Hip Replacement

Everything You Should Know About Hip Replacement

While there are a number of conditions that can lead to person requiring hip replacement surgery the most common cause is arthritis. The various types of arthritis that typically necessitate this type of surgery are osteoarthritis, rheumatoid arthritis and traumatic arthritis.

Types of arthritis

The various types of arthritis that typically necessitate this type of surgery are:

• Osteoarthritis – With osteoarthritis the cartilage in the hip joint gradually wears away. As the cartilage loss becomes more severe bone to bone contact increases as does the pain and stiffness. Eventually the pain becomes chronic and debilitating and mobility is reduced to almost nothing. Osteoarthritis is prevalent in athletes, manual labourers and people over 50.
• Rheumatoid arthritis – Rheumatoid arthritis occurs when a person’s immune system begins to mistakenly attack their own bodily tissues. Rheumatoid arthritis attacks the lining of the hip joint causing the synovial fluid to swell. This leads to painful, restricted movement and, over time, erosion of the bone and physical deformity.
• Traumatic arthritis – Traumatic arthritis is the result of injury. If a person is involved in an accident involving their hip – typically auto accidents or sporting accidents – the cartilage in the hip joint may become damaged. Over time it loses its integrity causing stiffness and increasingly severe pain.

Other reasons someone may undergo hip joint replacement include avascular necrosis, (where a portion of the joint bone loses its blood supply and dies), hip fractures (common in older people), developmental dysplasia, congenital hip dislocation, Perthes disease (a rare childhood disease affecting the hip) and more.

Why do People Undergo Hip Replacement?

People typically undergo total hip replacement surgery in order to:

• Obtain relief from chronic hip pain.
• Regain mobility in their hip joint.
• Improve the quality of their everyday life.

What is Hip Replacement Surgery?

Hip joint replacement or “total hip arthroplasty”, involves, as the name suggests, the replacement of the hip joint with manufactured components. During the procedure the diseased or damaged cartilage is removed from the joint along with any bone that may also be damaged either by wear and tear or a degenerative condition like rheumatoid arthritis. Once all the damaged material is removed a new hip joint is created using component parts fashioned from various materials including metal, ceramic and plastic. Exactly which components will be made from which materials will often vary from case to case, but should not impact the performance of the final product. Some joint replacement procedures will use a specially formulated cement called methylmethacrylate while in other cases the surgeon may advise a cementless procedure wherein the new material and the existing bone actually fuse with each other naturally. This process typically requires specially built components and can take much longer to recover from.

Notes: It is often recommended that those undergoing these types of hip replacement donate a quantity of their own blood beforehand. This is then kept on hand during surgery in case the patient requires a transfusion for any reason. Also, antibiotics are often given before, during and after the procedure and physical therapy is a necessary part of the recovery process.  

Who is a Candidate for Total Hip Arthroplasty?

As noted above people who have replacement surgery are most likely those suffering from an arthritic condition; typically rheumatoid arthritis, osteoarthritis or traumatic arthritis. Although people with certain congenital conditions are also candidates. Bone necrosis or bone death is also sometimes a factor. Bone death can be caused by avascular necrosis, hip fractures, drug abuse, alcoholism and diseases such as lupus erythematous. Often times the pain alone is enough to drive people to seek this type of surgery but an equally compelling factor is the loss of mobility that comes with these conditions. People are no longer able to engage in the simplest of their daily routines, are unable to climb stairs, find that even short walks are excruciating ordeals and may not even be able to sit upright without significant pain.

When things deteriorate to such a degree some lean heavily on pain medications but this carries the risk of addiction. Others start searching online for things like “How do you know if you need a hip replacement?” in order to learn more about their options. At the end of the day most will opt for the surgery because it affords them the best chance of a full recovery from hip replacement. Before electing to undergo this type of surgery it is important the patient fully understand the procedure, the chances of a successful outcome, the crucial role physical therapy plays in recovery as well as any associated risks and complications.

Possible Complications from Surgery

There are numerous potential complications associated with a hip replacement operation. These include blood clots in the lower legs that may travel through the bloodstream to the lungs; a potentially dangerous condition known as “pulmonary embolism”. In addition, the newly constructed hip may become infected, there may be a significant hip replacement scar that impedes motion and the newly installed hip joint itself may come loose in time necessitating further surgery to correct the problem. Some people experience difficulty urinating after this procedure and still others suffer hip replacement complications related to the anaesthesia involved including liver toxicity, pneumonia and heart arrhythmias. It’s important to note that while the risk of complications is real, the vast majority of patients experience no significant complications from their total hip replacement.

