Clarity Orthopaedics | Hip Surgery and Treatment

Frequently asked questions

Which anaesthetic do I need?

For the operation to be performed you will require an anaesthetic and will discuss which type of anaesthetic is best for you with one of our Consultant anaesthetists. These may include:

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Spinal anaesthesia: an injection into your back which blocks feeling in the lower part of your body. The pain relief usually lasts for several hours after the surgery has finished, which can make your initial recovery more manageable. This option has been shown to reduce blood loss during surgery.

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Sedation: if you do not wish to be aware of what is happening while having your surgery under spinal anaesthesia, medication can be administered to make you less aware of your surroundings.

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General anaesthesia: medication is administered to induce a deep sleep, during which you have no awareness and do not feel pain. Once you are woken from your anaesthetic you will be given strong pain killers to control symptoms of pain.

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Local anaesthesia: injection of local anaesthetic in the region of your surgery

What is causing the pain in my hip?

Pain in the region of the hip can present in several different ways. Classically pain from arthritis of the joint can feel like it is present deep in the groin, it is often worse after sitting for too long and can get better once you are moving around.

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Pain around the side of the hip is often caused by inflammation of tendons around the hip joint, the treatment for which is quite different from that of arthritis.

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In some cases pain in the upper leg may actually be caused by a problem in the spine.

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Through carefully exploring the nature of your symptoms, examining you, and undertaking investigations I can help you to confirm the cause of your hip pain and identify potential treatment options.

What is hip arthritis?

This is a very common condition in which the healthy layer of cartilage in the ball and socket joint of your hip becomes thinned. In its advanced stages the cartilage may have completely disappeared resulting in ‘bone-on-bone’ arthritis.

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Cartilage is important for the smooth movement of joints, and the absorption of stress passing through the joint. When worn the joints become stiff and painful. Patients with hip arthritis often struggle with getting to their feet to put socks on, and rotation of the hip becomes painful. Walking on flat ground is easier than uneven surfaces and sudden changes in direction may bring on your pain. It is common for hip pain from arthritis to feel as if it is spreading down the front of the thigh towards your knee; this pain usually goes away once the hip arthritis is treated.

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Sometimes hip arthritis can present with pain in different places, such as the buttock or side of the hip. As pain in these areas can also be caused by other sources (the spine or soft tissues around the hip) the degree of improvement patients get from these areas can vary.

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X-rays are usually sufficient to confirm a diagnosis of hip arthritis. If there is concern about other causes of your pain then further scans of the hips and/or spine may be required.

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Not everyone with hip arthritis needs a hip replacement, many can cope with their symptoms through a combination of pain killers, exercise, activity modification (changing what you do/how you do it), or using a stick for longer distance walks.

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Patients whose weight is higher than their height is designed to carry may be able to improve their symptoms through weight loss.

If the symptoms are mild or intermittent, or if there is suspicion that your pain may be caused by more than just your hip arthritis then a hip injection may be suggested.

What is a hip injection?

A hip injection involves introducing a needle into the hip joint to inject a combination of local anaesthetic and steroid. The local anaesthetic gives rapid relief of symptoms caused by your hip joint, which makes it a useful test to see how much your hip is causing your pain. The steroid component lasts for longer; in some patients it can give 6-12 months of pain relief in which case repeating it may be an option, in other patients the relief can be much shorter.

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This procedure is carried out in the operating theatre, usually under local anaesthetic which numbs the skin but sometimes sedation may be necessary. The skin of your upper thigh is cleaned with antiseptic solution and X-rays used to identify your hip joint. A needle is advanced into the hip joint using the X-rays to guide us and a small amount of dye is introduced to confirm this needle in the joint. The local anaesthetic and steroid mixture can then be introduced into the joint.

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If the injection is done for ‘diagnostic’ reasons (i.e. to confirm the hip is your main pain generator) then you may be asked to walk in the recovery room a few minutes after the injection to see what immediate effect it has had. You will be reviewed in the out patient clinic at approximately 3 months after your injection to assess the response. A long-lived response (more than 6 months) can justify a repeat injection 9-12 months after the first. If the relief is good but short-lived then further injections would be unlikely to be helpful.

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After a hip injection you should not undergo joint replacement surgery for at least 3 months due to the increased risk of infection.

What is a hip replacement?

A hip replacement is first and foremost a pain-relieving operation. It involves removing the cartilage lining the hip socket (acetabulum) and replacing it with an artificial cup. This cup is usually made from metal onto which your bone grows, a hard wearing plastic liner is fitted to the metal shell. The ball of the hip joint (head of the femur) is then replaced with a metal stem onto which a ceramic ball is attached. Muscles detached to perform the procedure are re-attached with sutures and your wound is closed with dissolving stitches. This avoids the need for removal of sutures or clips after your procedure.

What happens after my hip replacement?

