The decision to operate

The decision to have a total hip replacement is a significant undertaking, involving major surgery and there is always a small risk of complications, which are outlined in more detail elsewhere on the website (WEBLINK TO COMPLICATIONS). It is important that you should have a hip replacement performed for the correct reasons and at a time that is right for you. Your orthopaedic surgeon and you should consider several questions in detail before taking the decision to operate and these questions should include:

• Do you have hip pain?Hip replacement is usually done to relieve the pain arising from an arthritic hip joint, and in this respect it is a highly successful operation, but of course it is very unlikely to relieve pain arising from other areas. Hip pain is usually felt in the groin, the front and side of the thigh, and the knee. It may also be felt in the buttock, and sometimes below the knee, in the front of the shin. Pain felt in the back and pain shooting down the back of the leg are most likely to be coming from causes in the spine and are unlikely to be improved by hip replacement. Similarly pain felt only in the calf, made worse by walking, may be related to problems with the blood circulation, for which hip replacement will be of no use.
• Is your pain severe enough to justify surgery?Hip replacement should only be considered when the pain caused by your arthritic hip is causing significant difficulties in your everyday life. For most people this will mean pain on a daily basis, aggravated by walking, which limits the distance that can be walked in comfort. Pain that occurs at night and which disturbs your sleep is particularly troublesome, and is a good reason to consider hip replacement. Pain that occurs only occasionally and only during certain activities such as vigorous sport is probably unsuitable for treatment with hip replacement, and other treatments should be considered instead.
• Have other treatments been tried?Because of the small risk of complications following hip replacement surgery, it is important that before considering a hip replacement you should have tried other methods of treating your hip pain. Some of the alternative treatments include:

                       a.Anti-inflammatory and painkilling medicines. There are many different types of medicine available to treat hip pain and these can be discussed in detail with your orthopaedic surgeon, general practitioner or your pharmacist. Anti-inflammatory medicines work by reducing the inflammation in the hip joint and thereby reduce pain. This is different to so-called simple painkillers, which work by reducing the amount of pain that you feel and the two different types of medicine can be combined to be more effective. Some of the older anti-inflammatory medicines had significant side effects including stomach upset, but a newer type of medicine, know as COX-2 inhibitors may reduce some of these side effects. Many people also gain relief of hip pain from two treatments called chondroitin sulphate and glucosamine, although the way in which these treatments work to relieve pain is not known. They are available over the counter at chemists’ shops and at some health food shops.

                       b.Walking aids. A walking stick held in the hand opposite the side of the painful hip significantly reduces the amount of force passing through the hip joint and can therefore markedly reduce the amount of pain in the hip.

                       c.Life-style changes. Some people find that by making a few small changes to their lifestyle they can reduce the amount of pain felt in the hip. One of the most important ways in which a person may reduce pain is to lose weight if they are overweight, as this will reduce the forces passing through the hip joint. Weight loss can be difficult to achieve when the arthritic hip limits exercise, but advice can be sought from a general practitioner or a dietician. Other lifestyle changes that may help include the avoidance of heavy manual employment and strenuous exercise such as long-distance running. However, we would advise that you should continue with moderate exercise when possible, as this helps to avoid weight gain and maintains muscle fitness.

                       d.Physiotherapy. Physiotherapists can help those with arthritis of the hip in a number of ways including the use of exercises to maintain joint movement and muscle fitness. They may also prescribe a walking aid and make sure that this is properly fitted.

                       e.Minor surgery. Patients with moderate arthritis of the hip sometimes benefit from injection of the joint with a mixture of local anaesthetic and medical steroid. This acts locally to reduce inflammation in the hip joint, and thus may relieve pain, and it is sometimes combined with a manipulation of the hip under anaesthetic.

• Do you have severe joint stiffness or destruction of the joint?Although hip replacement is most frequently done to relieve pain, it is sometimes performed for other reasons related to the arthritis. Some people develop severe stiffness of the hip with their arthritis, and sometimes pain is not the main symptom. There may also be destruction of the hip joint and bone loss, which may lead your orthopaedic consultant to advise surgery to prevent worsening of the bone’s condition. In general, however, most people have the surgery preformed to relieve pain.
• Do you have a medical condition that may affect the outcome of surgery?Although most people are able to have a hip replacement without any increase in the normal risks associated with the operation, some people have medical conditions that may make the surgery hazardous to their general health, or which may adversely affect the likelihood of success. In particular, severe heart and lung diseases may cause problems during and after surgery, and may even pose a threat to life. Ulceration of the skin of the legs may risk introducing infection into the hip replacement, and therefore this should be treated before hip replacement is carried out. Other conditions that affect the chances of success include those severely affecting the nerves of the leg, which may cause paralysis of the muscles, or a loss of feeling in the legs. These conditions may be risk factors for dislocation (WEBLINK TO COMPLICATIONS) or may cause rapid failure of the hip replacement.

Having considered these questions, you and your surgeon will be able to decide whether hip replacement is the correct treatment for you. In the past many surgeons have been reluctant to carry out hip replacement in younger patients because of the risks of loosening in the long-term. Results using the Exeter Hip System have shown very low rates of loosening, even in younger and more active patients, and the results of revision (re-do) surgery are constantly improving, due in part to some of the techniques pioneered at Exeter. For these reasons, at Exeter we do not believe that the age of an individual should automatically prevent us from performing a total hip replacement.