How do I Know I’m Ready for to Have my Hip Replaced?

As a general rule this type of surgery is recommended when hip replacement symptoms and pain becomes chronic an overwhelming and your hip problem begins to have a serious negative impact on your quality of life. That is, it is indicated when:

• The pain in your hip is keeping you awake at night.
• You are unable to climb stairs, stand up from a chair unassisted or get into and out of your car.
• Running errands, conducting your business or even showering are difficult if not impossible.
• Other treatment options have been unsuccessful in alleviating your pain or providing mobility.

While all of these factors are important they alone do not determine whether one is a suitable candidate for hip joint replacement. You’ll need to have an in depth conversation with your doctor beforehand where he or she will assess how well you are likely to tolerate the stresses brought upon the body by this type of procedure. In all likelihood you will be approved but the assessment is still important just in case there are mitigating circumstances that might contraindicate surgery such as:

• You have significant pain but you are still able to perform normal activities.
• Other treatments such as therapy or medication are providing you significant relief.
• You have not exhausted non-invasive options yet.

Any responsible surgeon will want you to exhaust other possibilities before undertaking a surgical solution to a problem. That’s because it’s always preferable to try and make what you have work rather than just defaulting to the replacement option. Remember an artificial hip will not turn you into a superhero or allow you to do things you couldn’t ordinarily do with a natural, healthy hip.

Preparing for Hip Replacement

Before undergoing single or even double hip replacement the candidate will need to undergo an evaluation in order to determine their suitability. This evaluation will consider what, if any, medications the candidate is taking, whether or not the person has any pre-existing conditions like heart disease or diabetes and whether or not the person is currently beset by any active infections. Blood tests are typically conducted which look to determine kidney and liver function, electrolyte levels and more and there is typically a urinalysis, EKG, chest X-ray and as well as a full physical exam. If the prospective patient is taking any anti-inflammatories these are usually discontinued 1 week before surgery because they may affect blood clotting and platelet function. In some cases the surgeon may recommend a person engage in a series of exercises in the lead up to surgery in order to build hip strength that will aid in recovery. But for many patients exercise of this type may be too much to ask.

Why You Should Go Abroad for This Type of Surgery

There are many compelling reasons why you should consider having your hip surgery abroad including the cost of hip replacement elsewhere (which we’ll get into below), short or no waiting lists, some of the best trained surgeons you’ll find anywhere, clean, modern facilities and a level of personal service that puts many hospitals in western Europe to shame. While there are a number of locations where you might have this type of surgery perhaps the most compelling case can be made for Latvia. Latvia boasts brand new, state of the art facilities like the AIWA Clinic in Riga where world class surgeons use the latest technology and your hospital room is spacious, comfortable and fully appointed. In addition, the Latvian capital of Riga is only 2 ½ hours by air from London or Paris.

Are There any Risks to Having Surgery Abroad?

When traveling abroad for surgery there are always risks and one many people don’t consider is follow up. That is, if you choose a popular destination like Malaysia for your surgery and then experience hip replacement complications after returning to the UK you’ll need to make another significant investment in time and money to get back to see the surgeon. Also, you may be in such considerable pain that taking such a long flight is simply out of the question. You may also find local doctors in your hometown reluctant to take your case if the surgery was performed by someone in another country. If you have your hip surgery performed in Latvia however you’re only 2 ½ hours away by air. You can hop on a plane at Heathrow at 9 am, have lunch in one of Riga’s amazing restaurants and bistros, see your surgeon in the afternoon and be back in London in time for dinner.

When traveling to other countries for surgery many also encounter the problem of liability. If, for instance, you travel to Kuala Lumpur, Malaysia for your surgery and afterward you develop severe, perhaps even life threatening complications you’re likely to discover the surgeon has only minimal malpractice coverage and the local authorities are unwilling to bring charges against him or her. This happens more often than you realize, especially in places like Southeast Asia where accountability is trumped by notions of “face” and wealthy individuals can purchase immunity. Latvia on the other hand is a member of the European Union and as such medical professionals are held to a much higher standards of accountability.

Other Benefits of Having your Hip Replacement Abroad

There is no doubt that one of the most compelling reasons for having hip replacement abroad is cost. To illustrate that point we have compiled a list of what you can expect to pay for hip surgery in various different European cities. Note that these are average costs as of this writing.

As you can see hip replacement cost in Europe, especially in a major capital like Paris or London is considerable. Even in Dublin the cost of private hip replacement is formidable. Compare those costs though to what you’re likely to pay in Riga and you begin to understand why Latvia – and the AIWA clinic in particular – is in many ways the ideal place to undergo your replacement surgery.

