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The hip is a unique joint in the body. Sometimes it is known as the acetabulofemoral joint. It bears our weight as well as giving a wide-range of movement. It is very strong and very flexible. It is situated at the top of the femur (thighbone), where it fits into a round socket in the pelvis. This is commonly known as a ball-and socket construction.
The hip joint allows us to move our legs: backwards and forwards; out to the side and back towards the other leg; rotate the legs – pointing the toes inwards or outwards and straightening the leg in the direction of the toes.
There are five basic parts to a hip joint and a problem in any of these parts can cause pain and/or incorrect functioning of the hip. These are hip bones – the femur and pelvic bones among others; hip articular cartilage – this ensures that the bones glide smoothly and lessens the friction when they move; hip muscles – these support the hip joint; hip ligaments and tendons – these are tough and fibrosis and connect the bones to each other and to the muscles; synovial membrane and fluid – this covers the hip joint and lubricates it.
Hip replacement surgery (also known as hip arthroplasty) normally takes place when there is excessive pain from the hip joint or its movement is severely restricted. Most often a total hip replacement (or full hip replacement) is performed, which, as the name suggests, involves replacing part of the two major bones (femur and pelvic bones) with a prosthesis. Although a hip joint replacement is classed as major surgery, the operation itself is fairly well established and has been around for a while.
When was the first hip replacement? The first metallic hip replacement was performed by Dr Austin Moore in 1940. It took place in South Carolina USA. However, the pioneer of the modern-day hip replacement was Sir John Charnley, a British surgeon. He used ultra-high-molecular-weight- polyethylene (UHMWPE) on the components which gave a smooth gliding motion with little friction.
Nowadays hip replacement surgery is common. In the UK, there are approximately 80,000 hip replacement operations annually, and in the USA about 450,000.
Hip replacement surgery is common and well established.
Essentially a hip replacement is required when the hip joint is damaged in some way. There are five reasons why a hip replacement may be required . These are:
For the majority of patients osteoarthritis hip replacement is the most usual procedure. It is important to bear in mind, however, that pain in the hip joint is not always caused by osteoarthritis. It may also be due to tendonitis or bursitis. Tendonitis, an injury to a tendon, can be treated with painkillers and, sometimes, physiotherapy, while bursitis, which is inflammation of a bursa – a sac that contains a small amount of fluid to cushion the joint, is treated in the same way, sometimes with the addition of steroid injections when needed. In normal circumstances, neither of these conditions require surgery.
Pain from arthritis in the hip is usually felt in the groin or thigh, sometimes even travelling down to the knee. It may become more difficult to move the hip joint as the swelling increases.
Doctors will always endeavour to find a non-invasive solution before they resort to surgery. Anti-inflammatory drugs, physiotherapy and steroid injections can all help to delay surgery, sometimes for years. Only when these interventions fail to work will surgeons consider that there are good enough reasons for hip replacement. Sometimes the ‘Oxford Hip Score’ is used to determine the threshold for hip replacement, a bit like a ‘do I need a hip replacement quiz’.
What are the signs of needing a hip replacement? The following are possible symptoms of needing hip replacement, however they may also be symptoms of other conditions.
Other Treatments – If your hip joint issues are not actively affecting your life and/or you can find relief using medication, physiotherapy or hip resurfacing then probably you are not ready for a hip replacement. ‘Painspot’ also has a useful tool available which will help to identify what the pain is (see end of the article for website address). Ultimately, the only surefire way of establishing what’s causing the pain and therefore answering the question – do I need a hip replacement? – is to have an x-ray.
X-Ray will defenitely answer the question “Do I need a hip replacement?”
In order to help with an osteoarthritis diagnosis an x-ray (actually usually two x-rays) will be taken of the hip joint. This hip replacement x-ray will usually show up quite clearly when the arthritis is advanced but, if it’s still in its early stages, further tests may be required.
An x-ray gives a ‘picture’ of the inside of a body. It is very useful when doctors are assessing bones and allows them to diagnose a range of different conditions including arthritis. X-rays are a form of radiation which pass through the body and, because bones are denser than tissue and therefore allow less radiation through, they appear as white areas on an x-ray.
Normally, a total hip replacement x-ray consists of two x-rays. The first one will be a front view of the hip, although often the doctor will request a view of both hips in order to assess the differences between them. The second x-ray will be a side view of the affected hip.
Once a physician has seen these hip replacement x-rays, discussed with the patient the other symptoms for hip replacement and investigated what alternative methods (medication, physiotherapy, injections) have been tried so far, he/she may, at this point, suggest that the best course of action would be hip replacement surgery.
Apart from arthritis other reasons for a hip replacement operation can be a fracture to the hip, usually caused by injury or an accident or, in children, hip dysplasia. Hip dysplasia is a condition that some children are born with, which means that the hip bones do not form properly or form incorrectly. There are various treatments for it, but, in exceptional circumstances, it can lead to hip replacement surgery in later life.
Perthes disease is also a childhood condition, most often seen in boys aged between four years and eight years old. It involves a temporary loss of blood supply to the hip which means that effectively the joint dies. The bone does heal when the blood supply returns, however this can lead to hip problems later in life. So, a Perthes disease hip replacement is also a possibility.
There is no upper or lower age limit for this type of surgery. The average hip replacement age in the UK is between 65 and 84 years. Of the 81,130 hip procedures carried out in 2018/2019 in the NHS sector, 59.4% were carried out on women and 40.5% on men. The majority of patients were 50 years old or older (93.8%). Patients aged 50-69 accounted for 41.9% compared to 51.9% for those over 70 years old.
Full statistics from the NHS for the year 2018/2019 are shown above. These show the age for hip replacements performed per 100,000 people. As can be seen, for both men and women, the most hip replacement operations were carried out in the 75-79 year age bracket.
The chart also shows that operations have been performed in almost every age group.
Surgeons are less keen on performing hip replacements on younger patients for the simple reason that the expected lifespan of a hip prosthesis is 15+ years (sometimes even up to 25 years). For younger patients this will almost certainly mean that a second hip replacement (revision hip replacement) will be required during their lifetime. Generally revision hip replacements are less effective than the original surgery.
When it comes to a hip replacement in the elderly, there is no upper age limit. However, the surgeon must be satisfied that the overall general health of the patient is such that they will be able to recover from major surgery and be able to participate in the necessary physiotherapy after the operation.
There is no maximum BMI for hip replacement, however being overweight will increase the chances of medical complications, post-surgical infections and wound healing complications. Often obesity (BMI 30+) brings with it other medical conditions (e.g. diabetes etc), so the surgeon needs to be satisfied that the BMI for hip replacement will not jeopardise the success of the surgery. As with any surgery, overweight patients will be encouraged to lose some weight both before and after the hip replacement operation, but a BMI limit for hip replacement does not exist.
What are the benefits and risks of hip replacement surgery? As one of the UK’s most successful medical procedures, there are a number of hip replacement benefits. Probably, the most significant is the dramatic reduction in pain, which allows the patient to walk and move again without the associated agonising discomfort. A hip replacement operation will usually reduce the pain dramatically and sometimes even get rid of it completely. It also means that patients may be able to return to the activities and hobbies that they used to enjoy; things like swimming, cycling and playing golf. This can, of course, also improve the mental state.
The benefits of having a hip replacement include:
Aside from the usual risks associated with surgery, there are few disadvantages for hip replacement surgery. The first thing is that an artificial hip is not quite as good as a natural hip – extreme positions, like crouching, may still be difficult. Secondly, there may be a perceived or, indeed, actual difference in leg lengths after surgery.
There are various definitions of the term – ‘major surgery’. Usually, it implies that there is: some significant removal from the body, damage to tissues, a high risk of infection and an extended recovery period. So, to answer the question – Is a hip replacement major surgery? – the answer must be – yes, although one of the less riskier major surgeries.
Hip replacement success rate is 80-85%
There are two types of hip replacement surgery: Total (or full) hip replacements and Partial hip replacements.
The majority of operations (particularly those for osteoarthritis) are total hip replacements. Partial hip replacements are usually reserved for when the the hip has been fractured.
A total hip replacement consists of two parts. The first part – the femoral component – looks like a ball on a ‘door handle’. The end of the ‘handle’ is inserted into the femur or thigh bone. The second part – the acetabular component – looks like a bowl and this replaces the socket in the pelvis.
Hip replacement materials come in different combinations of metal, ceramic or plastic. The surgeon is the person who can recommend the best type of hip replacement materials for each individual. The ‘handle’ is always made of metal – titanium alloy, stainless steel and special high-strength alloys among others. As for the other parts, nowadays the most common combination is a metal ball with a plastic socket (metal-on-plastic).
Other combinations include: a ceramic ball with a plastic socket (ceramic-on-plastic) or a ceramic ball with a ceramic socket (ceramic-on-ceramic). These combinations are more often used on younger, more active patients. In the past, some patients have also been fitted with metal-on-metal hip replacements, however these are rarely used these days as they tend to wear out more quickly.
There is also a variety of different types of hip replacement procedures. Sometimes a surgeon will decide that the procedure can be done using a spinal/epidural anaesthetic where just the lower half of the body is numbed, in other cases a full anaesthetic is necessary.
The traditional method of performing hip replacement is to create a 10”-12” incision in the hip area. Sometimes it is possible to use minimally invasive hip replacement. This involves one or two much smaller incisions and can mean a quicker recovery time.
There are many different of types of hip replacement and every patient should discuss with the surgeon the best hip replacement for them.
Let’s consider some of the other types of hip replacements.
