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Hip Replacement

Patient information leaflet describing hip replacement surgery and the post surgery recovery process.

Information:

Information for patients
This leaflet can be made available in other formats including large print, CD and Braille and in languages other than English, upon request.

Introduction

This leaflet explains why you have been referred for a total hip replacement operation.

The orthorpaedic team are here to assist you with all of your needs, and we will provide you with advice and guidance.

Please contact the team if you have any questions or concerns.

What is a hip replacement?

The hip is a ball and socket joint, between the pelvis and the thigh bone. The upper end of the thigh is the ball part and fits into the socket in the pelvis. During the operation, the worn or damaged joint will be replaced with an artificial joint.

a healthy hip on the left compared with a hip with osteoarthritis on the right.
a hip replacement and how it fits into the pelvis.

What are the advantages of a hip replacement?

A hip replacement is usually carried out because of severe pain and restricted mobility. A hip replacement may provide benefits such as:

  • Reduced pain
  • Reduced stiffness

With a combination of reduced pain and stiffness, your overall mobility is likely to be improved. This helps you to return to a fitter and more active lifestyle.

What are the associated risks?

Hip replacements are generally very successful, and a high proportion of patients can gain an improved lifestyle benefit. There is, however, a risk of complications. These can include:

Leg swelling

It is very common for legs to be swollen after an operation, and this normally settles without any problems.

Occasionally, it can be due to deep vein thrombosis (DVT). DVT can occur after any operation, but it is more likely following operations on the lower limb.

DVT occurs when blood in the large veins of the leg forms blood clots within the veins. This may cause the leg to swell and become warm to touch.

There are several methods that we use to reduce the risk of DVT. We will apply calf pumps to both legs while in recovery as they stimulate circulation.

We encourage patients to move around as soon as possible, often on the same day of surgery as this increases the blood flow to the leg.

After assessment by the joint replacement nurses, most patients will be offered blood thinning medication. Tinzaparin or Enoxaparin injections are used for most patients between 10 to 28 days post-surgery.

If you have had any previous thrombosis, you will require this for 42 days. You will be given a sharps box in which to place the used injections after use, when you have finished the course of injections return the sharps box to the hospital for safe disposal.

Alternatively, patients who have been individually assessed and found suitable may be given 10 days Tinzaparin or Enoxaparin injections and then asked to switch over to Aspirin for a further 28 days.

This will be discussed with you on an individual basis prior to surgery.

Joint infection

You will be screened for bacteria before you come in for your operation to try to reduce the chance of infection.

It is very important you do not have any cuts, grazes or wounds on your body when you come in for surgery. You may wish to avoid activities such as gardening for a few weeks before coming in for your hip replacement.

We may encourage you to lose weight, as being overweight increases the risk of complications including infection.

We also encourage you to stop smoking if required, as there is evidence that smoking can increase your chance of infection, due to the wound taking longer to heal.

Infection in the wound or around the joint replacement can occur in hospital, or after you have gone home. Deep infection is a very serious complication but rare.

It is more common to have a superficial infection on the surface of the wound, but occasionally these can lead to a deep infection. For that reason, we always take these infections very seriously.

If you do have any concerns or problems you should let the specialist nurse team know immediately. Your GP or district nurse may be treating the infection, but we will need to be aware.

Dislocation of the joint

Occasionally following hip replacement, the ball can dislocate from the socket. This is a very rare complication. Normally the hip is relocated under anaesthetic without surgery.

Occasionally, patients do need to undergo further operations to make the hip more stable.

Loosening of the joint

Total hip replacements do have a limited life span of around 15 years. The younger you are, the more likely you are to need revision surgery.

Unequal leg length

Following total hip replacement surgery, you may have a difference in your leg length. In the majority of cases, it is not noticeable, but occasionally your leg will feel slightly longer or shorter.

This can usually be treated with a raise either in or on the heel of your shoe.

Fracture

There are occasions where your femur (thigh bone) may break during this procedure. Normally this is seen at the time of surgery and is treated with wires or plates.

It may sometimes be found with an X-ray following surgery. A return to theatre may be necessary to repair the fracture.

Nerve injury

Thee are several nerves located around the hip, and these can be damaged during total hip replacement surgery. These nerves supply sensation and power to the muscles in the leg.

