Hip replacement is one of the most successful medical technologies. Hundreds of thousands of people have their hips replaced every year, the vast majority with every expectation of many years of pain-free function from their new joint.
But can you go on with your life just the same after your hip is replaced? Not exactly. Even though your pain will be gone, it is wise to remember that a new hip is not your old hip. You will find you can go back to do all the things you used to do, the walking, the activities, the hobbies and the jobs, without pain. But it’s useful to observe a few thoughts about your new hip if you are going to get the best long term use from it.
Your new hip is different. It is steel alloy and plastic, the ball of the hip being much smaller than your original one. The steel thigh component is often cemented into the shaft of the femur. The metal and plastic parts bend in different ways to the bone into which they are inserted, setting up stresses across the junctions. The artificial materials do not have the ability to become inflamed and then heal like our own tissues, so if they become altered then they will either stay that way or worsen.
You want to ensure a long, pain-free life for your hip replacement. Revision surgery, where the hip is redone, is not the same as the original surgery in many ways. Apart from the fact that it is another operation to undergo with its attendant risks, revision surgery is harder to perform and the satisfaction scores of patients afterwards are lower than with first time surgery. First time is best.
There are things you can do to keep your new joint in good shape for as long as possible:
1. Observe the post-operative advice. The team who take you through the procedure are experts at getting the best results. If they ask you to do this or to avoid that, then observe their recommendations. There are always good reasons behind treatment programs, along with many years of experience. Use this knowledge.
2. Observe the weight-bearing instructions. Every operation is different and there may be different instructions for you depending on how the surgery went and what the surgeon hopes to achieve. Sticking to the recommended weight through your joint is very important. You may well find you can put much greater weight, even your whole bodyweight, on the new hip. However, what you can do and what is wise are two different things, so pay attention to the instruction and carry it out until told otherwise.
3. Avoid getting your thigh too close to your chest. The angle between the chest and the thigh should not be less than 90 degrees. If your new hip bends too much, the neck of the thigh component can impinge against the plastic socket component, levering the hip out of the socket. This is called dislocation and is potentially a significant problem as it can then recur. When you reach down to your shoes, let your knee fall outwards so you reach down between your legs, and do it slowly until you feel secure.
4. Watch putting your feet up. You may feel you want to put your feet up for a rest or to reduce swelling. This is fine as long as you don’t lean forward for something. If you want to lean forward, take your feet down first.
5. Avoid rotating with your weight on the new joint. This is similar to point 3 above. Standing on your replaced hip and swinging your bodyweight around puts huge leverages on the hip. Get used to moving your legs to get into a new position, leading with the replaced one.
6. Take care when sitting down. The correct technique will soon become automatic, but sitting down can be a risk. When we sit, our body weight forces our hips into a new position. This is fine as long as it does not happen too fast or go too far. Sitting onto an unexpectedly deep sofa would be an example of an risky scenario. Know your chair heights so you don’t get surprises, with 18 inches being a minimum. Chairs with arms are best as they allow you to let yourself down in a controlled way.
7. Avoid high impact activities. I know you want to do things you haven’t been able to, but there is a price to be paid for having an artificial joint, if you want it to last. What you can do with it and what you should do are two quite different things.
Avoid sports and activities such as running and jumping, carrying heavy weights, repetitive heavy work, football, rugby, soccer, squash, downhill skiing and anything else which requires extreme joint stresses. You really want your joint to last more than twenty years. Invest the care in it and it will.
Suitable activities could include walking, cycling, swimming, bowls, cross-country skiing, amongst others. Take advice if you are unsure.
For more detail about what goes on in the interfaces between the metal, bone and cement, see The 5 facts of implant fixation.
8. Avoid crossing your legs when you sit. This puts the hip into a more vulnerable position and should certainly be avoided during the first three months after surgery. Many people do cross their legs later on without ill effects but it remains a risk to some extent.
7. Avoid bending over rapidly. This can cause impingement on the socket like leaning forward too far, and risks dislocation. Using a long handled reacher and a long shoe horn can be sensible.
8. If you get an infection, tell your doctor straight away. Infection is the single biggest risk for successful joint replacements. Infections such as teeth, urinary or chest can spread to an artificial joint via the bloodstream, either in illness or during a procedure. Consult your doctor or dentist and get the problem sorted early on. This applies no matter how old your replacement is.
9. Enjoy yourself! Despite these restrictions, the positive aspects of joint replacement vastly outweigh the negative ones, so go on, enjoy all the things you’ve wanted to do, without the pain.
Even though these precautions are mostly more important during the initial 6 to 12 weeks after surgery, they remain sensible guidance over the long term.
Jonathan Blood Smyth is Superintendent Physiotherapist in an NHS Hospital in the South-West of the UK. He has over 15 years experience of managing orthopaedic conditions and looking after joint replacements. He specializes in the management of chronic pain conditions and is the author of the “Secrets of Pacing for Chronic Pain.” For more information on these subjects see The Physiotherapy Site