Bilateral hip replacement, also known as double hip replacement, is when both hip joints are replaced. It is possible to have a two-stage bilateral hip replacement, which just means that the patient has two separate operations, one on each hip joint, with a suitable length of time between each procedure. More often, when people talk about bilateral hip replacement, they mean simultaneous bilateral hip replacement i.e. where both hips are replaced during one operation.
The advantages of simultaneous bilateral total hip replacement include the fact that the patient is only operated on once, has only one anaesthetic and one stay in hospital. Overall recovery time is less than it would have been for two separate procedures. On the downside, however, the surgery risks are higher. Blood loss is greater and the surgery, and therefore the anaesthesia is longer – typically two to four hours, whereas a single hip replacement usually takes one to two hours.
Usually, simultaneous bilateral hip replacement is only offered to younger and more active patients, who can participate in the much more rigorous physiotherapy required after the surgery. Simultaneous bilateral hip replacement recovery time takes longer than with a single total hip replacement but shorter than the total recovery time for two procedures with a two-stage bilateral hip replacement.
A cemented hip replacement uses a special fast-drying cement to affix the prosthesis to the bone. This ‘cement’ is usually an acrylic polymer called polymethylmethacrylate (PMMA). A layer of this is placed between the patient’s natural bone and the prosthetic joint component and it dries within ten minutes, so that both the surgeon and patient can be sure that the prosthesis is firmly in place.
This special cement also allows a good bond with bones that may be slightly porous from osteoarthritis. Often, the surgeon will add a small amount of antibiotic material to the cement which can help to decrease the risk of subsequent infection.
The disadvantages of cemented total hip replacement is that the cement may break down so that the artificial hip comes loose, debris from the cement may irritate tissue and cause inflammation. Although rare, there is a very small chance that the cement can, by entering the bloodstream, find its way to the lungs, which is life-threatening.
Generally, however, the bond between cement and bone is very durable and reliable. Cemented total hip replacement is commonly used for patients over 60, those with rheumatoid arthritis and younger patients in less good health or with poor bone quality. These patients will likely put less stress on the cement bond.
An uncemented total hip replacement, also known as a cementless or non-cemented hip replacement, is where the natural bone grows into the prothesis and thus holds it in place. These new implant designs were introduced in the 1980s and are usually larger and longer than those used with cement. The artificial hip replacement, or press-fit prosthesis has a rough surface or porous coating, so natural bone growth will span the 1-2mm space between the prosthesis and the bone. It is a more difficult procedure for the surgeon who must ensure that the ‘fit’ between the bone and the prosthesis is very precise. In some cases, pegs or screws hold the prosthesis in place until the bone grows.
Advantages of uncemented total hip replacement are that it offers, long-term, an improved bond between the artificial hip and the bone and, of course, that there is no need to worry about a possible deterioration in the cement.
On the other hand, the patient must have healthy bones and osteoporosis often causes low bone density which means that a non-cemented hip replacement is not an option. It can also take up to three months for the bone to grow and connect with the prosthesis and experts are divided as to whether patients should wait these three months (sometimes only six weeks) before putting their full weight on the new hip joint. The fear is that the hip will become dislocated because it is not yet strongly affixed to the bone. A 2017 study showed that non-cemented hip replacement recovery can include immediate full weight bearing and that it did not have any effect on the incidence of postoperative complications. However, some surgeons remain skeptical, added to which no two hip replacement surgeries are identical, so it is best to adhere to the advice given by the surgeon in each individual case.
Uncemented total hip replacement is most often recommended for patients under 50 years of age, those who are more active and/or those with good bone quality.
Ultimately, the decision on whether to use a cemented versus uncemented hip replacement must lie with the surgeon who will know the full details of an individual procedure. Here, though, is a table showing the difference between cemented and uncemented hip replacement.
State of bone
Can be used even when bone is porous due to osteoarthritis
Can only be used where the bone is dense
Bond between bone and prosthesis
Cement may start to breakdown so revision surgery may be necessary earlier than expected
Bond is strong but may take up to 12 weeks to become secure
Usual expected recovery time up to 12 weeks
Recovery time may be delayed if patient is not allowed to put full weight on the hip until some time later
As the name suggests a hybrid total hip replacement is a combination of a cemented and cementless artificial hip joint. Usually the femoral component is cemented to the femur while the acetabular socket is inserted without cement. This technique started being used in the 1980s, so the long-term effects of this type of total hip replacement have only fairly recently been researched. Most medical studies show hybrid hip replacements in a favourable light.
Generally a surgeon can perform hip replacement surgery from the back (posterior hip replacement), side (lateral hip replacement) or front (anterior hip replacement) of the hip. In both the USA and the UK the most common form of surgery is the posterior hip replacement.
In the posterior approach a 4”-6” cut is made below the buttocks, so the anterior hip replacement scar tends to be smaller. The gluteus maximus muscle is divided into two and tendons are cut so that the surgeon can get easily to the hip joint. It gives the surgeon the best view of the hip joint.
The anterior approach hip replacement is also known as the direct anterior approach (DAA). The total hip replacement surgery anterior approach involves accessing the hip from the front, with (sometimes) a slightly smaller incision in the upper thigh. The muscles are not detached from the femur as they are in the posterior approach. The surgeon accesses the hip joint by creating a gap between the muscles. There is a higher risk of injuring the lateral femoral cutaneous nerve in the thigh. The surgery usually takes longer than the posterior approach.
Short-term, the anterior hip replacement procedure is less painful than the other procedures and usually means a quicker return to mobility and strength. The long-term outcomes are very good and similar to the other approaches. It is, however, technically much more difficult for the surgeon and, in the UK, the posterior hip replacement approach still dominates. Often the decision on anterior vs posterior hip replacement must lie with the surgeon performing the operation.
Let’s just summarise the difference between anterior and posterior hip replacement.
Typical length of surgery is 2-3 hours
Typical length of surgery is 1-2 hours
Less interference with muscles leads to a quicker recovery time
Interference with the muscle and re-attachment of tendons takes some time to heal
A technically challenging procedure for surgeons which requires a special surgical table
Gives an excellent view of the whole area of the hip joint
There is a small risk of injury to the lateral femoral cutaneous nerve
No risk to the lateral femoral cutaneous nerve and only a small risk to the sciatic nerve
May not be suitable for all patients
Suitable for almost all patients
This procedure is recognised in the US and Europe as having some very clear benefits over other approaches
The UK lags behind the US and Europe - many surgeons still use the posterior approach
There are about 71,000 UK patients who have had metal-on-metal hip replacement or have had metal on metal resurfacing. For the majority of these people, the hip functions well with a low risk of complication. In a metal on metal hip replacement both the ball and the socket are constructed from metal made of a chromium and cobalt alloy. It was believed that these metal-on-metal hip replacements would last longer, due to the metal’s durability. As the ball on these types of prostheses are larger, they also create a more stable hip joint and there is less likelihood of dislocation. In addition these metal hip replacements were not associated with the debris wear of hip replacements made of polyethylene/plastic.
However, recently there have been concerns raised about their use, particularly in the UK and Australia. Their durability is not as good as other hip replacements (plastic-on-metal, ceramic-on metal etc). In the same way that polyethylene can give off small particles of debris as it wears down, metal surfaces can do exactly the same and enter the space around the implant. People react differently to these metal particles, but they can cause inflammation and discomfort around the implant in some people. This is known as hip replacement metal toxicity or metallosis. If not treated, this may cause damage and deterioration in the bone and tissue surrounding the joint and a subsequent loosening of the implant may necessitate further surgery.
In addition, metal hip replacement side effects include the expression of metal ions into the bloodstream. No link has been found between ions from metal-on-metal hip replacements and illness, however there has been a very small number of cases where high levels of ions in the blood have been associated with problems elsewhere in the body.
For all the above reasons, metal on metal hip replacements are only used, nowadays, in exceptional circumstances.
A hemiarthroplasty is a partial hip replacement (‘hemi’ means half in Greek). Although a hemiarthroplasty can be used in cases of osteoporosis, it is most often used where a patient has a fractured hip. Only the top of the femur is replaced, while the acetabulum – the ‘socket’ of the hip joint – remains in tact.
There are two types of prostheses that can be used in this procedure. A unipolar prosthesis consists of a ‘handle’ or femoral stem which is attached to a large unipolar head which sits inside the patient’s hip socket. A bipolar prosthesis is very similar except that it has an additional head which fits into the bipolar head which, in turn, fits into the patient’s hip socket. Thus the bipolar prosthesis has an additional artificial joint between the two components of the prosthesis.
Total hip replacement vs hemiarthroplasty is usually not the patient’s choice. A hemiarthroplasty is dependent on the acetabulum (socket part of the hip) being strong. This may be the case with hip fractures, but rarely occurs when the patient is suffering from osteoarthritis. The advantages of a hemiarthroplasty are that the procedure takes less time, results in less blood loss and reduces the chances of a subsequent hip dislocation. Even taking this into account, a total hip replacement is probably better for younger and/or more active people. There will be less pain, better long-term function and greater walking ability than with a hemiarthroplasty.
The hip replacement operation has become a routine and fairly simple procedure. At some stage prior to the hip replacement procedure patients will go through a pre-operative assessment. This will include an assessment of things like blood pressure, pulse, weight, height and lung function as well as, possibly, an ECG (electrocardiogram), which measures heart activity, and/or x-ray. All of these tests are designed to check that the patient is healthy enough to undergo the procedure.
