep during the procedure) or an epidural (where the lower body is numbed).

The surgeon makes an incision into the hip, removes the damaged hip joint and then replaces it with an artificial joint that is a metal alloy or, in some cases, ceramic.

The surgery usually takes around 60-90 minutes to complete.

Read more about how a hip replacement is performed.

Recovering from hip replacement surgery

For the first four to six weeks after the operation you will need a walking aid, such as crutches, to help support you.

You may also be enrolled on an exercise programme that is designed to help you regain and then improve the use of your new hip joint.

Most people are able to resume normal activities within two to three months but it can take up to a year before you experience the full benefits of your new hip.

Read more about recovering from hip replacement surgery.

What to expect after a hip replacement

Since its introduction in the 1960s, hip replacement surgery has proved to be one of the most effective types of surgery in modern medical history. Most people experience a significant reduction in pain and, to a lesser extent, improvement in their range of movement.

However, it is important to have realistic expectations about what the operation can achieve. For example, you should be able to ride a bike but it is unlikely that you would be able to play a game of rugby safely (although, as with most things, there are always exceptions to this rule).

The rehabilitation process after surgery can be a demanding time and requires commitment.

Risks of hip replacement surgery

Complications of a hip replacement can include:

  • hip dislocation
  • infection at the site of the surgery
  • injuries to the blood vessels or nerves
  • a fracture
  • differences in leg length

However, the risk of serious complications is low – estimated to be less than 1 in a 100.

Read more about the risks of a hip replacement.

A modern artificial hip joint is designed to last for at least 15 years, but there is always the risk that the artificial hip joint can wear out or go wrong in some way before this time, meaning that further surgery is required to repair or replace the joint.

This is known as revision surgery. It is estimated that around 1 in 10 people with an artificial hip will require revision surgery at a later date.

There have been recent cases of metal-on-metal (MoM) replacements wearing quicker than would be expected, causing deterioration in the bone and tissue around the hip. There are also concerns that they could leak traces of metal into the bloodstream.

For more information, read our metal-on-metal hip implant advice Q&A.  

Alternatives

There is an alternative type of surgery to hip replacement, known as hip resurfacing. This involves removing the damaged surfaces of the bones inside the hip joint and replacing them with a metal surface.

An advantage to this approach is that it removes less bone. However, it is usually only effective in younger adults who have relatively strong bones.

Resurfacing is much less popular now due to concerns about the metal surface causing damage to soft tissues around the hip.

Read more about alternatives to hip replacements.

Future developments

Hip replacement surgery is being improved in several ways:

  • New, stronger materials for prosthetics are being developed that will allow longer wear and better joint mobility.
  • Enhancements are being made to new “cementless” implants. Patients can be recommended for newer types of joints, such as ceramic-on-ceramic and ceramic-on-plastic.
  • Computer-assisted surgery is being used to generate an image of the hip joint to allow greater precision.

Another area of research is looking at regenerating a hip joint by transfusing stem cells into damaged tissue. Stem cells are specialised cells that have a useful ability to help replenish other types of cells.

 

Page last reviewed: 20/07/2014

Next review due: 20/07/2016

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Comments

The 64 comments posted are personal views. Any information they give has not been checked and may not be accurate.

Greencat29 said on 10 October 2014

I had a right THR three years ago, with an ‘Amihip’. This is a metal and ceramic device that needs no cement. I had a small frontal incision. The muscles were not cut, just separated. I can honestly say that there wqs no pain afterwards, just discomfort from swelling and bruising, which soon went away. I made a rapid recovery and was back to normal within six weeks, though I could do most things after two weeks. The worst things for me were: having my elastic stockings changed (I should have shaved my legs before the op!), sleeping on my back and giving myself Heparin injections. I am looking forward to having my left hip replaced soon.

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EDDYtwo said on 16 September 2014

Hi everyone, I suffered what seemed years of agony with arthritis in my hip joints, they were both bone on bone and I was told it was a wonder I could still walk, I could with the help of pain killers, and I had the opportunity of having my first THR, on my left hip in Oct 2012, I have always kept myself in good shape and soon recovered with no problem, I had my right hip replaced in April 2013 and after 2 weeks was walking unaided. I am back doing weight training, bike riding and walking and feel I have been given a new lease of life. I am 62 and was fitted with ceramic on ceramic joints. I still get pains if I overdo things but not the type of pain I had with the arthritis.
A tip on how to get your shoes on until flexibility has returned….I used to tie my laces before putting them on ,using a long shoe horn and holding the tongue with a pair of pliers, I also bought a pair of trainers with Velcro fasteners and used a pair of pliers to pull the straps over.
If anyone is going in to have the op then I can say there is nothing to it, I had the epidural and was awake on both occasions and it was interesting to hear what was going on….

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GemniSparkle said on 10 September 2014

I had a titanium prosthesis put in my right hip.. (Total hip replacement) . No problems.. No muscles were cut — and no drain in my incision. It is about 4" long and healing very nicely. The pain I had before surgery ( 5 yrs) far outweighed any discomfort I may have had post surgery. Just move slow, everybody..Those "tweaks" really hurt if you move too fast. Those of you who can’t sleep on your backs..? When I hurt so bad prior to surgery, I could ONLY sleep on my back with my legs bent. So post surgery wasn’t too bad for me. I’d practice sleeping on your back before surgery so that you are more comfortable.. It’s a little awkward at first but you’ll get used to it. Put up with pain for 5 yrs – until I couldn’t walk anymore I had NO range of motion in my hip at all… and life was becoming miserable. Couldn’t put on pantyhose.. climb stairs.. etc. My recovery has been great ( 4 wks post op tomorrow) and I am no longer using a cane and did without a walker within the first l0 days.. Take your time. Go slow.. Don’t hurry the process. Let your body heal and listen to your therapists. My leg was lengthened, my gait is "off" and I limp but it will get better. Only issue I have now is stiffness in my hip – some swelling and back ache when I walk around the block. Good luck to all.

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Amnesia3637 said on 09 September 2014

I’m a 61 year old female with RA and who developed osteoarthritic changes in my right hip last November. Pain became excruciating and I was referred in March 2014 to orthopaedics. Had total right hip replacement in June 2014 which relieved the pain immediately. I had kept going despite not really being able to walk at all well prior to surgery and think this helped no end with keeping muscles strong afterwards. Despite small discomforts after what is after all, major surgery I have had a brilliant recovery and am now 11 weeks on and almost back to normal. Am walking my dog for two hours each day, doing normal household chores and have been driving since I abandoned crutches at 6 weeks. Tonight I had my first bath. Fantastic improvement to my general health. Am careful still with hip precautions and I know when I’ve overdone it but has it been worth it? A resounding yes!

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bob L said on 02 September 2014

I would be interested in any comments regarding the reliability, problems, or failure rate of different types of THR, such as metal and plastic, metal and ceramic, metal stem with ceramic head and acetabular cup.

bob L

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DeniseDix said on 02 September 2014

‘My hip replacement went really well, thank you NHS!’ Denise

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meyricke said on 25 August 2014

I am 62 and had my hip replaced 5 weeks ago. The operation was painless and my recovery in hospital was fast. After 10 days, I was reasonably mobile, on sticks, and able to look after myself. The main issues are the small ones which most people do not think are important.

I have to wear orthopaedic stockings until the specialist has signed me off. These can only be changed by another person. Luckily, the local NHS team have been very good and a "nurse" appears 3 times a week to change them for me. The same NHS team has also provided the sticks, raised toilet seats, bed raisers etc etc.

Once the stockings have gone, I will need to wear socks. I have bought one of the clever gadgets which facilitates putting them on and taking them off, but am having a battle with this. I will ahve to seek advice.

I am now able to walk a couple of miles, so need some decent walking shoes. It may well be a couple of months before I can handle laces so will have to go out to buy some shoes with velcro fasteners. If I had realised this in advance it would have been useful. Until now I have worn sandals but the onset of autumn requires a better solution.

Everything else round the house is simple enough with a little thought. The "helping hand" is very versatile and can pick up both a tiny screw and also a 5KG bin of flour. They can also be ised for velcro – see above!

Hope this helps.

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TvW 123 said on 17 August 2014

Hi, I am a 53 year old male. I had a right side THR done at the Nuffield Hospital in Glasgow in July this year. The surgery went very well and the hospital staff were brilliant!!

The first week at home was very difficult as I had a swollen right leg and pain all the way down. However, I persisted with the exercises that I had been given and lots of rest. . The exercises helped my recovery and I was swiftly back on my feet.. Only six week later now and I am going back work pain free .So persist with your exercising and Good Luck to you.

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crista d said on 07 August 2014

Hi i have had 2 total hip replacements but had 3 surgeries. The first surgery went great with no complications at all and i was home 2 days after the surgery. The second surgery went great too but the following morn my Dr looked at me and my blood work and it showed.i was low 4 pints of blood. After getting the 4 pints back into me i was seeing great. Up walking later that nite. The next morn i thought i was going to be able Togo home but again i was low 2 pints of blood so i had to stay another nite. I was home 4 days after the surgery. The difference between the first surgery and the second was he used glue to close the wound up and he used 33 staples to close the wound. I had slot of drainage with the second surgery. I was up walking by myself 2 weeks after the first one but with the second one i had to stay off my hip longer bc the Dr said my thigh bone was weakening and had to put a couple of screws in my thigh bone to keep it together so he wanted me to stay off of it a couple of weeks longer. Anyways i went back to the er to get my staples taken out 2 1/2 weeks after surgery and it drained a lil bit all week long. I went for my post op visit a week after the staples removal. He looked at.the wound and said that half was healed up and the other half didn’t look that good so he felt would be better to go back in and redo the surgery. He felt like a blood cot formed underneath the incision. So 2 days later he went back in and re placed the chrome ball and cleaned it all out again. The blood clot was sent to the lab and it did have the staph bug in it so he ordered 6 weeks of strong antibiotic thru a picc line in my arm. Everything with the surgeries went fine. I have no pain ay all. The only prob i do have is stiffness. I can’t get up from kneeling on my knees and just get up. If i don’t have a chair or something to help me up i just can’t do it. Also putting my shoes or sucks.i cant bend my legs to do them by myself. Has anybody else had this type of prob.

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Sandie53 said on 02 July 2014

I am a 61 year old female who is about to under go a hip replacement but I have a heart condition with 5 stents in I am really scared to the out come. Been told I could have heart attack blood clot chest infection one leg shorter then the other, if I lost weight took stronger pain killers would I still need hip replacement? The pain I have is unbelievable so days I could just end it all I just want my life bac.

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Dave Trev said on 25 May 2014

Please can anyone offer advice on how to tie shoe laces and put my sock on(without any aids). I am 10 weeks post op and still find this difficult and I feel nervous and don’t want to cause myself injury. Thanks

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France26 said on 25 May 2014

What can be done to a hip replacement that leaves the patient with one leg longer than the other by 1"

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cruiseellie said on 13 May 2014

I notice in your above advice that the hospital should ‘enrol you in an exercise programme’. At St Albans hospital however they have stopped what was an excellent programme stating that they had found that ‘people got on much better at home without the course’. Having been on that excellent programme I would very strongly disagree with that statement. I suspect that this is a cost saving exercise of a very cash strapped Trust.

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cruiseellie said on 26 April 2014

In July 2011 I had a ceramic on ceramic hip replacement, by December 2011 it had started to crack. By January 2013 I had a replacement ball and liner. By March 2014 I had a total replacement and now have a metal and plastic hip. That’s 3 operations in under 3 years! I also have a Psoas dysfunction (groin pain) and a torn ham string as a result of the operation. Not sure at the moment if it was actually worth it!

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jesuisstan said on 11 April 2014

My wife had a resurfacing in 2007 and from then on nothing but trouble constant pain
In 2011 revision after cup came away from pelvis full hip replacement
Now waiting to go in for another revision
Three operations in seven years same side she is only 54

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janwel said on 11 April 2014

Iha my hipreplacement,27 years ago and its still going strong,would recommend any one in pain to go ahead gave me a new lease of life

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Busymummy4 said on 29 March 2014

Hi Geordie-Nicola –
I’m due to have hip replacement in just over a month and I’ve just turned 30 too. Right nightmare with being a busy mum – how did your recovery go? How long were u in hospital? I’m dreading it if I’m honest!

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merseygull said on 03 March 2014

Why are you still featuring "Resurfacing"? – at the end of the day it’s a "metal on metal" articulation and should no longer be imlanted..

J.

