Hip Surgery

Causes and symptoms

Rheumatism, gout, previous surgery, injuries, and congenital abnormalities such as hip dysplasia can damage the cartilage. Age and being overweight can also increase risk.

• Pain in the groin and/or buttock, sometimes radiating to the knee.
• Stiffness when standing and reduced rotation/flexion.
• Reduced walking distance and, in advanced stages, limping may also occur.

When is total hip replacement necessary?

When walking distance is severely restricted and conservative options such as pain medication, weight loss, activity modification, and physiotherapy no longer relieve symptoms, your orthopedic surgeon may advise total hip replacement.

A total hip replacement usually gives substantial pain relief and improved mobility in advanced osteoarthritis.

Types of hip prosthesis

• Total hip replacement (THR): replaces both the femoral head and acetabulum.
• Partial hip prosthesis (hemi-arthroplasty): replaces the femoral head only.
• Cemented or uncemented fixation depending on bone quality and surgical planning.

Implant profile and lifespan

The type used in our clinic is typically uncemented with a ceramic head and polyethylene liner.

Most total hip prostheses last 15 to 25 years. Outcomes depend on age, activity, weight, bone quality, surgical technique, and complications such as infection or loosening.

Hip prosthesis - the surgery

• Pre-op screening includes blood analysis, chest X-ray, ECG, and a consultation with the anesthesiologist.
• Most procedures are done with spinal anesthesia and sedation; general anesthesia is used when necessary.
• Surgery includes femoral head resection, cup preparation and definitive component placement. The surgery usually takes about one and a half hours.

Recovery and rehabilitation

• Early mobilisation starts the day after surgery.
• Discharge follows when safe mobility with crutches is achieved.
• A blood thinner is usually prescribed for up to 30 days to prevent thrombosis.
• Stitches are removed around two weeks.
• Outpatient X-ray review around six weeks.
• Driving is often possible after 3 to 4 weeks.
• Full rehabilitation takes several months, with most gains in first three months.

Risks

Complications are generally rare. Risks associated with a total hip replacement can be, but are not limited to:

• Infection.
• Thrombosis and pulmonary embolism.
• Dislocation.
• Periprosthetic fracture.
• Post-operative bleeding or wound problems.

Discuss your personal risk profile with your orthopedic surgeon and seek immediate care if you have fever, increasing pain, redness, swelling, or breathing difficulties.

Why revision may be needed

A hip prosthesis can fail over time due to wear, infection, fracture around the implant, loosening, or instability with repeated dislocations.

Risk factors for failure of the primary hip prosthesis can be

• Younger and more active age profile.
• Overweight.
• Diabetes and other medical conditions.
• Previous surgery around the hip.

Possible symptoms

• Stiffness.
• New popping or clicking noises.
• Pain in the groin, buttock, or thigh during walking or at rest.
• Frequent dislocations.
• Persistent inflammation with swelling or redness.
• Noticeable leg-length change (one leg shorter or longer).

Diagnostic work-up

Assessment includes clinical examination, X-rays, and often blood tests if infection is suspected. CT or MRI with metal artefact reduction can provide additional detail.

Treatment approach

Treatment depends on the cause, including infection, aseptic loosening, wear, dislocation, peri-prosthetic fracture, or mechanical problems.

Revision surgery is custom work and should be performed in experienced centres with specialized orthopedic teams, microbiology support, intensive care capacity, and multidisciplinary rehabilitation.