Before the operation the patient will be given either a general anaesthetic or a spinal anaesthetic which numbs the lower half of the body. Sometimes, the surgeons will give an epidural for hip replacement which has a very similar effect to the spinal anaesthetic. With either an epidural or a spinal anaesthetic the patient will often also be given a sedative, which will make them drowsy and mean they do not have to lie awake and listen to the operation.
The hip replacement operation has become a routine and fairly simple procedure.
What Happens During Hip Replacement Surgery? Once the patient is anaesthetised, the existing hip joint is completely removed. The top of the femur is cut off and the bone is hollowed out. The acetabular component (socket) is positioned in the pelvis, while the femoral component is placed into the hollow in the femur.
How long is hip replacement surgery? Hip replacement opration time usually 1-2 hours, but the patient may spend another couple of hours in the recovery room where they will be monitored and the need for medication assessed. After this the patient will be taken to a ward.
How Long in Hospital After Hip Replacement? Ten years ago the average hip replacement hospital stay length was a week. Nowadays the length of hospital stay for hip replacement is usually 3-5 days, however each patient will be assessed before medical staff decide to end their hip replacement hospital stay.
The day after the operation the physiotherapist will help the patient to get back on their feet and show them exercises to strengthen the muscles. Initially the patient will leave the hospital using crutches. These may be necessary for four to six weeks.
How Long Does a Hip Replacement Last? A modern hip replacement joint is designed to last 15+ years. However, according to The Lancet – ‘patients and surgeons can expect a hip replacement to last 25 years in around 58% of patients.’ As with any artificial joint, its lifespan depends on how active the patient is and the pressures that are put on the hip. People in their 50s and younger would normally expect to have revision surgery (a second replacement joint) in their lifetime.
Hip replacement aftercare is very important. Immediately after the surgery, the patient may wake up with a pillow between their legs, so the legs are kept spread, slightly apart. This is designed to stabilise the hips and it is a good idea to use this pillow when sleeping or resting in bed over the days following the hip replacement. Medical staff will administer pain relief and the feeling in the legs should return.
Post op hip replacement the patient is often asked to do some exercises in bed – ankle pumps (bending and flexing the ankles) and contracting and relaxing the thigh and buttock muscles. These exercises, performed for a few minutes each hour, will help with blood flow. Medical staff may also propose that the patient takes a few steps with help. Those people who get up and bear some weight on their new hips (with assistance) soon after the hip replacement operation, tend to recover more quickly than those people who do not do this. More general hip replacement aftercare information can be found in our ‘hip replacement recovery’ section.
All patients are advised to start walking as soon as possible after the hip replacement surgery. The physiotherapist will advise what is the best walking aid to be used depending on how much weight the hip can bear. Walking after hip replacement surgery is a great activity and will help to recover hip movement, but the patient should progress slowly in order to avoid increasing the pain and swelling. e.g. if it is relatively comfortable to walk for five minutes, then try walking for six minutes the next day.
How much walking should you do after hip replacement? The target is to walk for 20-30 minutes, two or three times a day. In addition, it is better not to sit for long periods, so aim for a walk around the house every 1-2 hours.
At home the patient can start to reduce their reliance on aids (e.g. from two crutches to one crutch). It is very important, however, that the patient does not develop a limp. It is better to use a walking aid and walk straight and upright, than use no aids and limp. Most patients will be using crutches or other walking aid for up to four to six weeks after the operation. After this a patient can usually walk unaided after a hip replacement, although sometimes a walking stick may be needed when walking outside of the home.
How long does it take to walk normally after a hip replacement? One of the biggest challenges is the elimination of the limp. Before the hip replacement surgery, many patients will have had a limp or altered gait pattern. With a new artificial hip joint, the muscles and tissues must once again ‘learn’ how to work together to provide the proper flexibility and motion in order to achieve a smooth stride.
Compression stockings after hip replacement are used to prevent deep vein thrombosis (DVT). This is a condition where the blood forms clots and, if these clots reach the heart or lungs, it is life-threatening. The NHS recommends compression stockings to be worn when the patient has: surgery on the lower half of the body (knee, abdomen, hip, legs), an anaesthetic lasting more than 90 minutes, less mobility after an operation. A hip replacement operation ticks all three of these situations.
DVT can also be avoided by drinking plenty of fluids. In addition, patient are sometimes given anti-coagulation medicine in the form of tablets or injections. Usually, medical staff will recommend wearing calf-high compression stockings from between four to six weeks. These should be worn all the time 24/7, including throughout the night.
How to put on compression stockings after hip replacement? Compression stockings, by their very nature, are quite difficult to put on, and this is made doubly difficult when a patient has limited flexibility post hip replacement surgery. Below is a very good YouTube which demonstrates how to put on the stockings using a ‘sock-aid’. These can be bought online for around £5.
The ideal sleeping position post hip replacement surgery is on your back with a pillow between your legs. The ankles and legs must not be crossed. It is also possible to lie on the side which has not been operated on. In this case, you will need two pillows to separate the legs from top to bottom. It is essential to avoid bending the legs in this position. Sleeping on the side where the operation has taken place is not recommended for at least six weeks or until it feels comfortable. Here are some tips for sleeping:
Some of the most frequent questions about sleeping are:
Hip replacement aftercare is as important as the surgery.
How long does it take to recover from a hip replacement? Recovery times are very much individual to each person and are dependent on age, general health, ability/willingness to perform post-op exercises, and the small possibility of complications. Hip replacement recovery takes consistent work and patience. Generally, most patients should be able to go back to their ‘normal’ life by 12 weeks after the operation. A 100% recovery from any major surgery, however, will take a little longer than this.
Whichever type of total hip replacement is performed there is likely to be some damage to the muscles, even with the anterior approach the muscles tend to be extensively stretched due to the small incisions. A 2015 medical paper on muscular strength after a total hip replacement showed that at 3 months after surgery patients still had less strength in their leg of the operated hip than in the leg of the non-operated hip. Hip replacement muscle recovery may take up to two years, so it is important that patients continue to exercise during this time.
Healing both internally and externally can take 12-24 months. As people age, the body’s healing process takes longer, so, for example, the hip replacement recovery period for an 80 year old is likely to be longer than for a 60 year old (bearing in mind other factors like general health etc.).
Most patients should be able to go back to their ‘normal’ life by 12 weeks after the operation.
So, let’s look in more detail at a specific expected timeline for recovery time for hip replacement. Remember that for some people recovery may take longer and for others a shorter length of time.
The day of surgery: Post surgery medical staff will administer pain relief and they will put compression stockings the patient. Depending on the time of day of the surgery, the patient will be encouraged to sit up and, possibly, even take a few steps with a walker and with the help of a physiotherapist.
Following few days: Most patients will stay in hospital between three and five days. During this time the physiotherapist/occupational therapist will work closely with the patient. Before the patient is discharged from hospital they should be able to:
In some cases, patients will be shown how to modify the ways they do some tasks so that it is easier and less painful. They will also be given exercises to do at home.
After release from hospital: The patient will probably still need some help in doing every day tasks and continue to be dependent on a walker or crutches. It is important to continue with the exercises as this will speed up the recovery process. The following equipment may also be helpful:
Once at home the patient will be able to become less reliant on a walking aid, although this should be taken slowly, so as to avoid excess stress and not damage the hip prosthesis. It is also important to follow the doctor’s instructions for proper care of the incision, to ensure that it does not become infected. After ten to fourteen days the stitches or staples will be removed and, after this it will be possible to have a bath.
After about 2 weeks, the patient should be feeling stronger but still get tired quite easily. It may be necessary to take a mild pain killer from time to time. It may also be possible to walk with just one crutch or stick. The patient should be walking at least 2-3 times a day and gradually building up the distance. Let’s now consider hip replacement recovery week by week after this time.
3 Weeks After Hip Replacement Surgery: When it comes to hip replacement surgery-recovery time, the surgery incision should be healing nicely by now, although the internal ‘wounds’ will take longer. It is important to massage moisturising cream into the incision scar as this will help to keep the skin supple and the massaging action will promote the growth of new tissue.
It is crucial to continue with the exercises and also to increase, gradually, the distance walked. For most people there will now be very little pain, although this will vary from patient to patient. Everyday tasks should be becoming easier now.
6 weeks After Hip Replacement: Those people who have a sedentary job can usually, return to work after six weeks. Those, whose job is more physically demanding, will need to remain off work for several more weeks. It is worth exploring if, in the meantime, there are some lighter duties that could be done at your place of work.
6 weeks after hip replacement there should not be any difficulties with activities like walking, cycling and swimming. Many people will be able to walk totally unaided. Driving (a light vehicle) is also usually allowed at this stage, as is flying – short haul flights only. The risk of developing deep vein thrombosis is now decreasing. It is important to continue with the exercises – the physiotherapist may even be increasing the amount of exercises to be done each day.
8 Weeks After Hip Replacement: By 8 weeks after hip replacement surgery, many patients have regained a lot of the strength and endurance which they lost in the surgery and are beginning to participate in normal activities without restriction.
12 Weeks After Hip Replacement: By 12 weeks after hip replacement surgery the initial recovery period should be ending and at this stage most patients can now resume all their normal daily activities. Weakness in the muscles around the hip can continue for up to two years so it is important to keep doing the exercises. For many people the pain will have totally subsided by now, although for some it may linger. If this is the case, it is worth talking to the doctor.