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Geordie_Nicola said on 13 February 2014

I had a total hip replacement on 16th december 2013 at the age of 30 due to osteoarthritis. Recovery hasn’t been a walk in the park (especially the post-op blues!) however, despite this, it is one of the best things I’ve ever done! I can now chase after my little boy and we are looking forward to going swimming again from March.

After a thoroughly depressing year, I feel like a black cloud has lifted and I’m very excited about the rest of my life!

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cheryll9 said on 14 January 2014

I am a 43 year old female and on the 14th December I had a left HR

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David_Atkinson said on 24 December 2013

Recently My hip replacement operation was cancelled, on the morning of the operation. I have been given another date 3 weeks from the date of cancellation but have heard from various sources that I will be very lucky if the operation actually takes place on the given date, I work full time and my employers are rather annoyed at the inconvenience caused by altering the dates having to provide cover for me while off.
I do understand that trauma cases have to come first and that this time of the year there are a lot more admissions.
But what happens if my operation keeps getting cancelled or how many times can the hospital cancel before something has to be done?

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minibug said on 10 October 2012

i am 28 was born with no hip on my left side and i have been told all my life by the nhs i am far to young for a hip replacement so where am i going wrong ? all i am given is pain killers and cordial epidurals that are very very painfull.

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Tracy333 said on 19 June 2012

Vintagequeen
so pleased you are doing well my daughter is doing fab
good luck for the future
Tracy

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Tracy333 said on 19 June 2012

TracyHi Gary
my daughter had a total hip replacement just before he 14th birthday, her consultant would not do her replacement untill he thought she had stopped growing and only did my daughters as she had no quality of life and in constant pain she had no femoral head as it disintergrated having AVN , he did mesaure my daughter as girls normal stop growing around the age of 14 im not sure of boys her consultant is one of the top surgeons with children. I wish your son well my daughter had a leg diffrence of 56mm but her legs are the same now and she is leading a normal life. hope this helps
regards
Tracy

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Gary Collard said on 13 June 2012

Our son was born very premature in Exeter in 2008 and unfortunately contracted multi focal osteomyelitis and then septic arthritis, which resulted in one of his femoral heads being destroyed. He is 3 1/2 but still obviously small. He has a leg length difference which I guess will become more obvious as he continues to grow. Our Orthopaedic consultant has suggested that when he has finished growing i.e. around 18years old, he could have a hip replacement, but he has advised that although replacements could be done sooner, they would not be practical as he will out grow them. I was interested to read a number of recent comments from parents of children who have had replacements, and just wondered what other parents consultants opinions were of having the replacements in childhood years, whilst the child was still growing?
Has anyone been given any ‘earliest age dates’ that replacements are possible from?
At the moment our son is learning to walk, with a limp, but we don’t know how long this will last, and whether he is in any pain – although he can’t walk far.
We have been offered a temporary operation next year that will remove and rotate the top of his femur (I can’t remember the name of the operation) to try and create some extra leg length and a fabricate a temporary ball – but we understand this is pretty experimental and few ops have been carried out like this.
Any advice from parents who have a ‘young’ child with a missing femoral head and a hip problem would be well received.
Thanks

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stemcell jim said on 09 June 2012

had stem cell treatment after being told two years i had sciatica in lower back and right leg. my condition turned out to be avn. told hip job only option. NOT TRUE AT ALL!

found out about stem cells had bone samplefrom pelvis used to grow sells. after 8weeks went back left hip as good as new right regenerating. only take pain killers (tramadol) when weather turns very cold. 75%better than two year ago when would have 6-8 per day. stem cells work . dont let any one tell you hip replacement only trteatment available!!

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stemcell jim said on 09 June 2012

dear all. About me was suffering for two years with avn. as was told in 07 had sciaitca in lower back/right leg after nemerus xrays and physio sessisons was told its avn in nov 09!

told hip replacement was only option, bad depressive news for a active 34year old.

found out about stem cells had plevis bone removed from pelvis, sells grown from that and inserted 8weeks later. my xray showed that my left hip was as good as new and my damaged right hip was showing signs of regeneration!!!!
apposed to 2007 till may 2010 need no tramadols for pain relef at all. bar when its very cold or its frosty but that seldom . i still use cruches as bone grows back slow as we know, bull am 75% better than before..

. more options than hip replacement trust me i did my diligence and dont let Anyone tell you HIP REPLACEMENT ONLY OPTION! sorry i cannot tell you were i had it due but il say i had it done in England.

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vintagequeen said on 16 May 2012

Hi Tracy, thanks for your response. I’m now two weeks post op and can’t believe how well I feel! I really am pain free and ‘normal’ for the first time in years. Still a bit slow and stiff occasionally but quicker than before the op and off the painkillers. The physio exercises are really worth doing as they make a big difference. I appear to have both legs the same length too, which is great! Hope your daughter is still doing well,
Sarah

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Tracy333 said on 09 May 2012

Your welcome Heather
Wishing your Daughter a very bright future
All the best
Tracy

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Heather333 said on 08 May 2012

Hi Tracy
Many thanks for your response; am so glad to hear that your daughter is doing so well !! All your comments have given me so much hope; we really want to crack on with her THR straight away. Will be great for her to be pain freeand start being "normal" as she says!
Thank you for all your help and support.Will repost if I can think of anything else.
Best wishes to you & your daughter, Heather

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Tracy333 said on 07 May 2012

Hi Vintagequeen
so glad you are doing well as you may have read my 13year old daughter had a THR she is 12 weeks post op and doing great she couldnt sleep with pain either and said it is the best thing she has done it has given her a life back i have twins who are 21 this year so I know how much work that is you sound like you are doing great keep up the good work.
Tracy

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vintagequeen said on 06 May 2012

Well, after years of pain and thinking I was too young for a HR I finally had my right hip totally replaced on Tuesday last week. I had septic arthritis at the age of 11, and started noticing problems in my late 20’s. Having reached my 40’s it was obvious that I couldn’t remain mobile without a total HR. I have 10 year old twins and run my own retail business so can’t allow myself to become immobile. I was scared stiff, but had a fantstic surgeon who reassured me, and promised a less invasive aproach with rapid healing. Post surgery was fine, had a dodgy next day with nausea and muscle cramps but was on my feet a bit. On the third day I was climbing stairs and then went home! The most amazing things for me right now are that I am sleeping through the night, which I haven’t done for ages due to hip pain. The referred pain in my knee (which used to drive me mad) continued for a day or so but has now gone. I can stand up instantly, and have no hip pain at all. I also expected to have visible black and blue bruising, but there is none. I know it is early days (less than a week!) but so far it is fantastic, and I am so glad I gritted my teeth and did it. My family are amazed at how well I am.

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Tracy333 said on 02 May 2012

Hi Heather
We are in Bristol alot my husband is from Horfield, My daughter is still having physio once a week at hospital and will do for some time just to strengthen her muscle as it had wasted alot with the leg length diffrence she is also doing excercises they have given her to do at home these are important because they help them walk without a limp,she had a big day yesterday it was her first day ever in 4 years she went to school without any crutches My daughter said it is the best thing she ever did she only had pain killers for the first couple of weeks then no painkillers at all apart from last week her physio was very intense so needed some but not for hip pain its the muscle what hurt, Try to get Ceramic if you can for your daughter it is better in girls as it as doesnt give off any metal ions and it is stronger and doesnt wear as much they tend to use this in children anyway as they are more active they wouldnt tell me how long it would last but he said hopefully at least 20 years then hopefully there will be something out which may last her a lifetime with the way technology moves on I hope anyway he has told my daughter to do everything a child her age does and just to treat it as a normal hip and that is what she is doing. please ask away Heather if there is anything else.
Tracy

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Heather333 said on 01 May 2012

Hi Tracy;that is all so encouraging to hear;thank you very much.I’ve passed on your info to my daughter, she’s much more positive now.
we’re waiting for a date;her present surgeon in Bristol is referring her to another for the op itself but they’ve said imminently as she’s in so much pain, particularly at night.It sounds as thou the THR recovery will be less intensive than the previous hip restructural ops she’s had, so thats a huge relief.
Did your daughter have much physio after the op? Does she need pain relief now at all?Did they give you any indications how long the hip would last?
Thank you very much again
Heather

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Tracy333 said on 30 April 2012

Heather- all the comments were me sorry it kept re-posting my daughter had her operation under genral i not sure they do children under epidural i wouldnt have wanted my daughter to stay awake, she went in hospital on the tues had her op on the wed out of bed on the thursday and discharged on the friday as my daughter was in so much pain before the op she tells me she has no hip pain know at all, as she had a total hip replacement and not a resurfacing they cut her bone to what lengh they needed and left her with as much bone as possible because of her age they remove all the femoral head my daughter has ceramic it was done in birmingham they were excellent she was off school for 8 weeks please ask if you have more questions when is your daughter due for surgery?

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Heather333 said on 30 April 2012

Dear Both
Thats great to hear; really cheered me up so glad you responded.
I’ve got so many questions dont know where to start! Were your children under GA or epidural/sedative for the op & how long did it take? How long in Hospital and when did they get out of bed? Did the surgeon also do a bone graft to recify the leg length difference or was it slotted in lower? How has their pain levels been since the op? How much time did they have off school?
Thank you very much for your time;really appreciate it.
Heather

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Anonymous said on 28 April 2012

Heather- I have just been through the same thing my daughter had hip replacement on the 8th feb age 13 and also had 56mm leg length diffrence if i can help in anyway i will she is doing good now and leg length is the same .

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Anonymous said on 28 April 2012

Hello Heather333
I have just been reading about your daughter, my daughter had a total hip replacement on the 8th feb this year she was 13. she had avascular necrossis she also had a leg length discrepency of 56mm my daughter had lots of surgery to try and save her hip and I was very worried about her having a hip replacement at such a young age. We are now 11 weeks on and I cant keep her in the house, its so nice to see her out with her friends she is doing well now with both legs the same length, if you need someone to talk to i am more than willing to help with any questions you may have, I do understand everything you are going through and i wish I could have spoken to someone who was going through the same as me for reasurance.
all the best
Tracy x

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Anonymous said on 28 April 2012

Hello Heather333
I have just been reading about your daughter, my daughter had a total hip replacement on the 8th feb this year she was 13. she had avascular necrossis she also had a leg length discrepency of 56mm my daughter had lots of surgery to try and save her hip and I was very worried about her having a hip replacement at such a young age. We are now 11 weeks on and I cant keep her in the house, its so nice to see her out with her friends she is doing well now with both legs the same length, if you need someone to talk to i am more than willing to help with any questions you may have, I do understand everything you are going through and i wish I could have spoken to someone who was going through the same as me for reasurance.
all the best
Tracy x

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Heather333 said on 25 April 2012

My daughter has congenital dislocation of the hip, which was only diagnosed when she was 5.After 3 unsuccessful pelvic osteotomies, she is now due to have a total hip replacement, aged 12.In addition she has a 5cm leg length difference, which they are hoping to rectify.
I would love to hear from anyone who had a hip replacement as a child,or whose child has been through this.Any advice or assurance welcomed!

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stepher henry said on 25 April 2012

i need hip replacment but my doctor said its only slight
wear it also causing sever back pain.
last year i had both knees replaced no problem,
now it seems goverment cuts are starting to bite
if my doctor wont refer me what can i do

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120paphos said on 21 April 2012

I am 51, and due my first of both hip op’s, in a few months. What concerns me is that it’s my knees that give me terrible pain. Only ever get slight twinges in hips. However the consultants assure me, the problem is in the hips, and my knees are taking the hit.
Is this the case?
Also i have a very physical job, daily climbing scaffolds, ladders, steps, etc.
I am fairly fit, and intend to have as much exercise/physio after the op, but how long can i expect to be off work.

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lilybet2008 said on 19 April 2012

I have had 2 total hip replacements the1st one 7 years ago and the 2nd just on 2 years ago. I had both operations performed with an epidural and a light sedative this means you go in and out of sleep throughout the whole operation and I was told that I could request more sedative at any time.You can also use your ipod or MP3 player in theatre so be assured you do not hear anything. Having your operation this way means you have the control on talking or not and it also aids your pain relief for 24 hours. I feel as if I have been given my life back. Do not hesitate to have this operation if your surgeon recommends it.

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lou mccall said on 15 April 2012

Had triple.pelvic osteotomy 3 years ago and now facing a replacement due to limited mobility. Has anyone had the replacement with epidural and whats the verdict? Pros and cons. Do you hear all the noises? Would perhaps consider this option as i get nervous at the thought of anastetics. Please advise on all aspects of the replacement and revovery, thanx xx

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caravan2 said on 04 April 2012

I had a hip replacement 7 weeks ago. although I thought I was doing well I now realise I can’t yet walk without my crutch, it is causing me too much pain. Is this normal or should I have had physio? I am worried that I am damaging my leg by trying to walk?