The AIWA Clinic in Riga is one of the most up to date surgical facilities on the continent. Every effort was made during the design and construction of this facility in order to ensure it would compare favourably to even the most celebrated clinics in Western Europe. Every operating room features the latest state of the art equipment and patient rooms feature free WiFi, large flat screen TVs and accommodation for a family member should you want someone to stay with you. The 2 principal surgeons at AIWA Clinic have nearly 50 years of combined experience during which they have performed hundreds of joint replacements. Each has also spent considerable time studying and practicing in Western Europe’s most prestigious medical institutions. The AIWA Clinic also boasts:

• Deluxe hotel style accommodations.
• All the high-tech amenities you’d expect in London or New York.
• Round the clock personal care from the moment you check in.
• Proximity to Riga’s world-class international airport.
• 10 year follow up for all their surgical patients.
• A friendly, well-trained multilingual staff.
• An outstanding track record.

About Riga

It may surprise you to learn that 800 year old Riga is one of the most technologically advanced cities in the world. It is in the top 20 globally for both Internet speed and level of broadband adoption and it’s a leader in adopting smart technology to homes, schools and businesses. It also happens to be one of the most architecturally dazzling cities in Europe and if you need any proof of that look no further than Riga’s historic city centre with its combination of rare Jugendstil and priceless Art Nouveau buildings. Oh, and that city centre? It also happens to be a UNESCO World Heritage Site.

The Riga metro area is home to more than 1 million people, making it the largest city in the Baltics. The port of Riga is one of the busiest in Northern Europe and is connected by ferry to Stockholm. It also plays host to enormous cruise ships during the warm weather months. The passengers who arrive in Riga on those cruise ships make up just some of the 2.5 million tourists who visit the city annually; making it one of the most visited cities in Northern Europe as well. Riga is also a centre for culture and sport having played host in recent years to the IIHF World Ice Hockey Championships, the Eurovision Song Contest the Women’s World Curling Championships and the 2006 NATO Summit. In addition to its busy port and extensive railway network the city is also served by Riga International Airport which handles in excess of 5 million passengers per year; meaning it’s busier than Liverpool or Belgrade airports.

The Hip Replacement Operation

Whether you suffer from arthritis, have had an accident, were born with a congenital condition that has manifested itself in your hip or your hip is simply worn from years of wear and tear the first step in the process of joint replacement is the diagnosis of your condition and the determination that you should seek replacement. Following those steps you’ll be evaluated to determine if you are a good candidate for total hip replacement and if found to be so you will make a date for surgery. When the day arrives the procedure will unfold in the following manner:

• Removal of the diseased or damaged hip joint – Once you are properly anesthetized the surgeon will make an incision and open the area around the hip joint. Whether the incision is at the back of the joint or the front of the joint will be up to them. Once the joint is exposed the surgeon then works to remove the damaged bone and cartilage. The hip joint is composed of 2 primary parts: the ball and the socket. The surgeon cuts away the damaged bone on both sides of the joint then prepares both sides to accept the new artificial components.

• Placing the acetabular component – The acetabular component sounds like the name of a sci-fi movie but it’s really the name given to the new artificial socket or “cup” that will make up half of your new hip joint. Once all diseased or damaged bone has been removed the acetabular component is the first part of the new joint that is installed. It is joined to the pelvis and adjusted so that it will be properly positioned to afford you natural movement. Typically the pelvis side of the acetabular component has a rough surface that promotes the growth of new bone that will help hold the socket firmly in place.

• Placing the stem – The next step is to make the femur (thigh bone) ready to receive the new ball that will eventually fit into the socket. The stem is a long pointed shaft that is inserted down the hollow of the thigh bone. If the stem is to be held in place with cement the cement is first introduced into the hollow of the bone and then the shaft is inserted. The cement then hardens around the bone forming a permanent bond. The stem is now ready to accept the new ball component of the joint.

• Placing the ball – With both the acetabular component and the femoral shaft in place it will be time to place the new ball component on the end of the shaft. This new ball is typically made of metal and fits snugly onto the top of the shaft. The most important consideration when it comes to this type of surgery is making sure the new ball sits at the correct angle to both the femur and the pelvis so that the patient’s natural walking motion can be accurately recreated.

