Hip Replacement Surgery (Hip Arthroplasty) Cost and Guide

The main goals of hip replacement surgery

The main aim of a hip replacement is to improve your quality of life by reducing pain and allowing you to remain active. If your hip replacement is successful, your hip should function much better than before, and your mobility should increase. Therefore, this can help you continue to live life to the fullest and take part in the activities you enjoy. You may also find that you rely less heavily on painkillers after surgery. These factors can help improve other areas of your life, such as your mood and quality of sleep.

Of course, this is not an easy decision to make as it involves having major surgery. Therefore, hip surgery is often suitable for patients who have found no benefit from other methods to control their hip pain, such as:

• Painkillers
• Physiotherapy
• Steroid injections

If the above methods have failed, a hip arthroplasty may be a viable option to help manage your hip pain.

Cost of hip joint replacement

Broadly, the price of hip replacement with a private orthopaedic surgeon begins at around £9,000 and can cost as much as £16,000 or more. Prices can change depending on pre-existing health conditions, the surgeon's expertise and which highly rated CQC hospital the procedure takes place

After the consultation with the surgeon, patients will be given a customised price for their surgery.

Factors that may affect the price include the following:

• Costs related to your hospital stay
  • Accommodation
  • Nursing staff
  • Surgery theatre
  • Physiotherapy
  • Imaging costs
  • Medication
  • Pathology
• Aftercare
  • Medication prescribed by your surgeon
  • Mobility aid such as crutches or a cane
  • Post-operative physiotherapy sessions
  • Post-operative scans such as X-rays or MRIs
  • Post-operative appointments with your surgeon

The nature of all orthopaedic surgery is one size does not fit all. During the hip arthroplasty consultation, a treatment plan will be made and tailored to the individual patient.

A hip replacement may be suitable for patients if they have persistent and troubling hip pain which has not responded to medical treatment or physiotherapy. The ideal hip replacement candidates, therefore, include patients who:

• Have a damaged hip due to a condition like arthritis
• Are in constant, severe pain
• Have reduced mobility because of their hip
• Found pain medication and physiotherapy to be unhelpful
• They can no longer carry out their normal daily routine
• Have pain that has negatively impacted their mental health and social life.

If patients are considering having a hip replacement, they should try to optimise their health so that they are fit for surgery. As this is a major operation, it is important to consider fitness and recovery before deciding to have the procedure. To do this, patients should try and ensure that they are:

• At a stable weight with a BMI of less than 30
• Stopping smoking and using nicotine products for at least six weeks before surgery
• Doing regular exercise
• Eating a healthy diet
• Reducing your alcohol intake
• Stopping the use of any recreational drugs.

Who is not suitable for a hip replacement?

A small number of patients are not good hip replacement candidates. Patients who may fall into this category include:

• Those with a current serious illness or infection
• People with severe osteoporosis (brittle bones)
• People who cannot fully understand or follow the pre and post-operative instructions.

These patients may, therefore, wish to consider other options. However, this is not to say that if you fall into one of these categories, you will never be able to have a hip replacement. For example, an infection can be treated, and the surgery is performed once it has been cured. The surgeon will speak to you about your suitability for surgery and what the best type of treatment is for you.

Rheumatoid arthritis

Although rheumatoid arthritis (RA) usually affects the hands, feet, and wrists, it can also affect other parts of the body, including the hips. It is an autoimmune condition, which means that the body’s immune system attacks its own healthy tissue.

It is not fully understood what causes RA, although it has been linked to a combination of genetic and environmental factors. RA in the hips causes inflammation in the hip joints, which leads to pain, stiffness, warmth and swelling. The joint inflammation, in particular, comes from a thin layer called the synovial membrane, which coats many joints in the body, including the hip joints. The membrane contains joint fluid that provides lubrication and cushioning for the joints, helping the bones glide over each other.

The inflammation can lead to the hip joints swelling breaking down cartilage, and as RA advances, it can lead to deformity and destruction of the joints and bones.

For many patients, medication for RA will slow down or prevent further disease progression, but if the damage to the joint is too advanced, then a total hip replacement or a smaller surgery called synovectomy, usually via arthroscopy (removal of the synovial membrane via small incisions) might be performed.