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Bieffe said on 21 February 2012

I’ve been fighting the hip and associated leg, knee, and back pains since early 2001. Despite my poor previous hospital experiences, and resulting fear of hospitals and doctors, I have now finally given up fighting the hip, and have decided to go for the hip replacement.

However, previous experiences in my local hospital here in Cumbria have left me wanting to go elsewhere, but where?

Any suggestions anyone?

Also, what questions should I be asking.

Thank you.

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Tumblecat said on 12 February 2012

To tresjolies worries I had my total hip replacement three weeks ago I can honestly say it is nothing to worry about .I had a spinal block followed by a sedative so I slept right through , although you can opt to stay awake if you wish .I was in hosp for five days in total and am now recovering well .I was in The Golden Jubilee Hospital in Clydebank in Glasgow fantastic hosp it is a national waiting times hosp so you don’t have to live in Scotland (which I do ).I am going to have the left one done later in the year so it can’t be that bad eh

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xxannbxx said on 21 January 2012

I am going to be having hip replacement surgery this yearbecause i have a genetic disorder that more or less causes my bones to crumble. It’s going to be a very difficult op because my pelvis is supposed to be half the size of the average womans so they can”t actually get tje socet bit in so there’s a higher chance of it dislocating. I know that if it goes right that it’s going to get rid of a lot of the pain i get but there’s also a chance of me ending up with no hip at all.I’m in a wheelchair full time and if it goes wrong then I’m going to loose even more of my mobility Should i go through with it?
Tricky one huh?

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tresjolie said on 06 January 2012

Hi ali17….I also need a total hip replacement, have been for pre op assessment and am terrified also! Hospitals and anaesthetics scare me. Also thought I would have the spinal, but am now thinking…what about all the noises I would hear?? don’t know if I will go through with it in the end, but my life is severely affected by the pain, and I have already waited 3 years and have no cartilege left in the hip. Also, my x ray shows deterioration of the other hip, and I do experience discomfort there too. Have been taking oral steroid therapy for scleritis for 8 years and also have some osteoporosis and bad varicose veins in my leg…they said these things make me a high risk..anyone got words of comfort???

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lessay said on 06 January 2012

I am due for my op next Tues 10th Jan, any tips please.

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ali17 said on 04 January 2012

Taking comfort from hanabanana85 and jojostevo – I am yet another congenital hip dislocatiion girl – discovered at 21 months! I am due for a left total hip replacement on Feb 28th….. However I am totally terrified…… so many memories of many anaesthetics and operations as a little girl have left their mark. I know only too well how things have changed – I am 42 now! But I’m still really frightened. I plan to have a spinal anaesthetic – then I know I’m still alive!!! I desparately need it done as am in daily agony and my life is on hold but I just need to get over this terrible fear leading up to the op…. any tips?

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Eat Your Greens said on 13 December 2011

@Mike_lewis, I think you have been incredibly unfortunate. I have had both hips resurfaced in 2008 and it honestly has totally changed my life. No more constant pain, no more painkillers, better quality of life, pain free walking. I would recommend it to anyone, except that I’m on this site today, trying to see if NHS Choices had anything to say about an article which appeared in the Mail today, saying that hip resurfacing was very problematic and anyone who had had this surgery should visit their GP for blood tests due to metallosis and a high failure rate. I hope that it is just the De Puy prosthetics which are at fault, I had BHRs for my hips and no problems at all after four years.

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DGVale said on 09 November 2011

Could not agree less with Mike_lewis (June 2011). I had a hip resurfaced (BHR prosthesis) almost twelve years ago at the age of 51. Since then I have been very active – I play tennis, including singles, normally three times per week. I have never had a moment’s trouble with it.

The critical element appears to be surgeon skill. Do your best to get a good and experienced one.

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peterbees said on 04 November 2011

I had my right hip replaced in Dec 2010, at age 63 and my left in June 2011. Both ops went well, and I’m now well on the way to full recovery. I had excellent care in hospital and in physiotherapy post -ops. I waited a long time before seeking medical help, despite regular prodding from friends. Now I feel that every day is the best day of my life!

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jojostevo said on 19 October 2011

Sorry for posting twice – my first post never appeared for hours so I decided to write again and when I submitted they both appeared!

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jojostevo said on 19 October 2011

Hanabanana85 – thank you so much for your posting.
I am a 32 year old mum of 3 young children and my situation almost mirrors yours!
I too was born with hip displasia in my left hip which was not caught at birth but when I was 14mths old.
I had surgery on my pelvis in 1998 to build me a better socket, and have now been offered a hip replacement as I been diagnosed with arthritis and my pain is unbearable at the moment.
I was taking time out to think about this surgery as I have to take my children into consideration but from reading your post I think I’m going to contact my consultant sooner rather than later!
Please could I ask what type of hip they have used?
They have said they would use the best possible hip to get me the most out of it so this is a relief to me!

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jojostevo said on 19 October 2011

Hanabanana85 – thank you for posting on here!
My situation almost mirrors yours (but perhaps not as bad!)
I am 31 mother of 3 young children and too had hip displasia in my left hip which was not found until I was 14months old! I had surgery in 1998 to develop my socket which was almost non exsistant and my leg is 2+ cm shorter.
I have been offered a hip replacement and needed some time to think about it – (I have to take my children into consideration).
The pain in my hip is unbareable and your post has helped me realise that I should have this procedeure sooner rather than later – Thank you!

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Hanabanana85 said on 12 October 2011

Hello! I am 26 years old, and was born with hip displasia in my left hip. It was not caught at birth, so when I was 3 and 4 years old, I had to have surgery, placing my hip into the socket. Since it was out for that amount of time, the socket and the ball of my hip had lost some of its shape, plus my socket was way above where a normal socket would originally be, causing my leg to be around an inch shorter than my other leg. I got to the point recently where all of the cartilege was worn away, and I was in quite a bit of pain when walking short distances, or doing certain activites or positions. All of that led to having a total hip replacement. I just had it done 3 weeks ago tomorrow. My doctor was able to put my hip in the God-given place, bringing my leg even with my other leg, and he had to fill in the gap with a wedge…. needless to say, my case was a challenge and there was a lot more done in there besides just the hip replacement. Now, I am so thankful, and couldn’t be any happier about the end result. I have no pain, and am walking with just a cane. I am even walking distances that I would not have wanted to walk before I had the surgery. In reply to Leeanne, I have no children of my own yet, but have been a babysitter/nanny for many years. I was also finding it hard to do things with the children… even taking a simple walk. It’s only been 3 weeks since I’ve had the surgery, but I know already that it is well worth it, and nothing to be afraid of! The first week is the toughest, and yes, you do have restrictions like not being able to bend for a while. But the end result is wonderful! I thank the Lord for what He’s done in healing my hip and sending me to the right doctor!

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leeannejj said on 27 September 2011

hi my name is leeanne i am 21 years old i had a car crash 4 years ago in 2008 the hospitali i went to gave me an xray and told me i have a bruised pelvis and torn liginnent in my right leg. in 2010 i had an other xray now i have severe atharitis in my right leg and need a full hip replacement i am really scared and would like some advise. I have a 2 year old little girls and its really hard doing day 2 day thing with her like playing in the park and walking down the street thing like that i hope to here from some one soon thanks for listing

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Relieved mum said on 03 September 2011

My daughter who is 24, had a total hip replacement on 15th August 2011. She was home on 17th. She has been in pain for the last 11 years due to complications when she had a slipped epyphisis in 2000. She is now pain free ( apart from the operation site ) and is looking forward to starting a new life where she doesn’t have to take 17 painkillers every day or rely on her wheelchair. She says it’s the best thing that could have happened to her. So all you people reading this……go for it.

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carelesstalk said on 25 July 2011

Had right hip replacement (exeter-trident) on 19th July 2011, yes, just last week and was home on the 21st and feel incredible. Had one bad day post op. due to nausea but am now able to walk without any pain and only need to use a stick first thing in the morning due to a bit of stiffness. Have stopped taking the voltarol and only take 2 paracetamol at night.
Only problem is I feel so much better I keep forgetting I am not supposed to bend or twist for at least 6 weeks and do worry about dislocation.
Have been putting this op off for two years and now realise how much my life has improved already and wish I had done it earlier.

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jen39 said on 17 July 2011

I had my right hip replaced In April 2010 and if anythink it has made my mobility worse my left hip needs replacing but this first operation has put me of because i am only 39 and my right hip gives me constant pain so i am a bit worried to have the next one done has anyone else had this problem

Thankyouu

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Mike_lewis said on 08 June 2011

I have had both hips replaced, in 2003 i had my right hip replaced with a full replacement which i have had no problems with it has been exultant. My left hip was done in 2008 which was a re surfing type (not sure of name of re-surfing type). The re-surfing hip has been nothing but constant pain, i would never rec emend this to anyone. i know have to go through the operation all over again this is due to wear on the metal in the hip joint. If you are given the choice please go for the full hip replacement and not the re-surfacing type as it is crap

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aesclepius said on 11 January 2011

Why follow 12 weeks hip precations? What is this based on? Where is the evidence base for 12 weeks precautions?

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Hip fracture

Hip fractures are cracks or breaks in the top of the thigh bone (femur) close to the hip joint

Preparing for surgery

What you need to organise in the days leading up to your operation

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NHS Choices Syndication

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Hip replacement

How a hip replacement is performed

You may be able to choose the type of anaesthetic you are given during surgery.

There are two options:

  • general anaesthetic – where you are asleep during the operation
  • a spinal or epidural anaesthesia – where an injection is given into your spine that numbs the lower half of your body. This is often combined with sedation so you will be unaware of your surroundings and have no memory of the surgery taking place

Depending on the general state of your health your surgeon may recommend you have an epidural as this has less chance of causing complications in people with an underlying health condition.

The procedure

Once you have been anaesthetised, the surgeon removes the existing hip joint completely. The upper part of the thigh bone (femur) is removed and the natural socket for the head of the femur is hollowed out.

A socket is fitted into the hollow in the pelvis. A short, angled metal shaft (the stem) with a smooth ball on its upper end (to fit into the socket) is placed into the hollow of the thigh bone. The cup and the stem may be pressed into place or fixed with acrylic cement.

Metal-on-metal hip resurfacing is carried out in a similar way. The main difference is that less of the bone is removed from the femur as only the joint surfaces are replaced with metal inserts.

Materials used

The prosthetic parts can be cemented or uncemented:

  • cemented parts are secured to healthy bone using acrylic cement 
  • uncemented parts are made from material that has a rough surface. This allows the bone to grow on to it, holding it in place

Most prosthetic parts are produced using high-density polythene for the socket, titanium alloys for the shaft and sometimes a separate ball made of an alloy of cobalt, chromium and molybdenum.

Some surgeons use a metal ball and socket and in some cases ceramic parts are used, which do not wear as quickly as plastic.

There have been recent reports about metal-on-metal hip replacements causing complications. Read our metal-on-metal implant advice Q&A for more information.

The hip replacement operation has become a routine procedure. However, as with all surgery, it carries a degree of risk. Read more about the risks of hip replacement surgery.

Choosing your prosthesis

There are more than 60 different types of implant or prosthesis. In practice, however, the options are usually limited to around four or five. Your surgeon can advise you on the type they think would suit you best.

The National Institute for Health and Care Excellence (NICE) only recommends prostheses known to have a 95% chance of lasting at least 10 years. Ask your doctor if you will be getting one of these and, if not, why not. Your surgeon will also be able to discuss any concerns you have regarding metal-on-metal replacements.

The National Joint Registry (NJR), which collects details on total hip replacement operations from hospitals in England and Wales, can help you to identify the best performing implants and the most effective type of surgery.

Your specialist

Choose a specialist who regularly performs hip replacements and can discuss their results with you. This is even more important if you are having a second or subsequent hip replacement, known as revision hip replacement, which is trickier to perform.

Look for a specialist who will work with you to find the best treatment for you.

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NHS Choices Syndication

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Hip replacement

Introduction

A hip replacement is a common type of surgery where a damaged hip joint is replaced with an artificial one (known as a prosthesis).

The hips

The hip joint is one of the largest joints in the human body and is what is known as a “ball and socket joint”.

In a healthy hip joint, the bones are connected to each other with bands of tissue known as ligaments. These ligaments are lubricated with fluid to reduce friction.

Joints are also surrounded by a type of tissue called cartilage that is designed to help support the joints and prevent bones from rubbing against each other.