3-6 months after hip replacement surgery: it is safe to participate in low-impact sports such as: swimming, cycling, golf, hiking, low-impact aerobics, tennis (doubles)and rowing. These activities also have a low fall risk, which is very important after having a total hip replacement. Participation in other low-impact sports, but with a higher risk of falls like skiing, ice-skating, rollerblading, pilates and, even, yoga should be discussed with the doctor.
High-impact sports with the high risk of a fall should be avoided after a total hip replacement. These includes activities such as: football, snowboarding, squash, basketball and high-impact aerobics.
Will I be in pain all the time? The pain will gradually subside over time. Many patients are almost pain-free by 12 weeks, for others the pain may last up to a year. It is essential to talk to the doctor about this to ensure that the patient has access to effective pain relief.
How will my hip area feel after surgery? Immediately after the surgery the area will feel numb for some time. Exactly how long this numbness lasts varies greatly between patients. However, it is reported that this numbness had disappeared in about 43% of patients in the 6 weeks after the surgery and in 68% of patients by 6 months post hip replacement surgery.
How important are the exercises? Being and remaining active is extremely important. In the initial stages it is vital that the level of activity is closely monitored by the medical staff to ensure that the weight loading on the hip is satisfactory and that the intensity is suitable for the condition of the patient.
How can I help my hip replacement recovery?
The Royal College of Surgeons have produced an excellent leaflet concerning hip replacement recovery (available to download in Adobe Acrobat format). See the references at the end of this article.
How soon after hip replacement can I shower or bath is a frequently asked question. Generally it is unwise to get the surgery incision wet while the stitches/staples are still in place. Once these are removed – usually after about 14 days – it is fine to have a bath or shower. Sometimes, prior to this, patients are offered waterproof dressings which allow them to shower after hip replacement before the stitches/staples are removed. However, bathing after hip replacement surgery before the stitches/staples are removed is not allowed.
When can I legally drive after a hip replacement? One important aspect to consider is the wording of the car insurer’s section ‘driving after hip replacement insurance’. In the UK, some insurance policies will not insure a driver for a set number of weeks after this surgery. It is always best to check with the insurance company that handles the insurance policy for your vehicle.
Except for essential journeys, it is advisable to not even travel in a car as a passenger for the first three weeks after surgery. This is because the action of getting into and out of a car can strain the hip and stretch the healing tissues.
Driving after hip replacement surgery depends on a few different factors. Firstly, the driver should be fully recovered from the surgery and not in pain. Note that pain relief medication can often bring on drowsiness or a sedative effect, which may effect a driver’s reactions. Sitting in the driver’s seat should be comfortable and the driver should be able to control the car safely.
The Royal College of Surgeons (RCS) suggests the following test. Sit in the driving seat of the car without turning on the ignition and practise putting firm pressure on the pedals. If there is any immediate pain or even soreness afterwards, try again in a few days time. The driver must be able to put enough pressure on the pedals to perform an emergency stop before they are fit to drive again.
How soon after hip replacement can I take a long car ride? As a driver it is best to start with short journeys and increase the duration slowly. Even so, as either a driver or passenger, long journeys are not ideal because they involve sitting for long periods of time in the same position. When it is necessary to undertake a particularly long trip, ensure that there are plenty of stops planned (possibly every hour), in order to get out of the car and move the legs for a while. The higher and more upright the seat, the more comfortable it will be. Sports cars and bucket seats are not a good idea!
It may be possible to drive an automatic car a little earlier – assuming the hip replacement surgery is on the left hip for a right-hand drive car, however it is important to follow the advice of the insurance company and doctor. In the UK, there is no obligation to inform the DVLA after hip replacement surgery unless the driver has been advised to not drive for a three month period.
It is inadvisable to bend down for at least the first six weeks after surgery. This is where a reaching aid can come in very useful to pick things up from the floor as well as other places. During the period of 6 – 12 weeks after surgery patients are often advised not to bend more than 60º – 90º. The main risk being that the hip may dislocate, particularly when the hip replacement has been from the back (posterior approach surgery) and bending can weaken the ligaments that stabilise the hip.
With the increase in anterior approach surgery, however, some experts are now questioning the wisdom of this advice. Some doctors simply advise care when bending. Nevertheless, dislocation does remain a major concern for many hip replacement patients. The highest risk is during the first four weeks after surgery and then the risk reduces on a weekly basis. It is vital that patients take the advice of their doctor concerning bending down as only they will know the exact details of the surgery performed and be best placed to consider the risks involved.
Immediately after surgery, on return home. patients are advised to use a straight back sturdy chair with armrests. It is very important that your knees remain below hip level. The armrests are important as they can be used to help with sitting or standing up. It is not advisable to sit on soft chairs, rocking chairs, sofas, or stools. These will not provide the necessary support for the hips and/or back.
If the chairs at home are too low, the seat can be raised with a hip replacement chair cushion. Indeed, some patients use them just because they find it more comfortable sitting on one of these cushions. There is no doubt that for many patients finding a comfortable position to lie or sit in during the first few weeks after hip replacement surgery is a problem. Sometimes these cushions can help. It is even possible to purchase a special hip replacement chair, if required.
Remember that it is important to raise the legs, wherever possible, when sitting, so a footstool, ottoman or pouffe is also very useful. There seems to be very mixed opinions concerning recliner chairs, with some experts recommending them and some advising against them. The problem may rest with the construction of the chair – too soft a seat would not be suitable. Everyone does agree, however, that a recliner should not be slept in. The hip will get stiff in the flexed position and become harder to straighten out.
So, when can I sit on a normal chair after hip replacement? The medical staff will need to check on your progress and give a definitive answer to this question, however, patients are not encouraged to sit in soft, low seats for at least 3 months after surgery. Bear in mind that soft, low seats are not good for anyone because of their lack of support, so even after 3 months it is worth limiting the amount of time spent sitting on the sofa or on stools.
As mentioned previously there are a few different ‘recovery milestones’ along the way. Possibly the first milestone is the hip replacement incision healing time. This will be partially dependent on how big the incision is, but generally the healing time will be 3-6 weeks. The full hip replacement recovery time, from the point of view of the patient being able to perform everyday duties and to return to ‘normal’ life is approximately 12 weeks. Internally, however, the body will still be repairing itself after the trauma of surgery. Depending on age, general health and the willingness of the patient to exercise a total recovery may take up to two years.
Doing the hip replacement exercises is a vital part of the recovery from hip replacement surgery. Before being discharged from the hospital each patient will receive instruction on hip replacement recovery exercises. It is essential to follow these instructions, gradually increasing the number of repetitions but always ensuring that these exercises do not cause sudden pain. Total hip replacement exercises are designed to increase the flexibility in the hip joint and build strength in the surrounding muscles.
Doing the hip replacement exercises is a vital part of the recovery from hip replacement surgery.
It is always sensible to follow the hip replacement physical therapy as offered by the hospital physiotherapist, however here are some exercises suitable for weeks 1-4 which may or may not appear in your exercises schedule. Each position should be held for 5 seconds. Aim to gradually increase the number of repetitions.
Four weeks after surgery, some more strenuous exercises for hip replacement can be tried. Again these positions should be held for 5 seconds, gradually building up the number of repetitions. Here are some further exercises recommended by the same clinic:
Hip Replacement Exercises After 6 Weeks
After six weeks there should be some marked improvement in the strength and flexibility of the new hip. Here are four exercises which will help you build on this:
Exercises for Hip Replacement After 3 Months
After 3 months there should be a marked improvement in mobility and flexibility. However, it pays to continue with some exercises in order to maintain the progress the has been made and to continue to strengthen the hip joint. Here are three exercises for hip replacement after 3 months:
Exercises After Hip Replacement 6 months
By now, for most patients, life is back to normal and activities are resumed. Remember that activities like walking, cycling, swimming and playing golf are excellent for maintaining and advancing suppleness in the joint. However, it still pays to continue with a short exercise programme, which specifically targets the muscles around the hip joint once or twice a week. Any of the above exercises are suitable as exercises after hip replacement 6 months – try to increase the repetitions per session.
Exercises 1 Year After Hip Replacement
To maintain your current strength, you need to be exercising twice a week. In order to strengthen muscles, the exercises must be challenging. Muscles are sufficiently challenged when you cannot do another repetition or you are unable to move the limb through the full range of the movement or your muscle begins to shake. You can increase the difficulty of an exercise by:
If balance needs to be improved try one of the following, always making sure that there is something to grab on to nearby if you lose your balance:
Hip Replacement Exercises to Avoid
Probably, the biggest fear for patients after a hip replacement is that either the hip will become dislocated or that it will work itself loose. These scenarios may be avoided by refraining from the following exercises (particularly in the first 3 months):
As time goes on these total hip replacement exercises to avoid may become less risky, however, it is still best to try to avoid these actions where possible in order to keep the hip prosthesis in the best possible shape.
Patients are recommended not to exercise in a gym/fitness centre for at least the first six weeks after hip replacement surgery. After this time, it pays to workout slowly and very gradually build up. There are also some exercise machines to avoid after hip replacement. These include:
Remember that everyone’s body is slightly different and regardless of what is written about exercises which should or should not be done, it is important to listen to how your particular body is reacting. If there is a shooting or stabbing pain when performing an exercise, immediately discontinue. It may be putting too much stress on the hip joint.
Thigh pain after hip replacement is quite common.
Any major surgery, unfortunately, will involve a certain amount of pain both from the external injuries (skin incision) and from the internal trauma to bones, muscles, tendons etc. The immediate pain after hip replacement should be controlled by pain relief administered, initially, in the hospital and later at home. For the first few weeks swelling and bruising after hip replacement may also be painful. Obviously, most of the pain will be felt at the site of the surgery, however changes to the hip joint may also affect other parts of the body. Hip replacement surgery may also result in a slight change in the length of the leg. This can also lead to thigh pain as well as knee pain after hip replacement.