Post-traumatic arthritis

Post-traumatic arthritis is a form of osteoarthritis that occurs after an injury, usually a direct trauma to the joint. For example, if a broken bone or a fracture extends to a joint, this leads to early inflammation.

Although not fully understood, research indicates that post-traumatic arthritis is due to long-acting inflammation in the joint. Approximately 12% of osteoarthritis cases are suspected to be caused by this.

Post-traumatic arthritis can come on years after the injury with the characteristic osteoarthritis symptoms, such as pain, stiffness and tenderness. Patients following an osteoarthritis diagnosis may recall trauma to the area years before.

Treatment for patients depends on the disease progression; for more advanced osteoarthritis and damaged cartilage, an orthopaedic surgeon may recommend a total hip replacement or a hip arthroscopy.

Ankylosing spondylitis

Ankylosing Spondylitis (AK) is an inflammatory disease usually diagnosed in younger patients between 20 and 40 years old but sometimes earlier.

It primarily affects the spine, but commonly, some patients will also have symptoms in large joints such as the hips. If the disease progresses, it can fuse the spine, and AK-associated hip arthritis, known as spondyloarthritis, can damage the bones and cartilage in the joint.

Many patients who suffer from this do not necessarily need hip surgery, but if the damage to the joint is severe, an orthopaedic surgeon may recommend a total hip replacement to restore function and help alleviate pain, stiffness and other symptoms typical of arthritis in the hip.

Hip joint replacement surgery takes between 1 to 2 hours to perform, though it can be longer depending on the condition of the hip and if they have had hip surgery previously. Patients may only need a partial replacement, meaning only one part of the hip joint is replaced (either the socket or the ball of the joint).

This overview explains how a full hip replacement is performed, but the general procedure is identical to a partial replacement.

Types of hip replacement incisions

To perform hip joint replacement surgery, the surgeon will make an incision down the side of your hip. The picture below is of a hip replacement scar one year after surgery.

Incisions vary in size and location according to the technique used. Patients will be told where these incisions will be placed well before surgery after consulting with the surgeon.

Types of artificial hip joints

Artificial joints also called prostheses, are made of several different materials, including metal and ceramic, like those in the picture below.

Potential hip replacement risks and complications

As with any surgery, some risks and complications can occur with a hip replacement. Patients must be aware of these and are able to weigh up these risks with the benefits before they choose to go ahead with the treatment. This page outlines the main hip replacement risks and complications. Patients should read these carefully and take a while to think about them when deciding if this procedure is suitable for them.

Bruising & bleeding

Some bruising is common after surgery. This should resolve over the first couple of weeks. You may also experience some minor bleeding from the incision site. This often occurs right after surgery but may occur a few weeks later. However, please inform your surgeon straight away if you notice significant bruising, pain, or swelling. You may have a haematoma, which is a solid collection of blood under the skin. These often develop within 24 hours of surgery and require medical attention. You may be more at risk if you are male, have high blood pressure, or take certain medications.

Infection

Although every effort is made to reduce the risk of infection, it is still possible for one to develop. An infected artificial joint must be treated quickly and may require surgical removal if it becomes severe. You must, therefore, be aware of the signs of infection. Contact your surgeon right away if you notice any of the following signs:

1. Feeling feverish with a temperature over 38° C.
2. Redness at the incision site is spreading after the first 48 hours.
3. Yellow pus-like or foul-smelling fluid seeping from the incision.
4. Increased pain or discomfort that your pain medication does not resolve.

Scarring

Unfortunately, it is not always possible to avoid scarring where the surgeon has made incisions. The size and location of the scars will vary slightly according to the technique your surgeon uses. Usually, you will have one or two scars around your hip. Make sure you ask your surgeon to explain where your final scars will be. Remember that scars will also fade with time. How much they fade will depend on the healing ability of your skin. Your surgeon can also give you some tips on caring for your wounds and reducing the scarring that you are left with.

Skin discolouration

Sometimes, the skin where the surgeon has operated can change colour slightly after the surgery. This should settle over a few months as the area heals.

Nerve injury

If, during the surgery, the nerves in your hip or pelvis are injured, you may lose some feeling or movement in your leg. This is rare and, in most cases, temporary. However, even more rarely, more long-term loss of sensation or movement can occur. At Medbelle, we only work with highly skilled and qualified surgeons. This means that you will be at less risk of this occurring.