The main purpose of the hip joints is to support the upper body when a person is standing, walking and running, and to help with certain movements, such as bending and stretching.

Why do I need a hip replacement?

It might be necessary for you to have a hip replacement if one (or both) of your hip joints becomes damaged and causes you persistent pain or problems with everyday activities such as walking, driving and getting dressed.

Some common reasons why a hip joint can become damaged include:

  • osteoarthritis – so-called “wear and tear arthritis”, where the cartilage inside a hip joint becomes worn away, leading to the bones rubbing against each other
  • rheumatoid arthritis – this is caused by the immune system (the body’s defence against infection) mistakenly attacking the lining of the joint, resulting in pain and stiffness
  • hip fracture – if a hip joint becomes severely damaged during a fall or similar accident it may be necessary to replace it

Many of the conditions treated with a hip replacement are age-related so hip replacements are usually carried out in older adults aged between 60 and 80.

However, a hip replacement may occasionally be performed in younger people.

The purpose of a new hip joint is to:

  • relieve pain
  • improve the function of your hip
  • improve your ability to move around
  • improve your quality of life

Read more about why a hip replacement may be necessary.

What happens during hip replacement surgery?

A hip replacement can be carried out under a general anaesthetic (where you are asleep during the procedure) or an epidural (where the lower body is numbed).

The surgeon makes an incision into the hip, removes the damaged hip joint and then replaces it with an artificial joint that is a metal alloy or, in some cases, ceramic.

The surgery usually takes around 60-90 minutes to complete.

Read more about how a hip replacement is performed.

Recovering from hip replacement surgery

For the first four to six weeks after the operation you will need a walking aid, such as crutches, to help support you.

You may also be enrolled on an exercise programme that is designed to help you regain and then improve the use of your new hip joint.

Most people are able to resume normal activities within two to three months but it can take up to a year before you experience the full benefits of your new hip.

Read more about recovering from hip replacement surgery.

What to expect after a hip replacement

Since its introduction in the 1960s, hip replacement surgery has proved to be one of the most effective types of surgery in modern medical history. Most people experience a significant reduction in pain and, to a lesser extent, improvement in their range of movement.

However, it is important to have realistic expectations about what the operation can achieve. For example, you should be able to ride a bike but it is unlikely that you would be able to play a game of rugby safely (although, as with most things, there are always exceptions to this rule).

The rehabilitation process after surgery can be a demanding time and requires commitment.

Risks of hip replacement surgery

Complications of a hip replacement can include:

  • hip dislocation
  • infection at the site of the surgery
  • injuries to the blood vessels or nerves
  • a fracture
  • differences in leg length

However, the risk of serious complications is low – estimated to be less than 1 in a 100.

Read more about the risks of a hip replacement.

A modern artificial hip joint is designed to last for at least 15 years, but there is always the risk that the artificial hip joint can wear out or go wrong in some way before this time, meaning that further surgery is required to repair or replace the joint.

This is known as revision surgery. It is estimated that around 1 in 10 people with an artificial hip will require revision surgery at a later date.

There have been recent cases of metal-on-metal (MoM) replacements wearing quicker than would be expected, causing deterioration in the bone and tissue around the hip. There are also concerns that they could leak traces of metal into the bloodstream.

For more information, read our metal-on-metal hip implant advice Q&A.  

Alternatives

There is an alternative type of surgery to hip replacement, known as hip resurfacing. This involves removing the damaged surfaces of the bones inside the hip joint and replacing them with a metal surface.

An advantage to this approach is that it removes less bone. However, it is usually only effective in younger adults who have relatively strong bones.

Resurfacing is much less popular now due to concerns about the metal surface causing damage to soft tissues around the hip.

Read more about alternatives to hip replacements.

Future developments

Hip replacement surgery is being improved in several ways:

  • New, stronger materials for prosthetics are being developed that will allow longer wear and better joint mobility.
  • Enhancements are being made to new “cementless” implants. Patients can be recommended for newer types of joints, such as ceramic-on-ceramic and ceramic-on-plastic.
  • Computer-assisted surgery is being used to generate an image of the hip joint to allow greater precision.

Another area of research is looking at regenerating a hip joint by transfusing stem cells into damaged tissue. Stem cells are specialised cells that have a useful ability to help replenish other types of cells.

 

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Published Date
2014-07-25 07:31:05Z
Last Review Date
2014-07-19 00:00:00Z
Next Review Date
2016-07-19 00:00:00Z
Classification
Hip,Hip replacement,Hip surgery,Joint pain,Joint replacements


NHS Choices Syndication

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 /conditions/articles/hip-replacement/metal-on-metalimplants

Hip replacement

Latest metal-on-metal hip implant advice

Patients with a common type of metal hip implant should have annual health checks for life, according to the UK body for regulating medical devices.

The all-metal devices have been found to wear down at an accelerated rate in some patients, potentially causing damage and deterioration in the bone and tissue around the hip. There are also concerns that they could leak traces of metal into the bloodstream, which the annual medical checks will monitor.

In 2012, the Medicines and Healthcare products Regulatory Agency (MHRA) issued new guidelines on larger head forms of “metal-on-metal” hip implants. Advice on smaller head devices or those featuring ceramic heads has not changed.

Previously, guidelines issues in 2010 suggested larger metal-on-metal implants should only be checked annually for five years after surgery. The agency now says the annual check-ups should be continued for the life of the implant. Check-ups, they say, are a precautionary measure to reduce the small risk of complications and the need for further surgery.

Some medical quarters have called for tighter regulation of medical devices, perhaps bringing the approval process into line with that of medicines, which must undergo several years of laboratory, animal and human testing before being approved for wider use.

What should I do if I have a hip implant?

The guidance only applies to large head metal-on-metal implants, which have been used in only a minority of hip replacement surgeries. However, you can consult your doctor for further advice if you have any concerns about your hip replacement or do not know which type you have.

Patients with hip implants should also be aware of the warning signs that could signal a problem.

What are the warning signs?

Patients with metal-on-metal implants should ensure they attend any follow-up appointments as usual.

You should see your doctor if you have:

  • pain in the groin, hip or leg
  • swelling at or near the hip joint
  • a limp or problems walking
  • grinding or clunking from the joint

These symptoms do not necessarily mean that your device is failing, but they do need investigating.

Any changes in general health should also be reported, including:

  • chest pain or shortness of breath
  • numbness or weakness
  • changes in vision or hearing
  • fatigue
  • feeling cold
  • weight gain

What types of implants are involved?

There are numerous designs and materials used to make hip implants. In 2012 the MHRA issued major updates to its advice on a type of metal-on-metal hip replacement. As the name implies, metal-on-metal implants feature a joint made of two metal surfaces – a metal “ball” that replaces the ball found at the top of the thigh bone (femur) and a metal “cup” that acts like the socket found in the pelvis.

The MHRA’s updated advice concerned the type of metal-on-metal implant in which the head of the femur is 36mm or greater. This is often referred to as a “large head” implant. The agency now says that patients fitted with this type of implant should be monitored annually for the life of the implant, and that they should also have tests to measure levels of metal particles (ions) in their blood.

Patients with these implants who have symptoms should also have MRI or ultrasound scans, and patients without symptoms should have a scan if their blood levels of metal ions are rising.

The previous guidance on this type of hip implant, issued in April 2010, advised that patients should be monitored annually for no fewer than five years.

Advice on following up patients with other types of metal-on-metal implants remains the same, and guidance has not changed on:

  • metal-on-metal hip resurfacing implants – where the socket and ball of the hip bone has a metal surface applied to it rather than being totally replaced.
  • Total metal-on-metal implants where the replacement ball is less than 36mm wide.
  • A particular range of hip replacements called DePuy ASR – these hip replacements were recalled by their manufacturer, DePuy, in 2010 because of high failure rates. The company made three types of ASR implant.
  • Implants featuring ceramic heads.

How many people are affected?

It is estimated that in total, 49,000 people in the UK have been given metal-on-metal implants with a width of 36mm or above. This represents a minority of the patients given hip replacements, who mostly have devices featuring ceramic or smaller metal heads.

In 2010 there were 76,759 hip replacements, and approximately 5% of these surgeries used an metal-on-metal implant sized 36mm or above.

What exactly is the problem with metal-on-metal implants?

All hip implants will wear down over time as the ball and cup slide against each other during walking and running. Although many people live the rest of their lives without needing their implant to be replaced, any implant may eventually need surgery to remove or replace its components. Surgery to remove or replace part of the implant is known as “revision” and, of the 76,759 procedures performed in 2010, some 7,852 were revision surgeries.

However, data now suggest that large head metal-on-metal hip implants (those with a width of 36mm or greater) wear down at a faster rate than other types of implants. As friction acts upon their surfaces, it can cause tiny metal particles (medically referred to as “debris”) to break off and enter the space around the implant.

Individuals are thought to react differently to the presence of these metal particles, but in some people they can trigger inflammation and discomfort in the area around the implant.

Over time this can cause damage and deterioration in the bone and tissue surrounding the implant and joint. This, in turn, may cause the implant to become loose and cause painful symptoms, meaning that further surgery is required. 

News coverage focused on the MHRA’s recommendation to check for the presence of metal ions in the bloodstream, potentially released either from debris or the implant itself. Ions are electrically charged molecules. Levels of ions in the bloodstream, particularly of the cobalt and chromium used in the surface of the implants, may therefore indicate how much wear there is to the artificial hip.

There has been no definitive link between ions from metal-on-metal implants and illness, although there has been a small number of cases in which high levels of metal ions in the bloodstream have been associated with symptoms or illnesses elsewhere in the body, including effects on the heart, nervous system and thyroid gland.

The MHRA points out that most patients with metal-on-metal implants have well functioning hips and are thought to be at low risk of developing serious problems. However, a small number of patients with these hip implants develop soft tissue reactions to the ‘wear debris’ associated with some metal-on-metal implants.

How are medical devices regulated?

In the UK, the MHRA is the government agency responsible for ensuring that medical devices work and are safe. The MHRA audits the performance of private sector organisations (called notified bodies) that assess and approve medical devices.

Once a product is on the market and in use, the MHRA has a system for receiving reports of problems with these products, and will issue warnings if these problems are confirmed through their investigations. It also inspects companies that manufacture products to ensure they comply with regulations.

This system differs greatly from that for testing and approving drugs. Drugs require several years of research testing and trials before they can be approved for clinical use.

What action have regulators taken?

The MHRA has convened an expert advisory group to look at the problems associated with metal-on-metal implants, meeting regularly to assess new scientific evidence and reports from doctors and medical staff treating patients. The agency says it is continuing to monitor closely all the latest evidence about these devices and may issue further advice in the future.

In the US, the Food and Drug Administration (FDA) says it is gathering additional information about adverse events in patients with metal-on-metal implants. In the meantime, it advises patients with metal-on-metal hip implants who have no symptoms to attend follow-up appointments as normal with their surgeon. Patients who develop symptoms should see their surgeon promptly for further evaluation.

What actions have critics called for?

In light of the PIP breast implant controversy and the information on hip implants, there is currently intense scrutiny on the way medical devices are regulated in the UK and Europe, with patient groups and the media arguing that medical devices should be regulated in a similar way to medicines.

Clearing a medicine for use in the UK is a lengthy process involving several stages of laboratory and animal testing, and then carefully controlled and monitored tests in humans. Only once there is enough evidence to suggest that a medicine is reasonably safe can it enter clinical use, and even then patients will be monitored to look at the longer-term effects of the drug.

However, medical devices are not required to go through human trials before entering use, and can currently be approved on the basis of mechanical tests and animal research.

While certain devices, such as hip implants, have been monitored through systems such as the National Joint Registry, in light of health concerns over PIP breast implants, patient groups are calling for more testing before devices are allowed into clinical use, and closer, mandatory monitoring schemes to ensure their safety once they enter the market.

Further reading

D Cohen How safe are metal-on-metal hip implants?  BMJ 2012

Published Date
2014-07-24 14:21:37Z
Last Review Date
2014-07-19 00:00:00Z
Next Review Date
2016-07-19 00:00:00Z
Classification


NHS Choices Syndication

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Hip replacement

Preparing for the operation

A couple of weeks before the operation, you will usually be asked to attend a pre-operative assessment clinic to meet your surgeon and members of the surgical team.

During the clinic, the hospital team will take your medical history, perform a physical examination and may organise some tests to make sure you are healthy enough for anaesthetic and surgery.

These tests can include:

They will give you advice on anything you can do to prepare for surgery and ask you about your home circumstances so your discharge from hospital can be planned. If you live alone, have a carer or feel you need extra support, tell the team so that help or support can be arranged before you go into hospital.