Normally the nerves recover over a period of weeks and months. Occasionally, the problems can be permanent and can lead to pain, weakness and loss of sensation.

Muscle weakness

Patients may notice they have weakness in the muscles around the hip. This is because the muscles need to be cut during the operation, and sometimes they do not heal normally.

Exercises are given to you by the ward physiotherapy team to help build muscle strength following your surgery, it is advised you carry these out regularly.

Urinary incontinence

A small amount of people suffers from incontinence after anaesthetic. This is temporary and settles itself within a few hours.

Inability to pass urine can also happen and may require the insertion of a bladder catheter. This is usually a temporary problem and will settle in a few days.

Persistent pain

Total hip replacement is a very good treatment for arthritis. However, some patients are left with pain and discomfort around the wound site.

Memory problems (post-operative delirium)

12 out of every 100 patients are at risk of post-operative delirium. Patients complain of mild symptoms, which could be related to the operation, the anaesthetic or painkillers.

It is important you tell the specialist nurses if you suffer from memory problems or mental health problems prior to surgery as this may increase your risk.

Revision (re-do) of the joint

Occasionally, for various reasons, operations need to be re-done. This is normally after many years. Your orthopaedic consultant will discuss this with you.

You will also meet the joint replacement specialist nurse. You will learn about your care, rehabilitation and what is expected of you before and after your surgery.

We will discuss your anaesthetic, medications and pain relief. We will show you a model of a total hip replacement and teach you exercises you need to perform before and after surgery.

You will also have a final appointment with the specialist nurse approximately 2 to 3 weeks before your operation/admission.

During this clinic visit, you will have simple tests on your heart and lungs and may need a repeat blood test taken. You will be required to bring a urine sample with you (using the bottle provided at your education class).

This will be tested to rule out infection. You may require repeat X-rays.

You will be given body wash and nasal ointment to use 5 days before your operation. This is to help prevent MRSA infection.

You will need to bring a list of all medications you take or a repeat prescription with you. We will discuss with you any medications that you may need to stop before your medication date.

What if I need help at home?

You can discuss this with the occupational therapist, who can arrange for carers to be put in place for your discharge.

You will also be given a form on your final check appointment before surgery that will ask you questions regarding equipment that may be needed for your return home, this will all be explained to you by the joint replacement specialist nurse.

Your equipment will be delivered prior to your operation.

How should I prepare for my admission to hospital?

Please ensure you have a bath or shower before you arrive at the hospital to aid in the prevention of the risk of infection.

It is also important that you do not apply creams or make up after your bath or shower. Please do not shave your legs for at least 3 weeks prior to your operation.

Shaving is known to increase infection rates in joint replacement. It is not known whether hair removal creams increase infection risks so these are best avoided.

What should I bring to hospital for my admission?

You should bring well fitting, comfortable slippers or flat supportive shoes to walk in. New slippers may not fit if your feet become swollen, and slippers/shoes without a back are not recommended.

You should also bring easy fitting clothes.

You must bring any other medication normally prescribed by your own doctor, or any over the counter medication with you on admission. Please bring them in their original packets. any medication that is not in its original pack cannot be used on the ward.

Please bring in any leaflets, walking aids, and equipment provided to you for the operation. For example, a helping hand, shoe horn, or sock aid.

Please only bring in essential as there is limited space and no suitable storage for valuables.

What happens during my admission to hospital?

You will be admitted to hospital on the day of your procedure and given a time slot, which is designed to make your stay in hospital before the operation as short as possible.

You will be admitted to the access lounge, where all of the checks will be completed before you go into the theatre.

When you are admitted to the access lounge you will be seen by an anaesthetist, who will discuss your anaesthetic choices with you. Most patients will be recommended to have a spinal anaesthetic, in combination with a light general anaesthetic or sedation.

The spinal anaesthetic involves a small injection of local anaesthetic between the bones of the lower part of the back, around the nerves of the spinal cord.

This causes a temporary numbness and heaviness from the waist down and allows surgery to proceed without you feeling any pain.

Light general anaesthesia or sedation may the be given to reduce your awareness of theatre activity during surgery. This anaesthetic combination is preferred because it is safe, effective and its full effects usually wear off very quickly following surgery.