• Bringing it all together – With the 3 major components of the new joint in place it’s time to bring them all together and create a brand new hip joint. The ball is placed in the new socket and the entire complex is checked and rechecked to ensure all relative angles are correct and that the joint itself is stable. Should the ball not be stable in the socket it may dislocate when under future stress: a painful and serious complication that will require surgical redress. Once the surgeon is satisfied everything is as it should be your hip is sewn back up and you are moved to the recovery room.

Keep in mind that while this may seem like a lengthy process the answer to the question ‘how long does a hip replacement take?” is about 2-3 hours.

Hip Replacement Recovery

Following surgery you will spend several hours in the recovery room where you will be closely monitored. Once you awaken you will be moved to your room where the total hip replacement recovery process begins in earnest. You will likely spend several days in the hospital so that the medical team can assess your condition and keep an eye out for signs of trouble such as infection. You will be given pain medications to help you through the postoperative period and you may need to take some form of pain medication for some time even after being discharged.

• Beware of blood clots – While serious complications from this type of surgery are extremely rare a small percentage of patients will develop blood clots in their legs following surgery. If these blood clots wind up moving to your heart, lungs or brain they have the potential to be fatal. It doesn’t have to be however. Your medical team will provide you with support hose after surgery that will encourage proper circulation in the lower legs which should stave off the formation of clots. If you experience any of the following symptoms of blood clots however you should notify your doctor immediately:

• • Your leg becomes swollen.
  • The leg become tender to the touch or painful.
  • Skin of the leg is discoloured either red or blue.
  • Your leg becomes warm to the touch.

Remember: blood clots are rare but they do happen so keep your eyes open for signs of trouble and alert your doctor should you suspect something is wrong.

• Physical therapy – Physical therapy will begin while you are still in hospital and continue for months after you get home. It is critical to the long term success of this type of procedure that you adhere to the regime as laid out by the physical therapist. That will usually entail 3 or 4 sessions of physical therapy every week. Your physical therapist will be your best friend and closest ally once you get home from hospital. Treat them as such.

Hip Replacement Recovery Tips

You should take the time in the lead up to your surgery to plan for your return home. If you live in a multi-story house you should plan on sleeping on the ground floor for at least a couple of weeks and arrange to have someone who will run errands for you for at least that length of time. If you live alone you should arrange ahead of time for someone to stop in and check on you on those days the physical therapist is not scheduled to visit. Also, avoid alcohol or cigarettes during the first few weeks of recovery and don’t even think about driving for at least a month or two; perhaps longer. Because you’ll likely need to prepare at least some of your meals during the first few weeks of recovery you should stock your kitchen in the days leading up to surgery with foods that are easy to prepare such as canned foods, frozen foods and the like. Also, make sure you will have your phone with wherever you go so you can call someone in case of emergency.

Taking Care of the Incision

The incision the surgeon makes in your hip will be a sizeable one and will require care and attention after you return home. It will initially be closed with staples which should be removed after about 2 weeks. The general area will remain bruised for some time and may feel numb or itchy or just generally strange until the wound is completely healed. You are also likely to experience a burning sensation from time to time which you will be able to relieve with the use of an ice pack. Most importantly keep the area dry until a couple of days after the staples are removed.

Engaging in Physical Activity

Depending on how you feel and how well the recovery process is going you may be tempted to engage in exercises after hip replacement that are outside the boundaries laid down by your doctor and physical therapist. It’s in your best interest to resist this temptation. You need to take the long view when it comes to recovery from this type of surgery and that means returning to normal activity in a structured, graduated fashion under the guidance of people whose job it is to understand the recovery process. As such if you want to start climbing the stairs or taking walks without your crutches or cane you should clear it with the members of your medical team first. Many people who have had this type of surgery are under the impression that driving is not an issue since it doesn’t require any walking type movement. But driving exerts its own stresses on the hip joint and should be avoided for up to 2 months or possibly longer after surgery. It’s possible you may return to driving sooner than that but again, make sure you consult your therapist before attempting to.

Following Up

In the first year after hip replacement you’ll be expected to follow up with your surgeon at regular intervals. Keep this in mind if you are trying to decide whether to have your surgery abroad because following up with a doctor in Latvia is far simpler, faster and less expensive than following up with a doctor in Malaysia or Thailand.

How Long Does it Take to Recover From a Hip Replacement?

While each the hip replacement recovery timeline is somewhat different the following are what the average person who undergoes this type of surgery should expect at various points in their hip replacement recovery.

The day after surgery 

The day after surgery you should be able to stand with the aid of a walker, move to and from the toilet with some assistance, sit on the edge of the bed and possibly attempt some very short walks (again with a walker). You’ll also be taught about total hip replacement precautions. Avoid stairs at all cost the day after surgery.