Take a list or the packaging of any medication you are taking. Some rheumatoid arthritis medications suppress the immune system, which can affect healing. Blood thinning medications (anticoagulants) and hormone replacement therapy may also need to be stopped before surgery.

Your surgeon can advise you about alternative medications.

Exercising before the operation

You can prepare for the operation by staying as active as you can. Strengthening the muscles around your hip will aid your recovery. You may be referred to a physiotherapist, who can give you helpful exercises. If you can, keep up any gentle exercise, such as walking and swimming, in the weeks and months before your operation.

The following exercises can help maintain your muscle strength and movement before surgery:

  • Stand at the bottom of the stairs and put one foot on the second stair. Alternatively, put one foot on a kitchen stool. Hold on to the banister or another firm support. Lean forward to bend the top leg while stretching the front of the standing leg. Hold this for about 30 seconds, then repeat with the other leg.
  • Stand on the affected leg for short periods, lifting the good leg off the floor. Concentrate on holding the pelvis level. Use a support, if necessary, for balance.
  • Lie on your back on a bed. Pull one leg up to your chest, keeping the other leg flat down on the bed. Repeat the exercise with the other leg. (Only do this exercise if you have not already had a hip replacement on one side.)
  • Lie on your back on a bed. Bend your knee up so that your foot rests flat on the bed and allow the bent knee to fall out to the side as much as is comfortable.
  • Lie on your stomach and then flat on your back for approximately 20 minutes once or twice a day (early morning or late at night while in bed is often a good time), to stretch the front and back of your hip.

Planning for your recovery after surgery

You may not be able to walk unaided for at least four weeks after surgery, and other types of movement – such as stretching or picking things up – may also be severely restricted.

You may want to consider making some changes to your home to make life easier while you recover from the operation, such as:

  • adding a shower seat to your bathroom
  • placing any useful objects at hand level so you do not have to bend down to pick them up
  • stocking up on food that is easy to prepare, such as frozen ready meals, or prepare and freeze your own dishes to reheat during your recovery

Many people find it useful to buy a “reacher grabber” – a handheld device that allows you to pick up objects that are slightly out of reach. These devices are easily available through the internet as well as from shops that sell mobility products.

Preparing for surgery

For more general advice about going into hospital and preparing for surgery, see our surgery planner.

Published Date
2014-07-24 14:22:19Z
Last Review Date
2014-07-19 00:00:00Z
Next Review Date
2016-07-19 00:00:00Z
Classification
Hip replacement

Hip replacement – NHS Choices

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Hip replacement 

Introduction 

Hip operation: animation

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This detailed animation explains how a hip replacement is done and why it would be needed.

Media last reviewed: 11/07/2013

Next review due: 11/07/2015

How common are hip replacements?

Hip replacements are a very common procedure.

In 2013, the NHS performed just over 66,000 hip procedures in England and Wales.

Worries over metal-on-metal implants

There have been cases of some metal-on-metal hip replacements wearing sooner than would be expected, causing deterioration in the bone and tissue around the hip. There are also concerns that they could leak traces of metal into the bloodstream.

The Medicines and Healthcare products Regulatory Agency (MHRA) has issued new guidelines that certain types of metal-on-metal (MoM) devices should be checked every year while the implant is in place. This is so that any potential complications can be picked up early.

If you are concerned about your hip replacement contact your GP or orthopaedic surgeon. They can give you a record of the type of hip replacement you have and tell you if any follow-up is required.

You should also see your doctor if you have:

  • pain in the groin, hip or leg
  • swelling at or near the hip joint
  • a limp, or problems walking
  • grinding or clunking from the hip

These symptoms do not necessarily mean that your device is failing, but they do need investigating.

Any changes in your general health should also be reported, including:

  • chest pain or shortness of breath
  • numbness, weakness, change in vision or hearing
  • fatigue, feeling cold, weight gain
  • change in urination habits

For more information read our metal-on-metal implant advice Q&A.

A hip replacement is a common type of surgery where a damaged hip joint is replaced with an artificial one (known as a prosthesis).

The hips

The hip joint is one of the largest joints in the human body and is what is known as a “ball and socket joint”.

In a healthy hip joint, the bones are connected to each other with bands of tissue known as ligaments. These ligaments are lubricated with fluid to reduce friction.

Joints are also surrounded by a type of tissue called cartilage that is designed to help support the joints and prevent bones from rubbing against each other.

The main purpose of the hip joints is to support the upper body when a person is standing, walking and running, and to help with certain movements, such as bending and stretching.

Why do I need a hip replacement?

It might be necessary for you to have a hip replacement if one (or both) of your hip joints becomes damaged and causes you persistent pain or problems with everyday activities such as walking, driving and getting dressed.

Some common reasons why a hip joint can become damaged include:

  • osteoarthritis – so-called “wear and tear arthritis”, where the cartilage inside a hip joint becomes worn away, leading to the bones rubbing against each other
  • rheumatoid arthritis – this is caused by the immune system (the body’s defence against infection) mistakenly attacking the lining of the joint, resulting in pain and stiffness
  • hip fracture – if a hip joint becomes severely damaged during a fall or similar accident it may be necessary to replace it

Many of the conditions treated with a hip replacement are age-related so hip replacements are usually carried out in older adults aged between 60 and 80.

However, a hip replacement may occasionally be performed in younger people.

The purpose of a new hip joint is to:

  • relieve pain
  • improve the function of your hip
  • improve your ability to move around
  • improve your quality of life

Read more about why a hip replacement may be necessary.

What happens during hip replacement surgery?

A hip replacement can be carried out under a general anaesthetic (where you are asleep during the procedure) or an epidural (where the lower body is numbed).

The surgeon makes an incision into the hip, removes the damaged hip joint and then replaces it with an artificial joint that is a metal alloy or, in some cases, ceramic.

The surgery usually takes around 60-90 minutes to complete.

Read more about how a hip replacement is performed.

Recovering from hip replacement surgery

For the first four to six weeks after the operation you will need a walking aid, such as crutches, to help support you.

You may also be enrolled on an exercise programme that is designed to help you regain and then improve the use of your new hip joint.

Most people are able to resume normal activities within two to three months but it can take up to a year before you experience the full benefits of your new hip.

Read more about recovering from hip replacement surgery.

What to expect after a hip replacement

Since its introduction in the 1960s, hip replacement surgery has proved to be one of the most effective types of surgery in modern medical history. Most people experience a significant reduction in pain and, to a lesser extent, improvement in their range of movement.

However, it is important to have realistic expectations about what the operation can achieve. For example, you should be able to ride a bike but it is unlikely that you would be able to play a game of rugby safely (although, as with most things, there are always exceptions to this rule).

The rehabilitation process after surgery can be a demanding time and requires commitment.

Risks of hip replacement surgery

Complications of a hip replacement can include:

  • hip dislocation
  • infection at the site of the surgery
  • injuries to the blood vessels or nerves
  • a fracture
  • differences in leg length

However, the risk of serious complications is low – estimated to be less than 1 in a 100.

Read more about the risks of a hip replacement.

A modern artificial hip joint is designed to last for at least 15 years, but there is always the risk that the artificial hip joint can wear out or go wrong in some way before this time, meaning that further surgery is required to repair or replace the joint.

This is known as revision surgery. It is estimated that around 1 in 10 people with an artificial hip will require revision surgery at a later date.

There have been recent cases of metal-on-metal (MoM) replacements wearing quicker than would be expected, causing deterioration in the bone and tissue around the hip. There are also concerns that they could leak traces of metal into the bloodstream.

For more information, read our metal-on-metal hip implant advice Q&A.  

Alternatives

There is an alternative type of surgery to hip replacement, known as hip resurfacing. This involves removing the damaged surfaces of the bones inside the hip joint and replacing them with a metal surface.

An advantage to this approach is that it removes less bone. However, it is usually only effective in younger adults who have relatively strong bones.

Resurfacing is much less popular now due to concerns about the metal surface causing damage to soft tissues around the hip.

Read more about alternatives to hip replacements.

Future developments

Hip replacement surgery is being improved in several ways:

  • New, stronger materials for prosthetics are being developed that will allow longer wear and better joint mobility.
  • Enhancements are being made to new “cementless” implants. Patients can be recommended for newer types of joints, such as ceramic-on-ceramic and ceramic-on-plastic.
  • Computer-assisted surgery is being used to generate an image of the hip joint to allow greater precision.

Another area of research is looking at regenerating a hip joint by transfusing stem cells into damaged tissue. Stem cells are specialised cells that have a useful ability to help replenish other types of cells.

 

Page last reviewed: 20/07/2014

Next review due: 20/07/2016

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Comments

The 64 comments posted are personal views. Any information they give has not been checked and may not be accurate.

Greencat29 said on 10 October 2014

I had a right THR three years ago, with an ‘Amihip’. This is a metal and ceramic device that needs no cement. I had a small frontal incision. The muscles were not cut, just separated. I can honestly say that there wqs no pain afterwards, just discomfort from swelling and bruising, which soon went away. I made a rapid recovery and was back to normal within six weeks, though I could do most things after two weeks. The worst things for me were: having my elastic stockings changed (I should have shaved my legs before the op!), sleeping on my back and giving myself Heparin injections. I am looking forward to having my left hip replaced soon.

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EDDYtwo said on 16 September 2014

Hi everyone, I suffered what seemed years of agony with arthritis in my hip joints, they were both bone on bone and I was told it was a wonder I could still walk, I could with the help of pain killers, and I had the opportunity of having my first THR, on my left hip in Oct 2012, I have always kept myself in good shape and soon recovered with no problem, I had my right hip replaced in April 2013 and after 2 weeks was walking unaided. I am back doing weight training, bike riding and walking and feel I have been given a new lease of life. I am 62 and was fitted with ceramic on ceramic joints. I still get pains if I overdo things but not the type of pain I had with the arthritis.
A tip on how to get your shoes on until flexibility has returned….I used to tie my laces before putting them on ,using a long shoe horn and holding the tongue with a pair of pliers, I also bought a pair of trainers with Velcro fasteners and used a pair of pliers to pull the straps over.
If anyone is going in to have the op then I can say there is nothing to it, I had the epidural and was awake on both occasions and it was interesting to hear what was going on….

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GemniSparkle said on 10 September 2014

I had a titanium prosthesis put in my right hip.. (Total hip replacement) . No problems.. No muscles were cut — and no drain in my incision. It is about 4" long and healing very nicely. The pain I had before surgery ( 5 yrs) far outweighed any discomfort I may have had post surgery. Just move slow, everybody..Those "tweaks" really hurt if you move too fast. Those of you who can’t sleep on your backs..? When I hurt so bad prior to surgery, I could ONLY sleep on my back with my legs bent. So post surgery wasn’t too bad for me. I’d practice sleeping on your back before surgery so that you are more comfortable.. It’s a little awkward at first but you’ll get used to it. Put up with pain for 5 yrs – until I couldn’t walk anymore I had NO range of motion in my hip at all… and life was becoming miserable. Couldn’t put on pantyhose.. climb stairs.. etc. My recovery has been great ( 4 wks post op tomorrow) and I am no longer using a cane and did without a walker within the first l0 days.. Take your time. Go slow.. Don’t hurry the process. Let your body heal and listen to your therapists. My leg was lengthened, my gait is "off" and I limp but it will get better. Only issue I have now is stiffness in my hip – some swelling and back ache when I walk around the block. Good luck to all.

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Amnesia3637 said on 09 September 2014

I’m a 61 year old female with RA and who developed osteoarthritic changes in my right hip last November. Pain became excruciating and I was referred in March 2014 to orthopaedics. Had total right hip replacement in June 2014 which relieved the pain immediately. I had kept going despite not really being able to walk at all well prior to surgery and think this helped no end with keeping muscles strong afterwards. Despite small discomforts after what is after all, major surgery I have had a brilliant recovery and am now 11 weeks on and almost back to normal. Am walking my dog for two hours each day, doing normal household chores and have been driving since I abandoned crutches at 6 weeks. Tonight I had my first bath. Fantastic improvement to my general health. Am careful still with hip precautions and I know when I’ve overdone it but has it been worth it? A resounding yes!

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bob L said on 02 September 2014

I would be interested in any comments regarding the reliability, problems, or failure rate of different types of THR, such as metal and plastic, metal and ceramic, metal stem with ceramic head and acetabular cup.

bob L

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DeniseDix said on 02 September 2014

‘My hip replacement went really well, thank you NHS!’ Denise

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meyricke said on 25 August 2014

I am 62 and had my hip replaced 5 weeks ago. The operation was painless and my recovery in hospital was fast. After 10 days, I was reasonably mobile, on sticks, and able to look after myself. The main issues are the small ones which most people do not think are important.