This allows most patients to make a rapid recovery with few hangover side effects. It will also allow and promote early mobilisation.

Other anaesthetic choices include: general anaesthesia and/or combined with nerve block or epidural anaesthetic. An epidural anaesthetic is similar to a spina anaesthetic, but it can be continued after the surgery in the ward. You anaesthetist will discuss the pros and cons of these choices with you.

From the start of the anaesthetic until the end of your operation, your anaesthetist will stay with you watching your condition very closely. Your heart rate, blood pressure and breathing are monitored throughout and your body temperature is kept normal using a warming blanket.

As with all anaesthetic techniques, there is the possibility of side-effects or complications with a spinal anaesthetic.

Common side effects include:

Low blood pressure

This can make you feel a little bit sick, the anaesthetist is able to control this with fluids and medication to raise your blood pressure.

Pain during injection

If you feel pain in any place other than the needle tip, tell the anaesthetist immediately and they will reposition the needle to prevent any nerve injury.

Headache

This usually settles by itself, but if it persists tell the anaesthetist.

Difficulty passing urine

Due to the effect of the spinal anaesthetic your bladder will also be temporarily numb. This can sometimes make it more difficult to pass urine immediately after surgery. A tube (catheter) can be inserted into the bladder to relieve this problem.

Rare side effects:

Nerve damage

This is a rare complication. Most nerve injury will settle over a few days or weeks. The anaesthetic team will monitor you after the spinal to try and prevent any severe complications. Permanent nerve damage is very rare.

What happens during the operation?

You should be aware that in theatre the operating team wear specialist clothing, hoods and masks. This is to further minimise the risk of infection.

At the end of the operation, the surgeon will inject local anaesthetic into the tissues around the new joint which will assist to relieve your pain.

What happens following the operation?

You will go into the recovery unit. The staff will check your general condition, take observations of your pulse, blood pressure, temperature, oxygen levels (vital signs), check your wound, monitor the reversals of your spinal anaesthetic, and assess if you need any further pain relief.

Once the anaesthetist is happy with your recovery and vital signs, you will return to the ward where the staff will continue to monitor your vital signs, bladder and bowel function, the return of feeling in your legs and lower body following the spinal anaesthetic.

You will have regular pain relief prescribed.

If you feel your pain relief is inadequate at any time then you must let the ward nurses know so that they can help you get more comfortable, and provide you with medication required.

During your stay on the ward you may be seen by the pharmacy team. They will discuss any new medication with you and give you advice on how to take the medicine and the potential side effects you may experience.

Your stay in hospital will be short.

You will be encouraged to attend to your own personal hygiene with minimal assistance and be encouraged to be as independent as possible, you will be expected to get dressed into your normal clothes.

You will be visited by a physiotherapist/occupational therapist daily on the ward.

Continuing with your physiotherapy exercises, and learning how to walk with a Zimmer frame is important before progressing to elbow crutches or walking sticks. You will also practice stair climbing if necessary.

It is important that you exercise independently at times throughout the day when the physiotherapist is not attending you.

You will be escorted to X-ray to have imaging taken of your hip replacement. Blood tests will also be taken on this day.

The nursing staff will discuss your discharge plan with you as soon as possible after your operation, to ensure you have all of the necessary equipment and help in place at home before you leave the ward.

You will be discharged home when you are medically fit and have completed all of your physiotherapy and occupational therapy assessments.

Before you leave the ward you will be given a discharge letter. This contains information about your operation and medication. Your GP will receive a copy of this letter on email on the day you are discharged.

Will my medication change following surgery?

You will be prescribed some new medicines. Some are to help to reduce the amount of pain, and some help to reduce the risks of complications following surgery. There may also be some temporary changes to your regular medicine, but if there are it will be explained to you.

The nursing staff will give you your medication prior to you leaving the ward. You will be discharged from hospital with a 7 day supply of tablets to relieve the pain, and you will need to contact your GP for any further prescriptions required.

You and your GP will be given a copy of your discharge letter.

Movement following surgery

Going up stairs

first take a step up with your un-operated leg. Then take a step up with your operated hip leg. Then bring your stick or crutch up onto the next step. always go 1 step at a time.

If there is a rail, hold onto this with one hand, and you will be shown how to hold onto your other crutch or stick.