Osteoarthritis in the hip often leads to lower back pain, due to the link between the hip and the spine. A research paper published in 2018 showed that 27% of patients complained of pain in the lower back prior to hip replacement surgery. Six months after the surgery, 50% of these patients reported that their back pain after hip replacement surgery had disappeared. Other research has cited up to 66% of patients obtaining relief from back pain. One thing to remember is that arthritis in the hip, may sometimes also mean arthritis in the spine. A total hip replacement will not resolve arthritis in the spine.
For some reason, not wholly understood, patients can sometimes feel ‘referred’ pain. This is when pain is felt in a different place from where the pain actually originates. So, for example, some patients may feel referred knee pain after hip replacement. Excessive pain after hip replacement should always be discussed with the doctor as it may be a result of many different things, including a problem with the new prosthesis.
Muscle Pain After Hip Replacement – Muscle pain after hip replacement may persist for some time. Most muscle damage occurs with the posterior approach, whereas with the anterior approach less muscle damage occurs but to different muscles. Muscle soreness after hip replacement may continue up until week 12 after the operation, however it should gradually diminish during this time. To regain the strength in these muscles may take up to 2 years and this is one of the reasons why continuing with strengthening exercises is so important.
Buttock Pain After Hip Replacement – Buttock pain after hip replacement surgery is quite normal. The muscles in the buttocks (e.g. gluteus maximus and medius) are protected by gluteal tendons. These muscles and tendons are closely connected with the hip so they are often damaged during the operation. It is not uncommon, therefore, to feel buttock pain after hip replacement. Other causes of buttock pain after hip replacement may be connected with the fact that some patients may already have issues with these gluteal tendons prior to surgery, although they may not be aware of it.
Further damage to these tendons during surgery, may lead to tendonitis. Tendonitis (often, but not only in the buttocks) is common in the acute healing phase, just after the surgery. It can usually be resolved with pain medication, anti-inflammatories and physiotherapy. Acute pain in the buttocks which lingers should be investigated by a doctor as it could indicate problems with the prosthesis.
Groin Pain After Hip Replacement – Groin pain after total hip replacement is normal for the first few weeks, given that, like the buttocks, the groin is closely connected with the hip. However, research has shown that persistent long-term groin pain after hip replacement surgery is becoming more widespread. What causes groin pain after hip replacement surgery? When we are talking about long-term pain the causes are not always clear, however infections, a loosening of the components and soft tissue inflammation are common causes. As with buttock pain, tendonitis may also lead to groin pain. Long-term groin pain should always be discussed with a doctor, who may suggest tests to clarify the situation.
The intensity and duration of pain after hip replacement surgery varies greatly between individuals. The normal pain, experienced on a daily basis due to osteoarthritis prior to the surgery, should not return. However, immediately after the operation, this will be replaced by pain in the hip area and possibly in the groin and thigh areas. There may also be knee pain due to a change in the length of the leg.
For some people this pain will disappear after 2-4 weeks, for others it may linger a little longer. Most people should be pain free by week 12 if not before. For those in pain after this time, it is worth getting it checked out by a doctor as the cause could be an infection or damage to the prosthesis or other issues.
If the ‘normal’ is that pain will have disappeared after 12 weeks, why is it that a minority of patients still have pain after this time? Pain after surgery which has never gone away may be the sign of a tiny fracture around the implant or acute inflammation of the tendons. If the pain is only felt when weight is put on the relevant hip/leg it may be that one of the components of the prothesis is loose.
Research in Denmark in 2011 found that younger patients tend to get more pain than older patients after hip replacement and that 12.1% of patients 12-18 months after surgery were still suffering from chronic pain. Technology and procedures have moved on since this research about 10 years ago, so it is probable that this figure is now reduced, however, pain after hip replacement 18 months on can occur and should be investigated by the doctor. It is unusual for a patient to suddenly experience hip replacement pain after 7 years. Any pain that suddenly appears years after the original hip replacement needs to be investigated and diagnosed. It could be caused by a loose component or tendonitis among other things.
What happens when there is hip replacement pain after 10 years or more? This may be caused by any of the reasons mentioned above, however although the lifespan of many artificial hip joints can be as long as 25 years, it may be, rarely, as short as 10 years depending on how the joint has been used and looked after. In addition, about 5% of patients eventually experience some joint loosening and, although it may happen at any time, it most commonly occurs 10-15 years after the original surgery. Again it is important ask the doctor to check out any hip pain that suddenly occurs.
As time goes on, there are no long term permanent restrictions after hip replacement on what the patient may do after a full recovery. Providing they have adhered to their exercise programme almost complete flexibility will return to the hip joint, although a hip replacement may not give quite as much mobility as a healthy natural hip joint. When it comes to what you cannot do after a hip replacement there are no real restrictions.
It is possible to do practically everything after hip replacement, however it is wise to take the advice of the doctor and look after the joint.
However, there are some hip replacement precautions long term. If the new hip joint is not looked after, its lifespan may be considerably shorter than anticipated. Modern plastics although generally quite wear resistant, are thinner and more brittle and can therefore be a concern when patients are very active. It is therefore advisable to refrain from heavy work and repetitive high impact activities – high-impact sports/activities include hockey, jogging, mogul skiing, football, gymnastics and rock climbing.
Many people, however, do ignore this advice although they may increase their chances of the artificial hip wearing out, breaking or loosening. It is very difficult to measure the exact impact that these activities may have on the failure rate of a hip replacement. Some studies have shown that in people younger than fifty 95% of total hip replacements are still working properly after ten years. It is probably fair to say that many of these people are not taking total hip replacement precautions and are participating in high-impact sports.
When it comes to medium-impact sports, such as tennis, backpacking and using an elliptical trainer, these are a bit more controversial. A study in 1999 researched tennis players who had returned to the sport after a hip replacement. Bearing in mind that in 1999 older surgical techniques were still being used, only 4% of these tennis players needed additional surgery during the 8 years that they were studied.
More recent studies also seem to challenge the claim that high/medium-impact sports should be listed as hip replacement precautions. Research in 2014 – ‘Recommendations for return to sports after total hip arthroplasty are becoming less restrictive as implants improve’ – quoted the following: ‘With improved implant materials and surgical techniques, we observed recommendations for low-impact sports and increasingly liberal recommendations for high-impact sports after THA’ (total hip arthroplasty/replacement).
It is important to remember that muscles around the hip joint will be severely weakened by the surgery, so they should be strengthened through exercises prior to embarking on sporting activities. Strength and balance are vital to prevent falls which can damage the prosthesis. Low vitamin D levels and a lack of sleep have also been shown to raise the risk of poor balance and increased injuries.
Things you can’t do after a hip replacement? Physically, it is possible to do practically everything, however it is wise to take the advice of the doctor and look after the joint. Nobody wants revision surgery earlier than necessary.
Considering that the majority of patients prior to hip replacement, have had their lives severely limited by painful osteoarthritis, there can be no doubt that their quality of life after hip replacement is much improved. The ability to participate in more activities and social occasions pain-free also greatly benefits the psychological well-being. As mentioned in the previous section there are very few, if any, physical restrictions post hip replacement.
Research in 2011 concluded that patients who had undergone total hip replacement 16 years earlier reported that they had a slightly less good physical quality of life and hip functionality but they performed physically better than untreated patients with osteoarthritis. The level of satisfaction post hip replacement was very high. It is also important to remember that these people would have had their surgery in the mid 1990s and technology and methodology for total hip replacement surgery has changed considerably in this time.
Usually there will be a single scar in the hip region measuring anything from 3”- 12” (8-30 cms) – the length partially depends on the obesity and muscle system of the patient. Depending on whether the surgeon uses the posterior, lateral or anterior approach, the scar will be on the front, side or back of the hip. The wound will closed with stitches either that have to be removed or that are dissolvable, or with staples or with glue. If the surgeon has used stitches or staples to close the wound, it needs to remain covered until they are removed. This will be done 10-14 days after the surgery. Any leakage from the wound should be reported immediately.
Two weeks after surgery, you can massage a non-perfumed Vitamin E lotion or oil into the scar area on a daily basis. Vitamin E is known to help build collage. Massaging the scar tissue in a circular motion especially in the first two years has many benefits including:
Some things to remember are that hip replacement scars (indeed any scars)are easier to damage than regular healthy skin and they also get sunburned much quicker. So, if your scar will be exposed to the sun remember to slaver on the suntan lotion. Sun-damaged scars are more likely to remain discoloured. The eventual appearance of the scar will vary from person to person, for some people it may almost disappear over time, for others it will always remain quite prominent.
Sex after hip replacement surgery can be resumed as soon as the pain has subsided and it feels comfortable to do so. For most people this will be 3-8 weeks after surgery. In fact, sex after hip replacement should be more comfortable as the hip will be more flexible and less painful.
A review in 2017 found that 44% of patients reported improvements in sexual satisfaction and 27% an increase in sexual intercourse frequency after a hip replacement. In another survey 90% of patients claimed they experienced an overall improvement in sex after hip replacement surgery.
Bending the hip past 90º, crossing one leg over the other and other more ‘extreme’ positions should still be treated with caution especially at the beginning. Everybody must find a position which is the most comfortable for them, however the following are a good place to start:
Immediately after a hip replacement operation is not the time for fast, aggressive sexual escapades – slow and steady is the pace for sex after hip replacement.