I have to wear orthopaedic stockings until the specialist has signed me off. These can only be changed by another person. Luckily, the local NHS team have been very good and a "nurse" appears 3 times a week to change them for me. The same NHS team has also provided the sticks, raised toilet seats, bed raisers etc etc.

Once the stockings have gone, I will need to wear socks. I have bought one of the clever gadgets which facilitates putting them on and taking them off, but am having a battle with this. I will ahve to seek advice.

I am now able to walk a couple of miles, so need some decent walking shoes. It may well be a couple of months before I can handle laces so will have to go out to buy some shoes with velcro fasteners. If I had realised this in advance it would have been useful. Until now I have worn sandals but the onset of autumn requires a better solution.

Everything else round the house is simple enough with a little thought. The "helping hand" is very versatile and can pick up both a tiny screw and also a 5KG bin of flour. They can also be ised for velcro – see above!

Hope this helps.

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TvW 123 said on 17 August 2014

Hi, I am a 53 year old male. I had a right side THR done at the Nuffield Hospital in Glasgow in July this year. The surgery went very well and the hospital staff were brilliant!!

The first week at home was very difficult as I had a swollen right leg and pain all the way down. However, I persisted with the exercises that I had been given and lots of rest. . The exercises helped my recovery and I was swiftly back on my feet.. Only six week later now and I am going back work pain free .So persist with your exercising and Good Luck to you.

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crista d said on 07 August 2014

Hi i have had 2 total hip replacements but had 3 surgeries. The first surgery went great with no complications at all and i was home 2 days after the surgery. The second surgery went great too but the following morn my Dr looked at me and my blood work and it showed.i was low 4 pints of blood. After getting the 4 pints back into me i was seeing great. Up walking later that nite. The next morn i thought i was going to be able Togo home but again i was low 2 pints of blood so i had to stay another nite. I was home 4 days after the surgery. The difference between the first surgery and the second was he used glue to close the wound up and he used 33 staples to close the wound. I had slot of drainage with the second surgery. I was up walking by myself 2 weeks after the first one but with the second one i had to stay off my hip longer bc the Dr said my thigh bone was weakening and had to put a couple of screws in my thigh bone to keep it together so he wanted me to stay off of it a couple of weeks longer. Anyways i went back to the er to get my staples taken out 2 1/2 weeks after surgery and it drained a lil bit all week long. I went for my post op visit a week after the staples removal. He looked at.the wound and said that half was healed up and the other half didn’t look that good so he felt would be better to go back in and redo the surgery. He felt like a blood cot formed underneath the incision. So 2 days later he went back in and re placed the chrome ball and cleaned it all out again. The blood clot was sent to the lab and it did have the staph bug in it so he ordered 6 weeks of strong antibiotic thru a picc line in my arm. Everything with the surgeries went fine. I have no pain ay all. The only prob i do have is stiffness. I can’t get up from kneeling on my knees and just get up. If i don’t have a chair or something to help me up i just can’t do it. Also putting my shoes or sucks.i cant bend my legs to do them by myself. Has anybody else had this type of prob.

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Sandie53 said on 02 July 2014

I am a 61 year old female who is about to under go a hip replacement but I have a heart condition with 5 stents in I am really scared to the out come. Been told I could have heart attack blood clot chest infection one leg shorter then the other, if I lost weight took stronger pain killers would I still need hip replacement? The pain I have is unbelievable so days I could just end it all I just want my life bac.

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Dave Trev said on 25 May 2014

Please can anyone offer advice on how to tie shoe laces and put my sock on(without any aids). I am 10 weeks post op and still find this difficult and I feel nervous and don’t want to cause myself injury. Thanks

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France26 said on 25 May 2014

What can be done to a hip replacement that leaves the patient with one leg longer than the other by 1"

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cruiseellie said on 13 May 2014

I notice in your above advice that the hospital should ‘enrol you in an exercise programme’. At St Albans hospital however they have stopped what was an excellent programme stating that they had found that ‘people got on much better at home without the course’. Having been on that excellent programme I would very strongly disagree with that statement. I suspect that this is a cost saving exercise of a very cash strapped Trust.

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cruiseellie said on 26 April 2014

In July 2011 I had a ceramic on ceramic hip replacement, by December 2011 it had started to crack. By January 2013 I had a replacement ball and liner. By March 2014 I had a total replacement and now have a metal and plastic hip. That’s 3 operations in under 3 years! I also have a Psoas dysfunction (groin pain) and a torn ham string as a result of the operation. Not sure at the moment if it was actually worth it!

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jesuisstan said on 11 April 2014

My wife had a resurfacing in 2007 and from then on nothing but trouble constant pain
In 2011 revision after cup came away from pelvis full hip replacement
Now waiting to go in for another revision
Three operations in seven years same side she is only 54

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janwel said on 11 April 2014

Iha my hipreplacement,27 years ago and its still going strong,would recommend any one in pain to go ahead gave me a new lease of life

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Busymummy4 said on 29 March 2014

Hi Geordie-Nicola –
I’m due to have hip replacement in just over a month and I’ve just turned 30 too. Right nightmare with being a busy mum – how did your recovery go? How long were u in hospital? I’m dreading it if I’m honest!

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merseygull said on 03 March 2014

Why are you still featuring "Resurfacing"? – at the end of the day it’s a "metal on metal" articulation and should no longer be imlanted..

J.

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Geordie_Nicola said on 13 February 2014

I had a total hip replacement on 16th december 2013 at the age of 30 due to osteoarthritis. Recovery hasn’t been a walk in the park (especially the post-op blues!) however, despite this, it is one of the best things I’ve ever done! I can now chase after my little boy and we are looking forward to going swimming again from March.

After a thoroughly depressing year, I feel like a black cloud has lifted and I’m very excited about the rest of my life!

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cheryll9 said on 14 January 2014

I am a 43 year old female and on the 14th December I had a left HR

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David_Atkinson said on 24 December 2013

Recently My hip replacement operation was cancelled, on the morning of the operation. I have been given another date 3 weeks from the date of cancellation but have heard from various sources that I will be very lucky if the operation actually takes place on the given date, I work full time and my employers are rather annoyed at the inconvenience caused by altering the dates having to provide cover for me while off.
I do understand that trauma cases have to come first and that this time of the year there are a lot more admissions.
But what happens if my operation keeps getting cancelled or how many times can the hospital cancel before something has to be done?

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minibug said on 10 October 2012

i am 28 was born with no hip on my left side and i have been told all my life by the nhs i am far to young for a hip replacement so where am i going wrong ? all i am given is pain killers and cordial epidurals that are very very painfull.

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Tracy333 said on 19 June 2012

Vintagequeen
so pleased you are doing well my daughter is doing fab
good luck for the future
Tracy

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Tracy333 said on 19 June 2012

TracyHi Gary
my daughter had a total hip replacement just before he 14th birthday, her consultant would not do her replacement untill he thought she had stopped growing and only did my daughters as she had no quality of life and in constant pain she had no femoral head as it disintergrated having AVN , he did mesaure my daughter as girls normal stop growing around the age of 14 im not sure of boys her consultant is one of the top surgeons with children. I wish your son well my daughter had a leg diffrence of 56mm but her legs are the same now and she is leading a normal life. hope this helps
regards
Tracy

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Gary Collard said on 13 June 2012

Our son was born very premature in Exeter in 2008 and unfortunately contracted multi focal osteomyelitis and then septic arthritis, which resulted in one of his femoral heads being destroyed. He is 3 1/2 but still obviously small. He has a leg length difference which I guess will become more obvious as he continues to grow. Our Orthopaedic consultant has suggested that when he has finished growing i.e. around 18years old, he could have a hip replacement, but he has advised that although replacements could be done sooner, they would not be practical as he will out grow them. I was interested to read a number of recent comments from parents of children who have had replacements, and just wondered what other parents consultants opinions were of having the replacements in childhood years, whilst the child was still growing?
Has anyone been given any ‘earliest age dates’ that replacements are possible from?
At the moment our son is learning to walk, with a limp, but we don’t know how long this will last, and whether he is in any pain – although he can’t walk far.
We have been offered a temporary operation next year that will remove and rotate the top of his femur (I can’t remember the name of the operation) to try and create some extra leg length and a fabricate a temporary ball – but we understand this is pretty experimental and few ops have been carried out like this.
Any advice from parents who have a ‘young’ child with a missing femoral head and a hip problem would be well received.
Thanks

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stemcell jim said on 09 June 2012

had stem cell treatment after being told two years i had sciatica in lower back and right leg. my condition turned out to be avn. told hip job only option. NOT TRUE AT ALL!

found out about stem cells had bone samplefrom pelvis used to grow sells. after 8weeks went back left hip as good as new right regenerating. only take pain killers (tramadol) when weather turns very cold. 75%better than two year ago when would have 6-8 per day. stem cells work . dont let any one tell you hip replacement only trteatment available!!

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stemcell jim said on 09 June 2012

dear all. About me was suffering for two years with avn. as was told in 07 had sciaitca in lower back/right leg after nemerus xrays and physio sessisons was told its avn in nov 09!

told hip replacement was only option, bad depressive news for a active 34year old.

found out about stem cells had plevis bone removed from pelvis, sells grown from that and inserted 8weeks later. my xray showed that my left hip was as good as new and my damaged right hip was showing signs of regeneration!!!!
apposed to 2007 till may 2010 need no tramadols for pain relef at all. bar when its very cold or its frosty but that seldom . i still use cruches as bone grows back slow as we know, bull am 75% better than before..

. more options than hip replacement trust me i did my diligence and dont let Anyone tell you HIP REPLACEMENT ONLY OPTION! sorry i cannot tell you were i had it due but il say i had it done in England.

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vintagequeen said on 16 May 2012

Hi Tracy, thanks for your response. I’m now two weeks post op and can’t believe how well I feel! I really am pain free and ‘normal’ for the first time in years. Still a bit slow and stiff occasionally but quicker than before the op and off the painkillers. The physio exercises are really worth doing as they make a big difference. I appear to have both legs the same length too, which is great! Hope your daughter is still doing well,
Sarah

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Tracy333 said on 09 May 2012

Your welcome Heather
Wishing your Daughter a very bright future
All the best
Tracy

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Heather333 said on 08 May 2012

Hi Tracy
Many thanks for your response; am so glad to hear that your daughter is doing so well !! All your comments have given me so much hope; we really want to crack on with her THR straight away. Will be great for her to be pain freeand start being "normal" as she says!
Thank you for all your help and support.Will repost if I can think of anything else.
Best wishes to you & your daughter, Heather

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Tracy333 said on 07 May 2012

Hi Vintagequeen
so glad you are doing well as you may have read my 13year old daughter had a THR she is 12 weeks post op and doing great she couldnt sleep with pain either and said it is the best thing she has done it has given her a life back i have twins who are 21 this year so I know how much work that is you sound like you are doing great keep up the good work.
Tracy

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vintagequeen said on 06 May 2012

Well, after years of pain and thinking I was too young for a HR I finally had my right hip totally replaced on Tuesday last week. I had septic arthritis at the age of 11, and started noticing problems in my late 20’s. Having reached my 40’s it was obvious that I couldn’t remain mobile without a total HR. I have 10 year old twins and run my own retail business so can’t allow myself to become immobile. I was scared stiff, but had a fantstic surgeon who reassured me, and promised a less invasive aproach with rapid healing. Post surgery was fine, had a dodgy next day with nausea and muscle cramps but was on my feet a bit. On the third day I was climbing stairs and then went home! The most amazing things for me right now are that I am sleeping through the night, which I haven’t done for ages due to hip pain. The referred pain in my knee (which used to drive me mad) continued for a day or so but has now gone. I can stand up instantly, and have no hip pain at all. I also expected to have visible black and blue bruising, but there is none. I know it is early days (less than a week!) but so far it is fantastic, and I am so glad I gritted my teeth and did it. My family are amazed at how well I am.