Going down stairs

First put your crutch or stick 1 step down. The take a step with your operated hip leg, followed by your un-operated leg. always go 1 step at a time. On curbs or steps without a rail, both crutches and sticks are moved together.

Getting in and out of a car
  • Ask your driver to push your seat all of the way back and recline it slightly.

  • If needed use a small cushion to make the seat level.

  • Back up into the car until you feel the seat against the back of your legs.

  • Carefully lower yourself onto the seat, keeping your operated hip leg out in front of you as you sit down.

  • Slide across the seat towards the hand brake to give yourself sufficient room to get your legs into the car.

  • Turn towards the dashboard, reclining slightly backwards as you lift your operated hip leg into the car.

  • To get out of the car, reverse this procedure.

Physiotherapy

It is important to continue with the exercises you were given in hospital. Keep doing the until you see your joint replacement nurse, practitioner or consultant. Depending on where you live you may be given a physiotherapy outpatients appointment after discharge for you to attend.

What happens following discharge home?

A few days after you have been discharged, you will be contacted by a member of the joint replacement specialist nurses to see how you are getting on.

Your wound review appointment will be carried out approximately 2 weeks after surgery, this will be given to you at your pre-operative appointment prior to your operation.

You will have a consultant or joint replacement specialist nurse review around 6 to 8 weeks after surgery to check your progression and discuss hip precautions.

You will be reviewed again 5 months in a virtual clinic (phone call appointment), and asked to attend for an X-ray at your own convenience.

There will be another review at 1 year and asked to attend for an X-ray. If you have met all required milestones you will then be discharged back to the care of your GP.

If you have any concerns regarding your recovery, or think you may be developing a problem please contact the helplines (contact numbers in the back of this booklet). We will be able to offer advice and arrange additional support, or organise a review if required.

How to care for your wound?

Your wound may leak slightly into your dressing and dry up. This is normal, if it leaks outside of the dressing you must contact the service on the number provided.

Your wound dressing should remain in place for at least 14 days, the specialist nurse will give you a return appointment for wound/dressing check review.

Your dressing will only be changed if the dressing will not stay in place or attach to your skin or there is an issue with the wound.

Please do not change the dressing yourself.

The dressing on your hip wound has a bacterial barrier to help reduce the risk of infection, it is not advisable to shower for at least 14 days after surgery. Washes only are advised.

An infection at the site of your wound is unusual but may present as discharge from the wound, redness, swelling and heat, increased pain or an offensive smell. You must seek advice from the helpline number or contact the ward where you had your surgery.

If you are concerned about your wound, please call the helpline at any time.

If your GP or district nurse prescribes antibiotics for a possible wound infection, please contact the joint replacement specialist nurses or ward, we may need to arrange an appointment with your surgeon.

Seek advice from your hospital or GP if you notice any excessive bleeding, or any difficulty with breathing. If you become urgently unwell, call 999 and request an ambulance.

Frequently Asked Questions

How long will the benefits last?

total hip replacements do have a limited life span or an average or 15 years. The younger you are the more likely you are to need a revision at some stage.

Are there any other treatments available?

A hip replacement is the best option for you due to the severity of your arthritis. This option will only be offered to you, after others such as medication or physiotherapy have been tried and have not relieved your symptoms.

Why have I still got swelling?

It is normal for healing issues to be swollen. The swelling may last for several months. When you take a step the calf muscle works to help pump the blood back to the heart. If you are not putting full weight on your leg the pump does not work as well, and you may get swelling around your ankle, and down your whole leg, particularly at the end of the day.

What can I do about it?

Do your ankle pump exercises regularly when sitting, it is recommended that you rest on the bed after lunch for about an hour.

Why is my scar warm?

When tissues are healing within your hip they produce heat. This can be felt on the surface for several months.

How long will I have pain for?

It is likely that you may continue to experience some discomfort for several weeks. If the pain is not well controlled, please contact the joint replacement nurses. Alternatively, contact your GP.

Why do I get pain lower down my leg?

Wile the tissues are settling it is quite common to get referred pain into the shin or behind the knee.

Why does my hip stiffen up?

After sitting for a while your hip may feel stiff when you stand up. You may need to take several steps before your hip loosens and feels mobile again.

How far should I walk?