Hip dislocation

The artificial joint can become dislocated. Although uncommon, this may affect the result of the surgery. When it does occur, displacement of the implant tends to happen 6 to 8 weeks after the surgery. It often only happens once. If it happens more than once, surgery may be needed to re-stabilise the joint. To lower the risk of hip dislocation, avoid crossing the legs or fully bending your hip. For example, avoid sitting cross-legged and bending forward when in a seated position.

A difference in leg length

After a joint replacement of any type, there is always the possibility that there may be some mismatch between the natural joint and the prosthetic one. In the case of hip replacement procedures, this appears as slightly different leg lengths after the surgery. However, even if this is a problem, it is correctable with special shoes or an insole that fits inside the existing shoes to even out the legs.

General surgical complications

All surgeries carry some common risks. These include the development of blood clots, nausea and vomiting, and postoperative pain. In addition, as the surgery involves using an anaesthetic agent, it is also possible that you may develop complications relating to the anaesthetic itself.

Patients must follow their surgeon’s specific aftercare instructions to reduce the risk of complications.

Pain relief and physiotherapy are the usual first-line treatments for hip pain and problems with mobility. However, sometimes further treatment is needed. If you have a condition such as osteoarthritis, your doctor will often offer you a steroid injection into the hip to control your discomfort before thinking about hip replacement surgery, although this is not a permanent solution.

It is possible to carry out a partial hip replacement where only the part of the joint where your leg joins the hip is replaced. Your doctor and surgeon will be able to tell you which treatment plan is most suitable for you.

A hip replacement operation is permanent. The artificial hip joint often lasts for between 15 and 20 years. This means that most patients only undergo one hip replacement in their lifetime, with the exception of those patients who suffer from surgical complications such as an infected prosthesis, or those who have their hip replaced at a young age.

These repeat operations are often more complicated and less successful, but in most cases, they still improve hip function and reduce pain. You should follow general health advice to get the best long term results from your operation. This includes maintaining a healthy weight, exercising regularly and staying hydrated.

It is normal for your recovery to take between 3 to 6 months. After this time, you should feel like your usual self again and be able to partake in hobbies and sports as you did before the hip replacement surgery. It is therefore advised that you plan ahead.

Please ensure to discuss any specific sports or hobbies with your surgeon prior to your surgery. If you have a major event coming up such as a wedding, plan your surgery at least 6 months before if possible. Patients heal at different speeds, so it's important to be realistic in your expectations and not push yourself before you're ready.

Your surgeon will give you specific advice on how to wash and bathe after the hip replacement surgery.  In general, you may not shower or bathe as normal for the first two weeks in order to keep the wound dry and to protect you from falling whilst you are still improving your mobility. During this time, its suggested strip washing one area at a time instead.

After this time, you will be able to shower normally (assuming there is step-free access), but will not be able to sit in a bath for around 8 weeks. You must follow your surgeon’s specific aftercare advice to ensure the best results possible.

Smoking, drinking excessively and taking recreational drugs can increase your risk of a number of surgical complications. This is why we advise you to cut back on alcohol, refrain from taking drugs and stop smoking well in advance of the operation. Most surgeons ask that you are smoke and nicotine-free for at least 6 weeks before and after hip replacement surgery.

All of the information found on our website is sourced from highly reputable experts, government-approved authorities and is widely used by healthcare professionals.

• https://www.nhs.uk/conditions/hip-replacement/ NHS
• https://www.rcseng.ac.uk/ Royal College of Surgeons England
• https://britishhipsociety.com/ British Hip Society
• Uptodate.com Up to Date
• https://www.nhs.uk/conditions/ankylosing-spondylitis/ NHS
• https://orthoinfo.aaos.org/en/diseases--conditions/arthritis-an-overview/ Ortho Info
• https://pubmed.ncbi.nlm.nih.gov/17106388/ Public Medical
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3228584/ National Center for Biotechnology Information
• https://orthoinfo.aaos.org/en/diseases--conditions/arthritis-an-overview/ Ortho Info
• https://orthoinfo.aaos.org/en/diseases--conditions/inflammatory-arthritis-of-the-hip Ortho Info

Our content is written by our Medical Quality Managers and Patient Care Advisers, all of who have medical backgrounds and training. Before publishing, all the information is reviewed by a surgeon specialised within the relevant field.