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Tracy333 said on 02 May 2012

Hi Heather
We are in Bristol alot my husband is from Horfield, My daughter is still having physio once a week at hospital and will do for some time just to strengthen her muscle as it had wasted alot with the leg length diffrence she is also doing excercises they have given her to do at home these are important because they help them walk without a limp,she had a big day yesterday it was her first day ever in 4 years she went to school without any crutches My daughter said it is the best thing she ever did she only had pain killers for the first couple of weeks then no painkillers at all apart from last week her physio was very intense so needed some but not for hip pain its the muscle what hurt, Try to get Ceramic if you can for your daughter it is better in girls as it as doesnt give off any metal ions and it is stronger and doesnt wear as much they tend to use this in children anyway as they are more active they wouldnt tell me how long it would last but he said hopefully at least 20 years then hopefully there will be something out which may last her a lifetime with the way technology moves on I hope anyway he has told my daughter to do everything a child her age does and just to treat it as a normal hip and that is what she is doing. please ask away Heather if there is anything else.
Tracy

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Heather333 said on 01 May 2012

Hi Tracy;that is all so encouraging to hear;thank you very much.I’ve passed on your info to my daughter, she’s much more positive now.
we’re waiting for a date;her present surgeon in Bristol is referring her to another for the op itself but they’ve said imminently as she’s in so much pain, particularly at night.It sounds as thou the THR recovery will be less intensive than the previous hip restructural ops she’s had, so thats a huge relief.
Did your daughter have much physio after the op? Does she need pain relief now at all?Did they give you any indications how long the hip would last?
Thank you very much again
Heather

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Tracy333 said on 30 April 2012

Heather- all the comments were me sorry it kept re-posting my daughter had her operation under genral i not sure they do children under epidural i wouldnt have wanted my daughter to stay awake, she went in hospital on the tues had her op on the wed out of bed on the thursday and discharged on the friday as my daughter was in so much pain before the op she tells me she has no hip pain know at all, as she had a total hip replacement and not a resurfacing they cut her bone to what lengh they needed and left her with as much bone as possible because of her age they remove all the femoral head my daughter has ceramic it was done in birmingham they were excellent she was off school for 8 weeks please ask if you have more questions when is your daughter due for surgery?

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Heather333 said on 30 April 2012

Dear Both
Thats great to hear; really cheered me up so glad you responded.
I’ve got so many questions dont know where to start! Were your children under GA or epidural/sedative for the op & how long did it take? How long in Hospital and when did they get out of bed? Did the surgeon also do a bone graft to recify the leg length difference or was it slotted in lower? How has their pain levels been since the op? How much time did they have off school?
Thank you very much for your time;really appreciate it.
Heather

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Anonymous said on 28 April 2012

Heather- I have just been through the same thing my daughter had hip replacement on the 8th feb age 13 and also had 56mm leg length diffrence if i can help in anyway i will she is doing good now and leg length is the same .

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Anonymous said on 28 April 2012

Hello Heather333
I have just been reading about your daughter, my daughter had a total hip replacement on the 8th feb this year she was 13. she had avascular necrossis she also had a leg length discrepency of 56mm my daughter had lots of surgery to try and save her hip and I was very worried about her having a hip replacement at such a young age. We are now 11 weeks on and I cant keep her in the house, its so nice to see her out with her friends she is doing well now with both legs the same length, if you need someone to talk to i am more than willing to help with any questions you may have, I do understand everything you are going through and i wish I could have spoken to someone who was going through the same as me for reasurance.
all the best
Tracy x

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Anonymous said on 28 April 2012

Hello Heather333
I have just been reading about your daughter, my daughter had a total hip replacement on the 8th feb this year she was 13. she had avascular necrossis she also had a leg length discrepency of 56mm my daughter had lots of surgery to try and save her hip and I was very worried about her having a hip replacement at such a young age. We are now 11 weeks on and I cant keep her in the house, its so nice to see her out with her friends she is doing well now with both legs the same length, if you need someone to talk to i am more than willing to help with any questions you may have, I do understand everything you are going through and i wish I could have spoken to someone who was going through the same as me for reasurance.
all the best
Tracy x

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Heather333 said on 25 April 2012

My daughter has congenital dislocation of the hip, which was only diagnosed when she was 5.After 3 unsuccessful pelvic osteotomies, she is now due to have a total hip replacement, aged 12.In addition she has a 5cm leg length difference, which they are hoping to rectify.
I would love to hear from anyone who had a hip replacement as a child,or whose child has been through this.Any advice or assurance welcomed!

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stepher henry said on 25 April 2012

i need hip replacment but my doctor said its only slight
wear it also causing sever back pain.
last year i had both knees replaced no problem,
now it seems goverment cuts are starting to bite
if my doctor wont refer me what can i do

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120paphos said on 21 April 2012

I am 51, and due my first of both hip op’s, in a few months. What concerns me is that it’s my knees that give me terrible pain. Only ever get slight twinges in hips. However the consultants assure me, the problem is in the hips, and my knees are taking the hit.
Is this the case?
Also i have a very physical job, daily climbing scaffolds, ladders, steps, etc.
I am fairly fit, and intend to have as much exercise/physio after the op, but how long can i expect to be off work.

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lilybet2008 said on 19 April 2012

I have had 2 total hip replacements the1st one 7 years ago and the 2nd just on 2 years ago. I had both operations performed with an epidural and a light sedative this means you go in and out of sleep throughout the whole operation and I was told that I could request more sedative at any time.You can also use your ipod or MP3 player in theatre so be assured you do not hear anything. Having your operation this way means you have the control on talking or not and it also aids your pain relief for 24 hours. I feel as if I have been given my life back. Do not hesitate to have this operation if your surgeon recommends it.

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lou mccall said on 15 April 2012

Had triple.pelvic osteotomy 3 years ago and now facing a replacement due to limited mobility. Has anyone had the replacement with epidural and whats the verdict? Pros and cons. Do you hear all the noises? Would perhaps consider this option as i get nervous at the thought of anastetics. Please advise on all aspects of the replacement and revovery, thanx xx

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caravan2 said on 04 April 2012

I had a hip replacement 7 weeks ago. although I thought I was doing well I now realise I can’t yet walk without my crutch, it is causing me too much pain. Is this normal or should I have had physio? I am worried that I am damaging my leg by trying to walk?

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Bieffe said on 21 February 2012

I’ve been fighting the hip and associated leg, knee, and back pains since early 2001. Despite my poor previous hospital experiences, and resulting fear of hospitals and doctors, I have now finally given up fighting the hip, and have decided to go for the hip replacement.

However, previous experiences in my local hospital here in Cumbria have left me wanting to go elsewhere, but where?

Any suggestions anyone?

Also, what questions should I be asking.

Thank you.

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Tumblecat said on 12 February 2012

To tresjolies worries I had my total hip replacement three weeks ago I can honestly say it is nothing to worry about .I had a spinal block followed by a sedative so I slept right through , although you can opt to stay awake if you wish .I was in hosp for five days in total and am now recovering well .I was in The Golden Jubilee Hospital in Clydebank in Glasgow fantastic hosp it is a national waiting times hosp so you don’t have to live in Scotland (which I do ).I am going to have the left one done later in the year so it can’t be that bad eh

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xxannbxx said on 21 January 2012

I am going to be having hip replacement surgery this yearbecause i have a genetic disorder that more or less causes my bones to crumble. It’s going to be a very difficult op because my pelvis is supposed to be half the size of the average womans so they can”t actually get tje socet bit in so there’s a higher chance of it dislocating. I know that if it goes right that it’s going to get rid of a lot of the pain i get but there’s also a chance of me ending up with no hip at all.I’m in a wheelchair full time and if it goes wrong then I’m going to loose even more of my mobility Should i go through with it?
Tricky one huh?

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tresjolie said on 06 January 2012

Hi ali17….I also need a total hip replacement, have been for pre op assessment and am terrified also! Hospitals and anaesthetics scare me. Also thought I would have the spinal, but am now thinking…what about all the noises I would hear?? don’t know if I will go through with it in the end, but my life is severely affected by the pain, and I have already waited 3 years and have no cartilege left in the hip. Also, my x ray shows deterioration of the other hip, and I do experience discomfort there too. Have been taking oral steroid therapy for scleritis for 8 years and also have some osteoporosis and bad varicose veins in my leg…they said these things make me a high risk..anyone got words of comfort???

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lessay said on 06 January 2012

I am due for my op next Tues 10th Jan, any tips please.

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ali17 said on 04 January 2012

Taking comfort from hanabanana85 and jojostevo – I am yet another congenital hip dislocatiion girl – discovered at 21 months! I am due for a left total hip replacement on Feb 28th….. However I am totally terrified…… so many memories of many anaesthetics and operations as a little girl have left their mark. I know only too well how things have changed – I am 42 now! But I’m still really frightened. I plan to have a spinal anaesthetic – then I know I’m still alive!!! I desparately need it done as am in daily agony and my life is on hold but I just need to get over this terrible fear leading up to the op…. any tips?

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Eat Your Greens said on 13 December 2011

@Mike_lewis, I think you have been incredibly unfortunate. I have had both hips resurfaced in 2008 and it honestly has totally changed my life. No more constant pain, no more painkillers, better quality of life, pain free walking. I would recommend it to anyone, except that I’m on this site today, trying to see if NHS Choices had anything to say about an article which appeared in the Mail today, saying that hip resurfacing was very problematic and anyone who had had this surgery should visit their GP for blood tests due to metallosis and a high failure rate. I hope that it is just the De Puy prosthetics which are at fault, I had BHRs for my hips and no problems at all after four years.

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DGVale said on 09 November 2011

Could not agree less with Mike_lewis (June 2011). I had a hip resurfaced (BHR prosthesis) almost twelve years ago at the age of 51. Since then I have been very active – I play tennis, including singles, normally three times per week. I have never had a moment’s trouble with it.

The critical element appears to be surgeon skill. Do your best to get a good and experienced one.

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peterbees said on 04 November 2011

I had my right hip replaced in Dec 2010, at age 63 and my left in June 2011. Both ops went well, and I’m now well on the way to full recovery. I had excellent care in hospital and in physiotherapy post -ops. I waited a long time before seeking medical help, despite regular prodding from friends. Now I feel that every day is the best day of my life!

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jojostevo said on 19 October 2011

Sorry for posting twice – my first post never appeared for hours so I decided to write again and when I submitted they both appeared!

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jojostevo said on 19 October 2011

Hanabanana85 – thank you so much for your posting.
I am a 32 year old mum of 3 young children and my situation almost mirrors yours!
I too was born with hip displasia in my left hip which was not caught at birth but when I was 14mths old.
I had surgery on my pelvis in 1998 to build me a better socket, and have now been offered a hip replacement as I been diagnosed with arthritis and my pain is unbearable at the moment.
I was taking time out to think about this surgery as I have to take my children into consideration but from reading your post I think I’m going to contact my consultant sooner rather than later!
Please could I ask what type of hip they have used?
They have said they would use the best possible hip to get me the most out of it so this is a relief to me!

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jojostevo said on 19 October 2011

Hanabanana85 – thank you for posting on here!
My situation almost mirrors yours (but perhaps not as bad!)
I am 31 mother of 3 young children and too had hip displasia in my left hip which was not found until I was 14months old! I had surgery in 1998 to develop my socket which was almost non exsistant and my leg is 2+ cm shorter.
I have been offered a hip replacement and needed some time to think about it – (I have to take my children into consideration).
The pain in my hip is unbareable and your post has helped me realise that I should have this procedeure sooner rather than later – Thank you!

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Hanabanana85 said on 12 October 2011

Hello! I am 26 years old, and was born with hip displasia in my left hip. It was not caught at birth, so when I was 3 and 4 years old, I had to have surgery, placing my hip into the socket. Since it was out for that amount of time, the socket and the ball of my hip had lost some of its shape, plus my socket was way above where a normal socket would originally be, causing my leg to be around an inch shorter than my other leg. I got to the point recently where all of the cartilege was worn away, and I was in quite a bit of pain when walking short distances, or doing certain activites or positions. All of that led to having a total hip replacement. I just had it done 3 weeks ago tomorrow. My doctor was able to put my hip in the God-given place, bringing my leg even with my other leg, and he had to fill in the gap with a wedge…. needless to say, my case was a challenge and there was a lot more done in there besides just the hip replacement. Now, I am so thankful, and couldn’t be any happier about the end result. I have no pain, and am walking with just a cane. I am even walking distances that I would not have wanted to walk before I had the surgery. In reply to Leeanne, I have no children of my own yet, but have been a babysitter/nanny for many years. I was also finding it hard to do things with the children… even taking a simple walk. It’s only been 3 weeks since I’ve had the surgery, but I know already that it is well worth it, and nothing to be afraid of! The first week is the toughest, and yes, you do have restrictions like not being able to bend for a while. But the end result is wonderful! I thank the Lord for what He’s done in healing my hip and sending me to the right doctor!