Can you run after a hip replacement? Yes, inasmuch as you will have the ability to run, for example to catch the bus or run after the children. However, when it comes to running as a regular activity/sport there is some controversy.
The majority of surgeons discourage running after hip replacement. However, there are plenty of people who do run with a hip replacement. The main problem is that running is thought to speed up the wear on the joint compared to lower impact activities. Limiting the impact loading, in theory, will better preserve the surface of the new joint. There is, however, little data to support this theory either way. With the newest prosthesis expected to last 25-30 years, any research would need to take place over at least 20 years. There does seem logic in the thinking that the greater the impact on the joint, the greater the risk of it eventually failing. This can be seen in professional athletes who often have problems with their natural joints.
For those people who have never counted themselves as ‘runners’, it is probably better to not take up this sport after a hip replacement. Much better choices are cycling or swimming after hip replacement which are counted as low to medium impact activities and which are excellent for improving the strength and flexibility of the new hip. Impact on the hip joint apart, another problem is falling after a hip replacement. This can be particularly risky as it may damage the prosthesis. The chances of falling when running is probably higher than both cycling and swimming.
For those of you, for whom running has always formed a part of your fitness regime, it is best to discuss your plans to resume running with the doctor. Much will depend on the type of hip prosthesis and the level of recovery achieved.
Doing yoga after hip replacement is possible, however care should be taken that as it could lead to hip dislocation. In the early stages of recovery upper body chair yoga poses are a safe option as they will help to stretch and strengthen the arms.
Restorative Yoga is good to start with initially. This type of yoga uses props like rolled up blankets, yoga blocks and cushions, where the poses are held for longer than usual. It concentrates more on the meditative aspect of yoga. Sometimes there are classes held locally, but if not, there are plenty videos available on the Internet demonstrating restorative yoga. Remember though that it is better to avoid poses where the hip is bent more than 90º or the legs/feet are crossed. In the event of any sudden pain, immediately stop the exercise.
Restorative Yoga is good to start with initially after hip replacement.
When it comes to other types of yoga, most surgeons recommend waiting three months to a year after hip replacement. When you have been told it is OK to practise yoga, it is best to find a class with a good instructor. Always explain to the instructor that you have had a hip replacement. Yoga is all about teaching us self-awareness of our bodies and it is even more important after a hip replacement, to listen to your body, maintain proper alignment and ensure that the hip is protected. Avoid anything which does not feel right or causes pain.
Pilates after hip replacement is also a good discipline and will help with the flexibility of the hip after surgery. However, like yoga, you should wait at least 8-12 weeks post surgery before practising it and then only with the agreement of the doctor. In a 2015 study it was found that Pilates is more effective than standard exercise programmes. Those who did hip replacement Pilates-based exercises saw more significant improvements in overall physical functions than those who had done regular exercises. Like yoga, however, it is essential that any exercises involving over 90º bends or crossed legs/feet are avoided.
The two problems associated with flying after hip replacement are the ability of the patient to sit for a long time and the possibility of developing deep vein thrombosis (DVT) which is a risk after any surgery. How long after hip replacement can you fly? Advice on travelling short haul (approximately 4 hours flight time) varies from one week to three weeks, whereas there is a consensus of opinion about long haul flights (over 4 hours), which are only recommended three months post-surgery.
DVT is a type of blood clot which usually forms in the lower leg and may be fatal if it reaches the heart or lungs. Compression stockings may help and it is probably a good idea to wear these if travelling long haul and/or if travelling short haul soon after a hip replacement operation. Some doctors will prescribe blood-thinners.
Try to book an aisle seat so that you can get out your seat regularly, if possible, and walk around the cabin. When sat in your seat do calf exercises – moving toes up and down – and drink plenty of water to keep you hydrated.
Some other issues to consider when flying are:
Can you have an MRI with hip replacement? MRI or Magnetic Resonance Imaging is a type of scan which uses strong magnetic fields and radio waves which help to build detailed images of the inside of the body. The patient lies on a bed which moves into a large tube, The procedure takes between 15 and 90 minutes depending on which part of the body is being scanned.
The strong magnets used during the scan can affect any metal implants or fragments in your body, including hip replacements. It is vital to inform the staff that you have a hip replacement prior to an MRI. It does not necessarily mean that an MRI scan is ruled out. The medical staff will decide on a case-by-case basis if there are any risks or if further measures should be taken so that the scan is as safe as possible. It also depends on what part of the body is being scanned and how modern the equipment is. Generally, it is possible to have an MRI with hip replacement but it is essential to inform the medical staff.
As with any major surgery, hip replacement surgery carries a very small risk of complications. Complications with anaesthesia are probably the most life-threatening. Any major surgery using general anaesthesia carries a low risk of blood clots, stroke, heart attack, arrhythmia (abnormal heart beat) and pneumonia.
Blood Clots: One of the most serious hip replacement surgery risks is blood clots. DVT is a blood clot in the leg and usually manifests itself in leg swelling and calf tenderness. A pulmonary embolism is where a clot breaks off and travels to the lungs. Chest pain, an unusually fast heart rate or shortness of breath may mean a pulmonary embolism. Moving as soon as possible after the operation and doing the physiotherapy exercises will reduce the risk. Sometimes medical staff administer blood thinners for a short time after surgery.
Longer/Shorter Leg Length after Treatment: Another of the hip replacement problems is connected with leg length. The surgeon will do everything possible to ensure that the patient’s two legs are matched in length. Occasionally, the leg may be deliberately made slightly shorter or longer in order to make pain relief and joint stability and mobility as effective as possible. These small differences in leg length can usually be corrected by using inserts in the shoe. It’s worth remembering that immediately after hip replacement surgery, the leg may feel longer because prior to this the patient has been used to an arthritic hip where the space between the joint has been diminished. Over time the patient will get used to the new hip and leg ‘length’.
Femur Fracture: A further one of the hip replacement risks is the possibility, either during surgery or after, that the femur or thighbone develops a fracture. About 2% of patients develop a femur fracture after surgery. Depending on its severity it may repair itself, but in some cases further surgery may be required.
As with any major surgery, hip replacement surgery carries a very small risk of complications.
Death: It is estimated that 0.35% of patients die within 30 days of hip replacement surgery. Men, people over the age of 70, and those with heart disease or renal insufficiency are at greater risk.
When it comes to hip replacement in the elderly, complications are obviously greater. There is no doubt that the risk of problems afterhip replacement increases with age. These include blood clots, heart attack, confusion and even death. Sometimes these are connected with other underlying conditions (co-morbidities) that the patient has such as diabetes, high blood pressure and heart and lung disease. The surgeon’s aim will be to stabilise and, where possible, improve these existing conditions before surgery, thereby reducing total hip replacement complications. As with any surgery these potential risks have to be weighed up against the potential benefits.
In addition to the above, there can be an occurrence of hip replacement complications years later including dislocation, infection, the loosening of components and, of course, the necessity for a completely new prosthesis (revision surgery). Most of these hip replacement problems’ symptoms manifest themselves in pain suddenly appearing in the hip area.
Leg Swelling After Hip Replacement: Swelling is a natural part of the healing process. It is produced by thousands of cells being sent to the affected part of the body. This is the first stage of the healing process – the inflammatory phase. The influx of these cells causes more and more swelling and because the legs are below the heart, gravity causes even more fluid to go to the leg.
Once the patient returns home the swelling may get worse. In hospital, they have been sitting or lying and generally resting, when they return home they will be a little more active which will increase the swelling. It is not unusual to develop a swollen knee after hip replacement, although this should resolve itself fairly quickly after surgery.
Hip replacement swelling complications are manifest when the leg swelling is accompanied by red inflammation and the leg feels particularly hot, this could indicate a blood clot or some kind of lymphatic obstruction. It should be checked out.
How Long Does Swelling Last After Hip Replacement? It is not unusual for these hip replacement swelling complications in the leg to last, in a mild/moderate form, for up to 6 months after surgery. It is important to try to reduce this swelling as it can cause an increase in pain and difficulty in movements. How to reduce leg swelling after hip replacement? Raising the legs may help to alleviate the swelling, but remember to limit the hip bend to 90º or less. Applying an ice pack and wearing compression socks will also help.
Hip Replacement Dislocation: A hip replacement dislocation occurs when the ‘ball’ in the hip joint comes out of its socket. This can occur in natural hips or in an artificial hip. Hip dislocation after hip replacement is not common in those patients who follow the advice of the surgeon and physiotherapist. However, higher rates of total hip replacement dislocation occur in certain groups of patients such as: the elderly, those with other physical disabilities, those who had previously had a hip fracture or other hip surgery and those who have had hip dislocations previously. It may occur at any time after surgery.
The most common hip replacement dislocation symptoms are hip pain and difficulty in bearing weight (e.g. walking) on the affected leg. It will be very hard to move the hip normally and the leg will appear to be shorter and may turn inwards or outwards. On occasions there may also be a feeling of numbness and weakness on the side of the dislocation.
In the event of a dislocation, a doctor can usually put the joint back into place without the need for surgery. He/she will use a procedure called a closed reduction, where the doctor will manipulate the bones back into place. In the event that the hip continues to dislocate, further surgery may be required.
Following closed reduction, the patient may be told to wear a hip replacement dislocation brace, sometimes known as a hip abduction brace. This is used to prevent excessive motion in the hip and promote healing. It should be worn 24 hours a day for a few weeks to a couple of months, depending on the recommendation of the doctor. Hip replacement dislocation prevention includes not bending the hip over 90º nor crossing the legs or feet. The American Academy of Orthopaedic Surgeons have produced this short video about hip replacement dislocation prevention.
