You have been identified as a patient on a waiting list for a total hip replacement. Here you will find all the information you need to prepare for your surgery and get the most out of your new hip.
The information in this document has been provided by Versus Arthritis — the UK's largest charity dedicated to supporting people with arthritis. Please take some time to read all the information in Section 1 and familiarise yourself with the exercises in Section 2. You should aim to complete these exercises 2–3 times per week until your surgery.
Once you are confident with these exercises, you should also aim to complete at least one of the videos from Section 3: Let's Move for Surgery each week.
What to do now
- Your operation, your appointment or your admission
- NHS — my secretary, Evy Sennett: 01924 543584
- Private — Spire Methley Park Hospital switchboard: 01977 518518
- Your exercises or prehab programme
- Your physiotherapy team NHS patients can message them through PKB, the patient portal, or call the NHS hospital switchboard on 01977 747391.
- Anything else, or if you cannot get through
- enquiries@bagouri.uk Please include your name and a telephone number, and we will get back to you. Email is not checked out of hours, and it is not a secure way to send personal or medical details — so please ask us to call you rather than describing a problem in writing.
- If it is urgent, or you feel unwell
- NHS 111 — in an emergency, 999 Please do not wait for a reply by email.
Section 1: Background information
Staying active is important if you're waiting for or recovering from surgery. If you're fit and strong, your surgery has the best chance of success, and you'll likely recover quicker.
Over time, exercise can also increase your mobility, help your balance and boost your mood. We know it can be difficult to take the first step. You might be nervous or not know what exercises to try when you're waiting for surgery. That's why Versus Arthritis created Let's Move for Surgery.
Here you'll find tailor-made, follow-along exercise routines for your upcoming hip replacement, as well as full-body workouts to help you maintain overall fitness. You can also explore personal stories and advice from those living with arthritis who have been through joint replacement surgery, and tips on keeping active from a physiotherapist.
Why movement is so important before surgery
In this video you will learn more about the mental and physical benefits of keeping active while you wait for surgery. Keir, Sue, Lin and Leony, who all live with arthritis, describe their experiences and the impact that keeping moving had on their lives and their joint replacement surgeries.
Why movement is so important before surgery — youtu.be/gHNuMVmZdC4
Section 2: Hip replacement exercises
These exercises are helpful for problems and pain affecting the hips.
Before you get started
- Remember to stay hydrated while you're exercising.
- Make sure you have plenty of space around you to avoid injury.
- It's a good idea to start slowly and build up gradually if you're new to exercise.
- If you have any concerns about these exercises, please message our friendly Physiotherapy team.
Hip replacement exercises — youtu.be/H5K55p01AwM
Section 3: Let's Move for Surgery
You should aim to pick at least one of these videos to complete weekly, in addition to your total hip replacement exercises. However, these exercises have been designed to be done daily and to fit around your usual routine.
Stretching and strengthening for before and after hip replacement
In this 15-minute follow-along exercise video, physiotherapist Milly Abdullah is joined by Lin, who lives with arthritis and has undergone a hip replacement. Together they demonstrate the recommended stretching and strengthening exercises for before and after hip replacement surgery.
15-minute hip routine — youtu.be/7JSAghMHhO0
Full-body strengthening around the home
In this 10-minute follow-along routine, Keith joins Milly to demonstrate strengthening exercises. These focus on strengthening the whole body, including the quads, glutes and shoulders. Milly and Keith highlight different versions of the exercises so you can make them work for you.
10-minute full-body routine — youtu.be/Y8yRD24bhb4
Cardio workout for before and after surgery
This movement video is for those with arthritis who are undergoing different types of surgery, such as joint replacement.
Cardio workout — youtu.be/G9jwOQi8OuY
Section 4: How to keep active while waiting for surgery
Physiotherapist Milly provides advice on some of the best ways to keep active ahead of surgery, including: how to get started, how to make exercise work for you, how to form an exercise habit, and the importance of listening to your body and your healthcare professionals. Sue, Leony and Keir also share what worked for them as they prepared for surgery.
Keeping active before surgery — youtu.be/61kXUWlfLO4
Section 5: Why it is important to keep your joints moving before surgery
This animation illustrates the benefits of exercising and what happens to our joints when we exercise.
Why joints need to keep moving — youtu.be/J8RhxS_QydA
Section 6: Risks of the procedure and approach
In clinic we discussed the benefits and the drawbacks of this operation, and the approach we plan to use. We also discussed the risks. No operation is without risk, and the list below is not exhaustive — but these are the ones we talk through with every patient.
Risks that come with any major operation
- Infection. This can be serious. Rarely it can threaten your life or your limb, and it may need further surgery to treat — which can include removing the new hip.
- Bleeding.
- Injury to a nerve or a blood vessel.
- Risks related to the anaesthetic.
- Blood clots in the leg (DVT) or the lung (PE).
- A heart attack or a stroke.
- Your scar may feel numb, or become very sensitive to touch.
Risks specific to hip replacement
- Pain or stiffness that lasts longer than expected.
- Fracture — a break in the bone around the new hip.
- Dislocation — the new hip coming out of joint.
- A limp.
- A difference in the length of your legs.
- Loosening of the new joint from the bone over the years.
The added risk of the direct anterior approach
We also discussed the direct anterior approach itself. It is a muscle-sparing way of reaching the hip, and it is expected to give you a better early recovery — Section 7 explains why. It carries one added risk worth knowing about:
- Injury to the lateral femoral cutaneous nerve. This is a small nerve that gives feeling to the front and outer side of the thigh. If it is injured you may get numbness there, and sometimes pain.
What you have been given. A consent form, to take away, read and think about before you sign it; an information booklet; and a telephone number to call if you have questions.
If anything here is unclear, or you change your mind about any part of it, please get in touch before the day of your operation.
Section 7: More information about the direct anterior approach
Total hip replacement is one of the best orthopaedic operations. It relieves the disabling pain of hip arthritis and allows patients to return to their activities and enjoy their hobbies.
Surgeons use different techniques to reach the hip: mainly the posterior approach (the most common in the UK, which involves releasing muscles from the back of the hip), the lateral approach (releasing muscles from the side of the hip), and the direct anterior approach.
The direct anterior approach has gained increasing popularity recently. It is the only muscle-sparing approach among the three — that means the surgeon avoids cutting major muscles, as there are fewer muscles in the front of the hip and the surgeon works between them rather than cutting through muscle fibres or detaching muscles from bone and then having to make repairs at the end of the surgery. That leads to less pain after the operation, with patients requiring fewer pain medications and having better recovery.
Recent evidence has shown that anterior approach hip replacement patients need less time in hospital and stop using walking aids (such as sticks and walkers) 5–7 days sooner than patients who underwent traditional hip surgery.1
The direct anterior approach may not be suitable for everyone. It may not be appropriate for patients who are obese or very muscular, because the additional soft tissue can make it difficult for the surgeon to access the hip joint.
Like all hip replacements, direct anterior approach hip replacement carries the risk of complications, which can be divided into risks that can occur with any major surgery, and risks associated with hip replacement surgery.
The risks associated with any surgery include, but are not limited to: infection; bleeding; a scar that can be hypersensitive or associated with numbness around it; the risk of anaesthetic; blood clots in the leg, lung, heart or brain (for example DVT, PE, stroke); and the risk of nerve or vessel injury. With the anterior approach, the main nerve at risk is the lateral femoral cutaneous nerve, which supplies sensation to the front and side of the thigh. If injured it usually results in numbness that may recover with time; however, in rare cases it may cause pain, in what is called meralgia paraesthetica.2
The other group of risks that may occur with hip replacement surgery include leg length difference, fracture, dislocation and loosening. These risks can happen with any hip replacement surgery regardless of the approach chosen. A more detailed discussion of these risks and how they can affect you can be provided by your surgeon.
References
- Taunton MJ, Mason JB, Odum SM, Springer BD. Direct Anterior Total Hip Arthroplasty Yields More Rapid Voluntary Cessation of All Walking Aids: A Prospective, Randomized Clinical Trial. J Arthroplasty. 2014;29(9 Suppl):169–72. doi:10.1016/j.arth.2014.03.051
- Post ZD, Orozco F, Diaz-Ledezma C, Hozack WJ, Ong A. Direct anterior approach for total hip arthroplasty: indications, technique, and results. J Am Acad Orthop Surg. 2014;22(9):595–603.
- Kennon RE, Keggi JM, et al. Total hip arthroplasty through a minimally invasive anterior surgical approach. J Bone Joint Surg Am. 2003;85-A(Suppl 4):39–48.