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leeannejj said on 27 September 2011

hi my name is leeanne i am 21 years old i had a car crash 4 years ago in 2008 the hospitali i went to gave me an xray and told me i have a bruised pelvis and torn liginnent in my right leg. in 2010 i had an other xray now i have severe atharitis in my right leg and need a full hip replacement i am really scared and would like some advise. I have a 2 year old little girls and its really hard doing day 2 day thing with her like playing in the park and walking down the street thing like that i hope to here from some one soon thanks for listing

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Relieved mum said on 03 September 2011

My daughter who is 24, had a total hip replacement on 15th August 2011. She was home on 17th. She has been in pain for the last 11 years due to complications when she had a slipped epyphisis in 2000. She is now pain free ( apart from the operation site ) and is looking forward to starting a new life where she doesn’t have to take 17 painkillers every day or rely on her wheelchair. She says it’s the best thing that could have happened to her. So all you people reading this……go for it.

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carelesstalk said on 25 July 2011

Had right hip replacement (exeter-trident) on 19th July 2011, yes, just last week and was home on the 21st and feel incredible. Had one bad day post op. due to nausea but am now able to walk without any pain and only need to use a stick first thing in the morning due to a bit of stiffness. Have stopped taking the voltarol and only take 2 paracetamol at night.
Only problem is I feel so much better I keep forgetting I am not supposed to bend or twist for at least 6 weeks and do worry about dislocation.
Have been putting this op off for two years and now realise how much my life has improved already and wish I had done it earlier.

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jen39 said on 17 July 2011

I had my right hip replaced In April 2010 and if anythink it has made my mobility worse my left hip needs replacing but this first operation has put me of because i am only 39 and my right hip gives me constant pain so i am a bit worried to have the next one done has anyone else had this problem

Thankyouu

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Mike_lewis said on 08 June 2011

I have had both hips replaced, in 2003 i had my right hip replaced with a full replacement which i have had no problems with it has been exultant. My left hip was done in 2008 which was a re surfing type (not sure of name of re-surfing type). The re-surfing hip has been nothing but constant pain, i would never rec emend this to anyone. i know have to go through the operation all over again this is due to wear on the metal in the hip joint. If you are given the choice please go for the full hip replacement and not the re-surfacing type as it is crap

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aesclepius said on 11 January 2011

Why follow 12 weeks hip precations? What is this based on? Where is the evidence base for 12 weeks precautions?

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NHS Choices Syndication

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Hip replacement

Recovering from hip replacement

After the operation, you will be lying flat on your back and may have a pillow between your legs to keep your hip in the correct position. The nursing staff will monitor your condition and you will have a large dressing on your leg to protect the wound.

You may be allowed to have a drink about an hour after you return to the ward and, depending on your condition, you may be allowed to have something to eat.

How soon will I be up and about?

The staff will help you to get up and walk about as quickly as possible after surgery. Some patients are able to get up and walk the same day as their surgery.

Initially, you will feel discomfort while walking and exercising, and your legs and feet may be swollen. You may be given an injection into your abdomen to help prevent blood clots forming in your legs, and possibly a short course of antibiotics to help prevent infection.

physiotherapist may teach you exercises to help strengthen the hip and explain what should and should not be done after the operation. They will teach you how to bend and sit to avoid damaging your new hip.

Looking after your new hip

With care, your new hip should last well. The following tips will help you care for your new hip:

  • avoid bending your hip more than 90° (a right angle) during any activity
  • avoid twisting your hip
  • do not swivel on the ball of your foot
  • when you turn around, take small steps
  • do not apply pressure to the wound in the early stages (so try to avoid lying on your side)
  • do not cross your legs over each other
  • do not force the hip or do anything that makes your hip feel uncomfortable
  • avoid low chairs and toilet seats (raised toilet seats are available)

When can I go home?

You will usually be in hospital for around three to five days. If you are generally fit and well, the surgeon may suggest an enhanced recovery programme, where you start walking on the day of the operation and are discharged within one to three days.

How will I feel when I get home?

Do not be surprised if you feel very tired at first. You have had a major operation and muscles and tissues surrounding your new hip will take time to heal.

You may be eligible for home help and there may be aids that can help you. You may want to arrange to have someone to help you for a week or so.

An occupational therapist should be available to help you. They will assess how physically capable you are and, when you are about to leave hospital, they will assess your circumstances at home.

Your occupational therapist will be able to advise you on how to do daily activities, such as washing yourself. They will also advise about any equipment you may need to help you to be independent in your daily activities. This may include a raised toilet seat and aids to help you dress. 

How soon will the pain go away?

The pain that you may have experienced before the operation should go immediately, although you can expect to feel some pain as a result of the operation itself, but this will not last for long.

Is there anything I should look out for or worry about?

After hip replacement surgery, contact your GP if you notice redness, fluid or an increase in pain in the new joint.

Will I have to go back to hospital?

You will be given an appointment to check up on your progress, usually 6-12 weeks after your hip replacement. The surgeon will want to see you a year later to check that everything is OK, and every five years after that to X-ray your hip and make sure it is not beginning to loosen.

How long will it be before I feel back to normal?

Generally, you should be able to stop using your crutches within four to six weeks and feel more or less normal after three months, by which time you should be able to perform all your normal activities.

It is best to avoid extreme movements or sports where there is a risk of falling, such as skiing or riding. Your doctor or a physiotherapist can advise you about this.

When can I drive again?

You can usually drive a car after about six weeks, subject to advice from your surgeon. It can be tricky getting in and out of your car at first. It is best to ease yourself in backwards and swing both legs round together.

When can I go back to work?

This depends on your job, but you can usually return to work 6-12 weeks after your operation.

How will it affect my sex life?

If you were finding sex difficult before because of pain, you may find that having the operation gives your sex life a boost. Your surgeon can advise when it is OK to have sex again. As long as you are careful, you should be able to have sex after six to eight weeks. Avoid vigorous sex and more extreme positions.

Will I need another new hip?

Nowadays, most hip implants last for 15 years or more. If you are older, your new hip may last your lifetime. If you are younger, you may need another new hip at some point.

Revision surgery is more complicated and time-consuming for the surgeon to perform than a first hip replacement and complication rates are usually higher. It cannot be performed in every patient. However, it is much more successful than it used to be and most people who can have it report success for 10 years or more.

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Published Date
2014-07-24 14:21:57Z
Last Review Date
2014-07-19 00:00:00Z
Next Review Date
2016-07-19 00:00:00Z
Classification
Hip,Hip replacement,Hip surgery,Joint replacements


NHS Choices Syndication

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Hip replacement

Risks of hip replacement surgery

The most common complication of hip replacement is that something goes wrong with the joint, which occurs in around 1 in 10 cases.

Joint problems

Some common types of joint malfunctions are listed below.

Loosening of the joint

The most common problem that can arise as a result of a hip replacement is loosening of the joint. This can be caused by the shaft of the prosthesis becoming loose in the hollow of the thigh bone, or due to thinning of the bone around the implant.

Loosening of the joint can occur at any time, but it normally occurs 10-15 years after the original surgery was performed.

Signs that the joint has become loose include pain and feeling that the joint is unstable.

Another operation (revision surgery) may be necessary, although this cannot be performed in all patients.

Hip dislocation

In around 3% of cases the hip joint can come out of its socket. This is most likely to occur in the first few months after surgery when the hip is still healing.

Further surgery will be required to put the joint back into place.

Wear and tear

Another common complication of hip replacement surgery is wear and tear of the artificial sockets. Particles that have worn off the artificial joint surfaces can be absorbed by surrounding tissue, causing loosening of the joint.

If wear or loosening is noticed on X-ray, your surgeon may request regular X-rays. Depending on the severity of the problem, you may be advised to have further surgery.

There have been reports about metal-on-metal implants wearing sooner than expected and causing complications. The Medicines and Healthcare products Regulatory Agency (MHRA) advises that particular metal-on-metal implants should be checked anually. You can consult your doctor for further advice if you have any concerns about your hip replacement or do not know which type you have.

Read our metal-on-metal implant advice Q&A for more information.

Joint stiffening

The soft tissues can harden around the implant, causing reduced mobility. This is not usually painful and can be prevented using medication or radiation therapy (a quick and painless procedure during which controlled doses of radiation are directed at your hip joint).

Serious complications

Serious complications of a hip replacement are uncommon, occurring in fewer than one in a 100 cases.

These are described below.

Blood clots

There is a small risk of developing a blood clot in the first few weeks after surgery.

There are two main places a blood clot can develop:

Symptoms of a DVT include:

  • pain, swelling and tenderness in one of your legs (usually your calf)
  • a heavy ache in the affected area
  • warm skin in the area of the clot

Symptoms of a pulmonary embolism include:

  • breathlessness, which may come on suddenly or gradually
  • chest pain, which may be worse when you breathe in
  • coughing

If you suspect that you have either of these types of blood clots you should seek immediate medical advice from your GP or the doctor in charge of your care. If this is not possible then call NHS 111 or your local out-of-hours service.

In order to reduce your risk of blood clots you may be given blood thinning medication such as warfarin, or asked to wear compression stockings.

Infection

There is always a small risk that some bacteria could work its way into the tissue around the artificial hip joint, triggering an infection.

Symptoms of an infection include:

  • a high temperature (fever) of 38°C (100.4°F) or above
  • shaking and chills
  • redness and swelling at the site of the surgery
  • a discharge of liquid from the site of the surgery
  • hip pain that can persist even when resting

Seek immediate medical advice, as detailed above, if you think you may have an infection.

Published Date
2014-07-24 14:21:47Z
Last Review Date
2014-07-19 00:00:00Z
Next Review Date
2016-07-19 00:00:00Z
Classification
Hip replacement,Hip surgery


NHS Choices Syndication

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Hip replacement

See what the doctor sees with Map of Medicine

The Map of Medicine is used by doctors throughout the NHS to determine the best treatment options for their patients. NHS Choices offers everyone in England exclusive and free access to this cutting-edge internet resource, which lets you see exactly what your doctor sees.

The information in the Map has been approved by the UK’s leading clinical experts, is based on the best available clinical evidence, and is continually updated. To take advantage of this unique resource go to:

Map of Medicine: Hip pain

Map of Medicine: Hip fracture

Published Date
2013-11-11 15:30:14Z
Last Review Date
2010-01-14 00:00:00Z
Next Review Date
2012-01-14 00:00:00Z
Classification
Hip replacement


NHS Choices Syndication

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 /conditions/articles/hip-replacement/why-it-should-be-done

Hip replacement

When a hip replacement is necessary

A hip replacement may be recommended if one or both of your hip joints is damaged to such an extent that: 

  • you have persistent hip pain that is not responding to other treatments and/or
  • the range of movement in your joint is so restricted that day-to-day tasks such as walking are very difficult or impossible
  • the problems with your hip are significantly reducing your quality of life

Who can have a hip replacement?

Most people are suitable candidates for a hip replacement, and there is no age limit. However, a hip replacement may not be recommended for people with certain serious health conditions.

This could be because they are:

  • unable to follow the physical rehabilitation programmes required after surgery
  • less likely to recover, they have a high risk of damaging the replacement hip
  • at a high risk of complications after surgery

Common causes of hip damage

Some of the most common causes of hip damage are described below.

Osteoarthritis

Osteoarthritis is the most common type of arthritis. It occurs when the joints become damaged over time and causes the surrounding cartilage to wear away. This causes the bones of the joint to rub together leading to hip pain, stiffness and loss of movement. Osteoarthritis affects around 1 million people in England and Wales.

Rheumatoid arthritis

In cases of rheumatoid arthritis, the immune system – which usually fights infection – attacks the cells that line the joints, making them swollen, stiff and painful. Over time, this can damage the joint itself, the cartilage and nearby bone.

Hip fractures

Hip fractures are one of the most common causes of bone injury in older people, with an estimated 70-75,000 occurring each year in the UK. Most cases of hip fracture occur as a result of a fall.

It is possible to repair a fractured hip, but in some circumstances a hip replacement is recommended.

Less common causes of hip damage

Less common causes of hip damage include:

  • septic arthritis – this form of arthritis occurs when the joint becomes infected
  • crumbling of the bone (avascular necrosis) – due to many different reasons
  • Paget’s disease of bone – this affects bone growth and can make bones weak and deformed
  • bone tumours – abnormal cancerous growths that develop inside the bone
  • hip dysplasia – which is where a baby is born with incorrectly formed bones in the hips. Over time this misalignment can become worse, which sometimes means that it becomes necessary to replace the affected joint
  • other childhood hip problems which can lead to long term hip damage – for example, Perthes disease or slipped upper femoral epiphysis
Published Date
2014-07-24 14:22:45Z
Last Review Date
2014-07-19 00:00:00Z
Next Review Date
2016-07-19 00:00:00Z
Classification
Hip replacement

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