This will vary depending on your fitness. Set yourself realistic targets, building up the distance you walk gradually, on a daily basis. Overall, your exercise tolerance will improve, and the distance you cover will increase.

When can I drive?

You should usually wait 6 weeks before driving, before you consider driving you must be confident that you have sufficient movement and strength so that you can do an emergency stop.

You should also inform your insurance company that you have had an operation before you drive again.

When can I return to work?

This depends entirely on the nature of your job, but it is usually around 6 to 12 weeks after your operation. you may be able to negotiate a phased return to lighter duties if required.

Can I go swimming?

You should not swim for the first 6 weeks, and your wound should be fully healed. Start off gently and avoid breast stroke until your hip is more comfortable.

Is it normal to have numbness around my scar?

As with sitting, when you are in bed your hip may stiffen up and the discomfort may wake you. Your sleep pattern may also be disturbed if you are not used to sleeping on your back.

It is not advisable to sleep or lie on either side during the early stages of your recovery.

Following your 6 week review it will be discussed about lying on your side. Placing a pillow between the knees can help with discomfort.

Why does my joint click?

Your new hip works in a different way. If your joint clicks it should improve as healing continues.

When can I walk with one crutch/walking stick unaided?

Routinely you will be discharged from hospital with 2 crutches, walking sticks or frame. As your strength and confidence improves you will be able to progress your walking onto one stick.

Always use the stick in the hand on your un-operated side, and move the stick forward at the same time as your operated leg.

When can I return to the gym?

We advise against returning to the gym for 6 weeks (due to hip precautions). Low impact activities such as cycling, treadmill, walking and swimming are recommended after 6 weeks. high impact activities such as sports and running should be avoided until after your consultant clinic review.

What are Patient Reported Outcome Measures (PROMs)?

Patient Reported Outcome Measures (PROMs) involves filling in a questionnaire with your nurse prior to surgery about your knee and then again 6 months after surgery to measure success rates and covers regional and national statistics.

References

  • NICE (The National Institute for Health and Care Excellence)

www.nice.org.uk

  • NJR (National Joint Registry)

www.njrcentre.org.uk

  • Journal of Orthopaedic Surgery and Research  

www.josr-online.biomedcentral.com

Contact Numbers

Joint Replacement Specialist Nurses

Monday to Friday, 8:30am to 4:30pm

Hartlepool

01429 522493

Ward 4 Hartlepool

01642 382804

Physiotherapy Ward 4 Hartlepool

01429 522030

Ward 32 North Tees

01642 382732

Ward 33 North Tees

01642 382733

Returning equipment:

Durham and surrounding districts

(01325) 524531

TCES Equipment Hartlepool, Stockton and Middlesbrough

(01642) 224205

Comments, concerns, compliments or complaints

Patient Experience Team (PET)

We are continually trying to improve the services we provide. We want to know what we’re doing well or if there’s anything which we can improve, that’s why the Patient Experience Team (PET) is here to help. Our Patient Experience Team is here to try to resolve your concerns as quickly as possible. The office is based on the ground floor at the University Hospital of North Tees if you wish to discuss concerns in person. If you would like to contact or request a copy of our PET leaflet, please contact:

Telephone: 01642 624719

Freephone: 0800 092 0084

Opening hours: Monday to Friday, 9:30am to 4:00pm

Email: [email protected]

Out of hours

Out of hours if you wish to speak to a senior member of Trust staff, please contact the hospital switchboard who will bleep the appropriate person.

Telephone: 01642 617617

Data protection and use of patient information

The Trust has developed Data Protection policies in accordance with Data Protection Legislation (UK General Data Protection Regulations and Data Protection Act 2018) and the Freedom of Information Act 2000. All of our staff respect these policies and confidentiality is adhered to at all times. If you require further information on how we process your information please see our Privacy Notices.

Telephone: 01642 383551

Email: [email protected]

Privacy Notices

Leaflet feedback

This leaflet has been produced in partnership with patients and carers. All patient leaflets are regularly reviewed, and any suggestions you have as to how it may be improved are extremely valuable. Please write to the Clinical Governance team, North Tees and Hartlepool NHS Foundation Trust, University Hospital of North Tees, TS19 8PE or:

Email: [email protected]

Information:

Leaflet reference: PIL1463
Date for Review: September 2026

Page last reviewed: