A comprehensive guide to hip replacement
Total hip replacement surgery involves a cup that is fixed into the acetabulum (the socket of the joint) and a ball and stem that is fixed into the femur. Your surgeon will replace your hip joint by removing the existing damaged cartilage and bone from your hip before inserting the prostheses (implants). The procedure can be performed under local, regional or general anaesthetic. These can be used in combination and will depend on clinical need and patient preference.
Patients typically spend between 1 and 3 nights in hospital. Rapid recovery programmes in hospitals with extensive orthopaedic expertise ensure patients are up and walking within 3 hours of surgery relatively pain-free, and leaving hospital after one to two nights stay.
Getting the diagnosis right
At the initial consultation, your consultant hip surgeon will confirm your diagnosis. He or she will take a detailed medical history, perform a careful clinical examination and review radiological imaging (eg X-rays and occasionally MRI scans). Once the diagnosis is confirmed a treatment plan can be discussed and agreed with you. Note: in the event you already have a diagnosis and solutions proposed, these will need to be reviewed and confirmed by your new surgeon before proceeding to a surgical plan.
Questions you may want to ask your hip surgeon
There are various surgical approaches and options when it comes to hip replacement - each affecting the subtleties of the procedure and the care you receive. The below will help inform discussions with your surgeon and ultimately help you when selecting both hospital and surgeon.
1. What are the different surgical approaches to the hip joint?
There is some variation in the surgical approach, the type of implant used, and also variability in the materials used for the moving parts of the prosthetic hip (the articulation).
Surgical approaches to the hip are broadly divided into the direct anterior approach, the direct lateral approach and the direct posterior approach. Different surgeons will employ different approaches, but it is generally true that the less damage that is caused to the muscles around the hip by the approach, the faster the recovery and the better the long term results will be.
2. Should a minimally invasive surgical approach be considered?
Minimally invasive surgery has been popular for over a decade. Some emphasise the benefit of smaller skin incisions, but the true aim of a minimally invasive approach is to minimise internal damage that could be caused during hip surgery.
Both the minimally invasive "posterior approach" and the "direct anterior approach" are often favoured today, given that the abductor muscles are spared by both of these procedures.
We advise you to discuss options carefully with your surgeon during your consultation.
3. How is a hip replacement secured in place?
Your surgeon may choose to perform a cemented hip replacement, using bone cement to fix the implant to the bone. A good and popular alternative is to use a cement-less implant that either has a coating of mineral (hydroxyapatite) or a porous coating. This allows the bone to grow directly into the implant. Both cemented and cement-less hip replacement surgery have extremely good success rates but each has some pros and cons.
In theory, a cement-less hip replacement may take some time to bond to the bone and may have a slightly higher early failure rate (due to the implant not bonding, or fractures occurring around the bone), however, once the implant has bonded to the bone, it is likely to remain well fixed and last for many decades. The cemented variety is often more reliable in a weaker bone but does face a long term risk of possible loosening between the cement and bone fixation interface.
Each patient should therefore have a very careful discussion with their surgeon as to which fixation method is ideal for them. Experienced hip surgeons will carefully assess the patient and suggest the most appropriate implant for their needs.
4. What bearing surfaces should you choose in a hip replacement?
The bearing surface (of the prosthetic) in a hip replacement can vary and patients can choose their ideal bearing following discussion with their surgeon.
Popular bearing surfaces include metal-on-polyethylene, ceramic-on-ceramic, and ceramic-on-polyethylene. Your surgeon will explain the pros and cons of the following prior to agreeing on what is best for you.
Metal-on-metal bearings have been favoured over the last 20 years, but have decreased in popularity in the last decade due to a condition called ALVAL, an inflammatory response of the body reacting to metal debris in some cases. It nevertheless remains an option in selected cases.
Ultimately, the quality of the implant and its known track record is often captured in its ODEP (Orthopaedic Data Evaluation Panel) rating. The longer an implant has been in use and the more data that is collected on it, the higher the ODEP rating it is given (ie an implant with a longer - positive - track record). Most patients would choose to have a higher ODEP rated implant with a known track record of survival.
How quickly do patients recover from hip surgery?
Within hours of surgery, patients are encouraged to walk sometimes using crutches or a walker (Zimmer Frame). Early mobilisation can reduce complications such as deep vein thrombosis and pulmonary embolus, and contributes significantly to a better recovery - both short and long term.
In a good surgeon's hands, functional recovery from hip replacement surgery typically takes between two and six weeks - often determined by a patient’s age and fitness. After that, patients will experience a gradual improvement as the hip becomes more supple and patients find they're walking more normally - and even driving if comfortable (from 2 weeks). The hip should continue to improve over the next 6 to 8 months to the point where it is essentially forgotten.
To support the optimum recovery, physiotherapy and a progressive exercise regime is recommended over the ensuing three months.
What are the potential complications of hip replacement?
Possible complications to be aware of following hip replacement surgery include infection, dislocation, leg length discrepancy, abductor muscle dysfunction associated with limp (depending on surgical approach), urological complications (such as urinary retention), and venous thromboembolism (Deep Vein Thrombosis or pulmonary embolus).
You should discuss complication rates with your surgeon and have a clear understanding of how your hospital is set up to cope with these - in the unlikely event that they arise.
Should complications relating to your surgery occur which require you to have further treatment in theatre (another operation within 12 months), our Protect my Care insurance policy will refund the cost of your original care. This policy is included in your care at no extra cost to you.
Choosing a hospital and surgeon to suit you
Volumes and specialisation
Generally, it is reasonable to expect that a fellowship-trained specialist consultant hip surgeon who undertakes a significant volume of procedures each year is likely to give you a good outcome from your surgery.
Surgeons undertaking hip replacement surgery in the UK perform an average of 50 implants per year (see the National Joint Registry), with some surgeons performing far greater numbers.
Please note, consultants surgeons often say that a major procedure performed more than 100 times a year by a surgeon is more likely to result in a better outcome.
Higher volume of hip replacement performed correlate with better outcomes
In general the higher the volume of hip replacements a surgeon performs each year, the greater their expertise will be. So, you should aim to choose a higher than average volume hip replacement surgeon with low revision rates. Compare my Care reviews this information held in the National Joint Registry.
Please note: you can also ask your surgeon for their up-to-date revision (re-do) rates, contained in their own unpublished annual NJR summary report. Alternatively Compare my Care can support patients with this.
Hospitals experienced in orthopaedics
From a hospital perspective, a dedicated orthopaedic ward (with only screened elective orthopaedic patients), senior resident doctors, dedicated specialist nurses and physiotherapists, and a dedicated pain control team are desirable to carefully manage your post-operative care, any pain and identify potential complications early.
Ideally, your pain medication should be tailored to optimise early mobilisation of your hip, alongside a rapid recovery programme to give your recovery the best start.
One of the most common complications after surgery can be urine retention due to anaesthetic. Specialist orthopaedic units often have robust urology protocols involving bladder scanning and catheterisation policies to deal with postoperative urinary retention. Similarly, dedicated units will also have robust venous thromboembolism prevention protocols and policies.
Please note: hospitals vary in the way postoperative complications are dealt with - both clinically and financially. This is worth understanding further prior to self-funding. Compare my Care can provide more clarity around this when you book through our concierge team.
Paying for Treatment
The price of hip replacement surgery ranges from £9,000 to over £18,000 with the hospital you select. This figure generally consists of hospital costs, surgeons fees, anaesthetic fees and occasionally extra imaging and implant costs.
Typically prices won't include other aspects of your treatment such as the initial diagnostic workup. Compare my Care aims to provide you with a fixed price for your procedure, hospital stay and surgeon follow up.
How Compare my Care works for you
Compare my Care works by analysing surgeon and hospital performance data, the quality of facilities and patient experience information to compare and rank providers' hip replacement surgery against others in the area.
Our medical specialist concierge team will then coordinate with you to arrange an initial consultation with an experienced, specialist surgeon at your selected hospital, using our knowledge to find the highest performing one for your surgery.
Introducing Protect my Care
‘Protect my Care’ is a unique ‘cash-back' insurance policy provided by Compare my Care. It was created to give patients additional protection and peace of mind when paying for their own surgery - and comes at no extra cost to the patient.
All surgeries come with risks but in the hands of a super-specialist surgeon these can be reduced further. However, in the rare event that a repeat surgery is needed, patients will be refunded the cost of their original procedure - to spend as they see fit.