Hip Replacement Infection: A hip replacement infection can occur at any time. Sometimes they occur immediately after surgery, sometimes they can occur years after the surgery. The risk of infection does decrease as the surgical wound heals. Approximately 1% of patients may fall victim to an infection after hip replacement. Infections are caused by bacteria in the body. Usually they are controlled by the immune system, however, because a hip replacement is made of metal and plastic, it is very difficult for the immune system to attack the bacteria in these implants.
Hip replacement infection symptoms (particularly shortly after the hip replacement surgery) include warmth and redness around the wound as well as wound drainage, fevers, chills or night sweats and tiredness. When an infection occurs some time after the surgery it will manifest itself in pain, stiffness and swelling around the joint, which up to that point had been functioning well and may also involve fevers, chills or night sweats and tiredness.
Blood tests and x-rays/bone scans are needed to confirm the infection and, provided only the skin and soft tissue around the hip are infected – a superficial infection, a course of antibiotics will probably resolve the problem. Where the infection has gone deep into the artificial hip joint, surgery will be required.
Deep types of infections after hip replacement which are caught early may often be cured by debridement. In debridement a surgeon removes all the contaminated tissue and conducts a surgical washout of the implant, replacing the plastic liners and/or spacers. A six week course of antibiotics will then be administered.
Late infections occurring months or even years after the hip replacement and those infections that have been present for a longer time will require staged surgery. This, initially involves a debridement but including a removal of the prosthesis. After the six week (or possibly longer) course of antibiotics, the patient will then be eligible for revision surgery (a new hip replacement). Single-stage surgery is now starting to become more popular, where the insertion of a new artificial hip takes place at the same time as the debridement. In other words the six week antibiotic stage is missed out. Research published in 2019 showed that single-stage revision is a viable option for the treatment of chronically infected hip replacement joints.
The risk of Infections after hip replacement surgery are very serious. Prosthetic joint infection is associated with an increased risk of death. Viral infections e.g. flu are not a risk.
The risk of Infections after hip replacement surgery are very serious.
Hip Replacement Complications Nerve Damage: Hip replacement nerve damage is relatively rare with a reported overall incidence of 0.3%. Those patients who have a hip revision seem to have a higher risk. 90% of cases involve the sciatic nerve, while the femoral nerve takes second place.
Injury to either of these nerves leads to a weakness in the leg as well as sensory changes. Nerve damage (or nerve palsy) will be felt fairly soon after surgery, although causes are often not obvious. Occasionally, a source of compression can be found in which case this will be removed. This nerve damage can also cause foot drop which will affect how the patient walks. Foot drop (sometimes also called drop foot) is when weakness or paralysis makes it difficult to lift the front part of the foot and toes. It can cause the patient to drag their foot on the ground when they walk.
Recovery from hip replacement nerve damage is very slow taking 1-2 years and the prognosis is not good, some 30% of patients may never recover. Treatment involves ankle-foot orthoses, physiotherapy and pain management. In the USA it has been found that a hip replacement nerve damage lawsuit is the primary litigation after hip replacement surgery.
Hip replacement revision is essentially ‘re-doing’ the original hip replacement operation or a second hip replacement. This is usually due to hip replacement failure caused by loosening of the implant, infection, recurrent dislocation, a bone fracture around the implant, patient allergy to the metal in the prosthesis as well as general wear and tear on the implant. Modern hip replacements, with care, are expected to last about 25 years, but older hip implants have a shorter lifespan. How do I know if my hip replacement is failing? The most obvious signs of hip replacement wearing out will be a sudden occurrence of pain either in the hip or groin and difficulty in putting weight on the leg.
When hip replacement failure occurs, the doctor may suggest a second operation to remove some or all of the parts of the original artificial hip and replace them with new ones. This is what is known as revision hip replacement or a second hip replacement.
Although hip replacement and revision hip replacement are very similar, revision hip replacement is a longer and more complex procedure requiring specialised implants and tools. Special revision implants are needed because of the existing damage to bone and soft tissue around the hip joint replacement. Revision hip replacement patients will usually need to stay in hospital for several days after surgery. Post-surgery rehabilitation is the same as for primary hip replacement, however the recovery period is generally longer.
The vast majority of patients have a long-term favourable outcome after hip replacement revision, however it is not always possible to fully restore all the functionality of the hip and, for some patients, some pain still remains.
There is never an ‘obligation’ to have hip replacement surgery, it is usually classed as ‘elective’ surgery i.e. does not involve a medical emergency. Its success rate is high, but the operation itself is classed as major surgery and the recovery process may be quite gruelling. There are alternatives to hip replacement and, indeed, patients will not be accepted for surgery until they have tried some of these other treatments. These include:
A surgeon will have expected patients to have tried these non-surgical alternatives to hip replacement surgery before they will consider undertaking this major surgery.
For many reasons, including underlying health issues, some people would prefer not to go through a surgical hip replacement. So, once they have tried the above, and are still suffering with limited movement and pain, what are the alternatives to hip replacement surgery?
There is a common procedure known as a partial hip replacement, however it is not a good option for cases where a hip replacement is necessary due to osteoarthritis. In this procedure only the ‘ball’ of the ball and socket joint is replaced. This works well when only the ball of the hip joint is damaged, as in certain hip fractures, but, in osteoarthritis other parts of the joint are also damaged. The recovery period is similar to a total hip replacement.
Another alternative procedure is the hip fusion, although this is rarely used these days. In hip fusion surgery the femur and pelvic bones are joined together with a large metal plate and screws. This effectively eliminates all motion in the hip joint, which means that the patient will walk with a limp. Further surgery is usually required later to convert to a hip replacement.
A more modern alternative to hip replacement is subchondroplasty. This involves injecting a cement-like material into the joint to strengthen the damaged hip. This Bone Substitute Material is eventually reabsorbed by the body and replaced by healthy bone. Recovery is slightly quicker than in a traditional hip replacement, however this procedure is not suitable for everybody. This treatment is currently not available on the NHS, but trials are taking place.
Hip resurfacing surgery involves putting a ‘new’ surface on the both the ball and socket of the hip joint. Normally there is cartilage between these two bones but with osteoarthritis this cartilage decreases so that the ends of the bones are exposed and this causes friction. With hip resurfacing the ball and socket are covered with a new metal covering so that they can slide against each other more easily. Hip resurfacing is usually only offered to patients under 60 years of age. After this age the bones in the hip joint may not be strong enough and a total hip replacement, replacing totally the top of the femur and the socket, is a better option.
An advantage of hip resurfacing is that it is relatively easy to convert to a total hip replacement. Like total hip replacement prostheses, hip resurfacing devices have a limited lifespan (15-20 years), but because less bone has been removed it is easier to exchange this device for a total hip prothesis. It is also generally agreed that the risk of dislocation is lower than in a total hip replacement.
There are, however, some disadvantages to hip resurfacing. One is the possibility of a fracture to the femoral head. The other disadvantage of hip resurfacing is that both the ball and the socket are covered with metal. Over time, the friction between theses two surfaces may release tiny metal molecules called ions, which can cause pain and swelling because of a reaction in the bone and soft tissue around the joint. So, for much the same reasons as the metal-on-metal hip replacements, hip resurfacing is falling out of favour as a procedure. However, the NHS in the UK are currently trialling an all ceramic hip-resurfacing device, but this is ongoing and no results have been announced as yet. In both these scenarios, the solution is to convert to a total hip replacement.
When it comes to hip resurfacing surgery vs hip replacement, there can be no doubt that hip resurfacing is a less intrusive procedure. It preserves the original bones, just smoothing them down in order to fit the metal covers. The recovery timeline is very similar for both procedures. Other similarities are the possibility of fractures and the relatively small risks associated with the surgery. Unfortunately, patients over about 60 years of age do not have the choice of hip replacement vs hip resurfacing as a total hip replacement will eliminate the risk of brittle or weak bones.
A hip resection arthroplasty is also known as the Girdlestone Procedure. It involves removing the bone around the hip joint and allowing the space so created to be filled with scar tissue. The outcome is that the patient is left with a stiff, but usually pain-free hip and a leg which is unable to bend at the hip.
This hip resection arthroplasty will alleviate the pain in nearly all patients, but the improvement in the ability to walk and the level of possible activity will probably be minor. Patients will have to use some aid to walk (walker, sticks etc) and there will likely be a shortening of he leg which can be anything up to 11cm. This resection arthroplasty of the hip is only really used in the following scenarios:
A hip osteotomy basically realigns the bones in the hip joint. It is usually used in developmental conditions such as hip dysplasia where the femur does not fit together properly with the pelvis. Normally people are born with this condition which leads to the bones in the hip becoming maligned and often to early arthritis in the hip joint. After the hip osteotomy procedure patients are not allowed to walk for about 6 weeks, although hydrotherapy is recommended. As with a total hip replacement it is expected that normal activities can be resumed about 12 weeks after surgery.
Stem cell therapy is a relatively new procedure and extensive research is still currently being undertaken. In the USA and UK it is only approved for the treatment of some blood cancers. In addition, the NHS has been authorised to use it to treat patients suffering with Multiple Sclerosis but it is seldom used. Private clinics, however, do advertise stem cell treatment as an alternative to hip replacement.
How does stem cell hip replacement work? Adult stem cells, also known as mesenchymal stem cells (MSCs) can be found in various places in the human body including bone marrow, fat and, what is known as, peripheral blood. These MSCs can form new tissues and repair and regenerate cartilage and bone.
A stem cell hip regeneration involves harvesting these MSCs from the body and then introducing them into the hip joint in order to regenerate the cartilage that has been lost through osteoarthritis. The procedure is designed to preserve the natural hip joint for as long as possible thus delaying or preventing a total hip replacement.
It is difficult to establish a stem cell hip replacement cost, as it is dependent on so many different factors. An estimate would be a starting price of around £7,000. A recent BBC news article from January 2020 highlighted the fact that these clinics which offer stem cell treatment are not regulated in any way. Over 70 private providers in the UK offer stem cell treatments for painful joints. According to hip and knee surgeon Prof Fares Haddad from University College Hospitals in London – ‘there was ‘no evidence base’ for the treatments’.
Many private hospitals and clinics throughout the UK offer hip replacement surgery. For those people with private medical insurance the cost of hip replacement may be met by your insurers. It is always best to discuss any procedure with them before going ahead.
How much does a hip replacement cost? The cost of private hip replacement in the UK averages at about £11,760. This cost will usually include surgery and a stay of 3-5 days in hospital. Additionally, however, there will be other costs – consultant’s appointments, a walker and a pair of crutches, tests such as x-rays and blood tests, removal of stitches and later check-ups. All of these things will add a considerable amount to the basic cost of the surgery. It is also quite common that a blood transfusion is required after a hip replacement and again this will be added to the bill.
What is the average hip replacement cost UK. According to Private Health Care UK, here is the average private hip replacement cost in the various regions. Don’t forget to add on the ‘extras’.
Average Cost in £s
East of England
North East England
North West England
South East England
South West England
Yorkshire & Humberside
Of course, costs are sometimes not the only thing to be taken into account. How can you know that you are paying for a reputable surgeon? Which? magazine provides the following guideline to establish hip replacement surgeons’ ratings UK. They suggest checking these five points:
Some of this information is only available for NHS sites.
Any eligible person can be considered for an NHS hip replacement.
The surgery will normally take place in a hospital belonging to your local NHS trust, however you have the right to be treated in any hospital of your choice in NHS England /Scotland/Wales (and sometimes even private clinics and hospitals). The NHS ‘Find and Choose Hospitals’ is the most sophisticated hospital comparison system in the UK. All costs including additional tests, x-rays, walker/crutches, follow-up appointments and, if necessary, blood transfusions are free of charge.
In theory, the NHS hip replacement waiting time for non-urgent referrals (which most hip replacements are) is 18 weeks from the date your GP books your first appointment using the e-referral system or the date that his/her referral letter arrives at the hospital.
Unfortunately, however, NHS hospitals have been forced to cancel tens of thousands of routine operations during the Covid pandemic. Researchers say that 160,000 hip and knee replacement operations have been delayed. So the hip replacement NHS waiting list is getting longer and longer. Some academics fear that it could take the NHS more than 10 years to clear the backlog. They are calling for special operating centres to run seven days a week as well as recommending that retired surgeons be asked to help out. So hip replacement waiting times are getting longer and longer.
The NHS hip replacement criteria is quite clear. Hip replacement is only recommended if other non-surgical treatments, such as physiotherapy and/or steroid injections, have failed
to reduce the pain or improve mobility. If this is the case then the NHS hip replacement criteria (as indicated on their website) is as follows:
For those eligible (residents of the UK) NHS procedures are totally free of charge.
Hip replacement abroad can be considerably cheaper than private hip replacement in the UK and with the extra long NHS waiting times, treatment overseas can be a very attractive proposition. One thing to bear in mind with hip replacement surgery abroad is that a long flight home is not a very comfortable proposition after this type of surgery. Generally, therefore, it is best to consider countries in Europe with short haul (around 4 hours) flights back to the UK. What’s also important, patients can get secured for their medical trip, which makes their travel and stay abroad much safer. Clinic Hunter & AXA Partners have created a medical insurance for overseas dedicated solely to medical tourists.
It is wise to always check exactly what costs are included in a private hip replacement abroad. Many will include all necessary tests, the actual procedure, hospital stay and even physiotherapy sessions on a daily basis. Sometimes hotel nights (needed in addition to hospital nights) are not included and usually flights from the UK and back are also not included. The hip replacement cost in Europe starts at around £6000, which is about 50% of the average private costs in the UK.
One of the biggest costs of a private hip replacement is the actual prosthesis, it is always worth discussing with the surgeon before arrival which type and make of prosthesis they will be using. Hospitals and clinics which specialise in medical tourism often employ some of the best orthopaedic surgeons for hip replacement. They specialise in this procedure and perform many surgeries a year (remember the Canadian survey recommended surgeons who performed at least 35 operations a year). However, as in the UK, it pays to find out as much about your prospective surgeon as possible. Our consultants are happy to give you as much information as you need. Since Brexit NHS hip replacement abroad is no longer paid for in the UK.
Poland is one of the countries which offers the best value when it comes to medical treatment abroad. It is now a vibrant, modern, go-ahead country with a relatively low cost of living compared to many other European countries. A low cost of living, however, does not equate to a poor private medical sector. Private clinics in Poland are thriving. They are equipped with the latest state-of-the-art technology and the top surgeons in Poland are trained to the highest standard. Some of the best surgeons in Poland work in these medical facilities.
All hospitals/clinics have to be approved by the government and the best clinics are given accreditation by the Polish Health Ministry. Many also have certification from the following organisations – ISO (International Organisation for Standardisation), ESQH (The European Society for Quality in Healthcare) and TAS (The Treatment Abroad Scheme). Poland also hosts one of the largest orthopaedic medical centres in Europe which has been certified as a FIFA Centre of Excellence.
Hip replacement surgery in Poland starts at about £6500 and will often include accommodation for a companion. A plethora of budget flights from many UK provincial airports to the main airports in Poland mean airline tickets are cheap.
Poland is an excellent destination when it comes to medical tourism. The cost of hip replacement surgery in Poland is much lower than in the UK (as is the cost of living, hotels, food etc), it is a relatively short plane ride from the UK (approx 2.5 hours from London), English is widely spoken both within the clinics and in general life and it has some of the best-equipped clinics and most highly trained surgeons. Our consultants can provide specific details on the clinics we represent together with details of surgeons and testimonies from other patients.
Turkey is another country which is extremely popular when it comes to medical treatment abroad. According to the International Medical Travel Journal (IMTJ), Turkey holds the third position in the list of countries most often visited for private medical treatment. About one third of patients treated in medical centres in Turkey are from abroad.
The cost of medical treatment in Turkey is very low compared to UK prices and like Poland, Turkey can offer modern treatment methods in state of the art clinics and hospitals. Some clinics in Turkey have been awarded the JCI (Joint Commission International) certificate, which is the highest quality standard for joint replacement.
Is it safe to travel to Turkey? Many patients have put their trust in Turkish surgeons, however it does pay to check out the credentials of both the medical centre and the surgeon. There are many high quality clinics in Turkey with excellent standards, however there are also some unlicensed clinics which prey on foreigners. Booking your hip replacement through a reputable agent will ensure that you are given a choice of only the best and most reputable medical facilities.
Flights from London to Istanbul are just under 4 hours and the flight costs are very reasonable. All medical staff speak English. Our consultants can provide specific details of clinics in Turkey which would best suit the needs of the individual patient.
In these days of fast and easy Internet access for almost everyone it is worth checking out some of the information available. Bear in mind, however, that the Internet is not regulated so anybody can post anything they want without it necessarily being the truth. However, a hip replacement forum is a good place to start, as, more often than not, these comments are posted by people who have had first hand experience of a hip replacement. Patient.info manages a very informative UK forum as does BoneSmart.org to name just a couple hundreds exist.
Hip replacement images and hip replacement surgery pictures are also available on Google Images and other sites. Arming yourself with as much information as possible makes it much easier to come to the correct decision about your hip replacement surgery. After all, this is major surgery and it is essential to know that your hip is being treated in the best way for you personally.
When other non-surgical treatments have been tried but a patient is still in pain with limited hip mobility, hip replacement surgery is a good option. The decision to have this operation should not be taken lightly as it is major surgery and involves a fairly long recovery phase. As with any surgical intervention there are a small number of risks. However, successful hip replacement surgery can give the patient a new lease of life, diminishing pain and vastly improving mobility. Physical improvements can also lead to psychological improvements.
Hip replacement surgery is available on the NHS free of charge in the UK for eligible patients, however, due to the covid pandemic, waiting lists are exceptionally long. The surgery is available in the UK private medical sector with prices averaging about £12000 plus extras. The same high-standard surgery in modern well-equipped medical centres is also available abroad for about half this price and there is no waiting.
When it comes to major surgery, like a hip replacement, it does pay to do some homework and check out the credentials and success rate of the medical facilities and the surgeons.
Physical improvements after hip replacement can also lead to psychological improvements.
In the UK Anne was a professionally qualified trainer with many years of experience in the training industry. She mainly worked in the travel, tourism and leisure industries (including Thomas Cook and British Airways) as well as in other sectors.
Since moving to Poland twelve years ago, Anne has become involved in other business sectors – teaching English as a foreign language and translating documents from Polish into English. She specialises particularly, in medical translations and works closely with dentists, cardiologists and neurologists in translating and preparing articles for publication. She has also trained as a practitioner in the field of neuro-linguistic programming and is a qualified hypnotherapist.
Any spare time is spent renovating the house in Poland which Anne bought some years ago.
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