2 days after surgery

2 days after surgery you should be able to perform some simple exercises without supervision, sit on the edge of the bed and move about with some assistance. You may be well enough to take a short, slow stroll down the hall using a walker and if your medical team permits you may attempt a few stairs. You’ll also want to start practicing your grooming and hygiene rituals as you’ll need them once you get home.

3 days after surgery

You should be able to stand up by yourself and move about independently using crutches or a walker. You may attempt a few more stairs but don’t push it. You will be taught some more exercises that will help keep the new joint loose and strong and you should be able to sit on the edge of the bed with no assistance and no pain.

1 week after surgery

You should be home now and able to take yourself to the bathroom, prepare simple meals and move about the house in a limited way. Your physical therapist should have given you some exercises which you should do without fail and you might try climbing some more stairs, but only if there is someone there to assist if you need it.

3 weeks after hip replacement surgery

After 2-3 weeks the staples in your incision will be removed and you’ll start feeling more like your old self again. Your mobility will still be limited but you may no longer need someone to run to the grocery store for you. The temptation at this point is getting ahead of yourself. You may start to feel significantly better but hip replacement recovery time is what it is and shouldn’t be rushed. And hip replacement recovery time for the elderly can be significantly longer.

6 weeks after surgery

After approximately 6 weeks many patients are given the go ahead to resume driving. The 6 week number is not etched in stone however as it may take longer with some people and others may still be taking pain medications 12 weeks after hip replacement and they definitely should not drive until they’re finished with them.

6 months after surgery

By 6 months after surgery you should be walking without aids, driving, taking care of yourself, working at your job and continuing to rebuild strength in the reworked joint. Always adhere to any limitations imposed on you by the surgeon or physical therapist. You don’t want to do all over again a second time. It’s possible you may still be taking some pain medications at this point. If you are you should avoid driving.

You can expect that during the recovery time for hip replacement you will become less dependent on assistive devices and more confident in the way you move, your balance and your endurance. None of that means that you should take your recovery into your own hands. Instead work closely with your physical therapist, stay in contact with your doctor and don’t exceed the limits your medical team advice. Also, even after several months you should keep your eyes open for signs of blood clots or infection and inform your doctor immediately should you suspect trouble. Here are a couple of more relevant questions and answers.

How Long Does a Hip Replacement Last?

Anywhere from 15 to 20 years and more depending on the age the person had their operation.

How Long Does Swelling Last After Hip Replacement?

Anywhere from a couple days to a month or more.

Some Things Patients Have Difficulty Dealing with After Hip Surgery

• Burning sensation near the incision – Sometimes the area around the incision can produce a burning sensation. 10 to 15 minutes of ice pack application should calm things down. Just be sure not to get the incision wet.

• Pain in previously unaffected areas – After surgery you may feel pain in areas that were not painful before. This is not unusual and is likely related to the surgery itself.

• Sounds emanating from the new hip joint – You may hear clunking sounds coming from the new hip joint in the weeks after surgery. This is usually caused by the muscle around the joint still being weak and not holding the joint together tight enough. In time these sounds should dissipate. However, if you feel pain as well call your doctor immediately.

• Having to keep the leg fairly immobile while sleeping – Who has the ability to control what their leg does while they’re asleep? You may have to. It’s important to keep your leg from crossing the body’s centre line while sleeping for the first few weeks after surgery as it could stress the muscles or ligaments in the hip. Easier said than done.

• Impatience – Even though they’ve been told how long recovery will take some people become impatient with the recovery process. This is typically when mistakes are made. Mistakes that could lead to having to redo the surgery.

• Stiffness – People are sometimes confused when their newly constructed hip gets stiff after sitting in one place for a while. Try to keep things loose.

• Squeaking sounds from the joint – Some have reported hearing squeaking sounds coming from their hip joint when exercising.

Life After Hip Replacement

The benefits and risks of hip replacement surgery are many with the benefits clearly outweighing the risks. If you really want to get the most out of your hip arthroplasty you’ll remember to listen to your doctor and physical therapist in the days before and after the operation. Trouble typically comes to visit when patients decide to take their recovery into their own hands. While the drive and determination of these folks is admirable it’s nonetheless the far wiser choice to listen to the members of your medical team. If you are fastidious in your dedication to exercise, healthy eating, getting enough sleep and patiently rebuilding strength your overall prognosis is excellent. Just keep in mind that the cost of hip replacement surgery is greatly reduced in places like Riga, which is actually the best of both worlds when it comes to this type of procedure.