Your anaesthetist will prescribe painkillers to control the pain from surgery as much as possible, you are likely to have some pain but you will be encouraged to walk on your new hip as soon as it is safe for you to do so, this is usually on the same day as your surgery. Early mobilisation is important as it helps to reduce risks of blood clots, disturbance to your bladder and bowels, and issues with pressure areas. Experienced physiotherapists and nurses will be on hand to help you to get used to walking with your new hip. They will provide instruction in avoiding positions which could cause problems for your new hip joint and guide you in the use of different walking aids (e.g. a frame or crutches).

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X-rays of your new hip will be taken to confirm its position, and blood tests will be taken to check your blood count and kidney function. Your vital signs (blood pressure, pulse, etc) will be regularly monitored.

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Once you are safely mobile, your wound is dry, your blood tests and X-rays have been reviewed, and your vital signs are satisfactory you are free to go home. This is usually on day one or two after your surgery, meaning you will likely be in hospital for one or two nights.

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At home your recovery continues as you complete exercises you learnt in hospital, with out-patient reviews with our physiotherapy team. A nurse will check your wound around two weeks after your surgery to confirm it is healthy and healing as expected.

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I will then see you in the out-patient clinic at 6-8 weeks after your surgery. This appointment is a clinical review of your progress but can sometimes involve an X-ray. It is common for patients to be walking without crutches by the time of this appointment, although this does depend on the complexity of your surgery and the level of function you had before your operation.

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NHS Patient Reported Outcome Measures (PROMs) show that 95% of people having a hip replacement feel that their hip is much better or a little better after the surgery, and 93% describe the results of their surgery as Good, Very Good, or Excellent. Although this does mean that some people who are less happy with their knee replacement, this group is small. The graph below shows the NHS outcome data for hip replacement surgery in more detail:

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NHS outcome data for hip replacement surgery

What is trochanteric bursitis?

Your hip joint has a fantastic range of movement, to achieve this a large number of muscles attach your trunk to your femur (thigh bone) to move it. The areas where these muscles run over bony parts of the femur are protected by fluid filled sacks or ‘bursae’. One of these which can cause problems is the trochanteric bursa, which sits on the side of your femur at the hip level. If this becomes inflamed it can result in a cycle of pain and inflammation.

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Exploring your symptoms and examining your hip can help to identify this as a potential cause, which can be confirmed using an MRI scan or sometimes and ultrasound scan.

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Once the diagnosis is confirmed then treatment consists of physiotherapy to stretch and strengthen the affected muscles and tendons. This is usually combined with shockwave therapy (using ultrasound pulses to stimulate healing of affected tissues). An ultrasound-guided injection of steroid and local anaesthetic can also help to break the cycle of pain. Treatment for this condition is unfortunately not a speedy process and the exercises you learn will need to become part of your regular exercise routine to reduce the risk of recurrence.

What is a labral tear?

The bony hip socket (acetabulum) is deepened by a tough, fibrous ring of cartilage called the acetabular labrum. This can sometimes become torn which generates pain in the groin. This problem is more common in younger patients but can also occur in the older age group.

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Your history of symptoms and clinical examination findings will raise suspicion of this diagnosis, and it will be confirmed by an MRI scan. To obtain clear pictures of the acetabular labrum the scan usually requires an injection of dye to help the MRI scanner find subtle tears.

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Once a tear has been confirmed on MRI a hip injection is usually suggested. This is used to address inflammation associated with the labral tear. If it causes complete resolution of symptoms then this may be sufficient treatment.

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If symptoms recur and there is minimal evidence of arthritis on your MRI scan then you would likely be referred to a specialist in hip-preservation surgery to discuss treatment options further.

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Older patients with hip arthritis who have MRI scans are often found to have labral tears present. These are often caused by degeneration (wear) rather than acute injury and the hip arthritis is their main problem. In this group of patients research has shown that surgery to treat the labral tear is very rarely successful and can in fact bring forward the need for a hip replacement. Patients having hip replacements for arthritis all have the labrum surgically removed as part of the procedure, which addresses any pain originating from their issue.

Which anaesthetic do I need?

For the operation to be performed you will require an anaesthetic and will discuss which type of anaesthetic is best for you with one of our Consultant anaesthetists. These may include:

‍

‍Spinal anaesthesia: an injection into your back which blocks feeling in the lower part of your body. The pain relief usually lasts for several hours after the surgery has finished, which can make your initial recovery more manageable. This option has been shown to reduce blood loss during surgery.

‍

‍Sedation: if you do not wish to be aware of what is happening while having your surgery under spinal anaesthesia, medication can be administered to make you less aware of your surroundings.

‍

‍General anaesthesia: medication is administered to induce a deep sleep, during which you have no awareness and do not feel pain. Once you are woken from your anaesthetic you will be given strong pain killers to control symptoms of pain.

‍

‍Local anaesthesia: injection of local anaesthetic in the region of your surgery

Getting fit for Surgery

Download the PDF here to learn more about getting fit for surgery.

Total Hip Replacement risks

Download the PDF here to learn more about the Total Hip Replacement Risks.

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Hip procedures

Frequently asked questions

Orthopaedic practise of hip and knee replacements

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