Hip replacement
Total hip replacement resurfaces the femoral head and acetabulum with metal, ceramic, and polyethylene components, providing highly reliable pain relief and restoration of function for end-stage hip arthritis.
📊 Over 100,000 total hip replacements are performed annually in the UK. It is consistently rated as one of the most cost-effective and successful interventions in healthcare, with over 95% of patients reporting significant improvement.
What is hip replacement?
Total hip replacement (THR) replaces both the femoral head (ball) and the acetabulum (socket) with prosthetic components. The femoral component consists of a stem inserted into the femoral canal and a femoral head (ball). The acetabular component consists of a metal shell pressed into the acetabulum with a liner (polyethylene, ceramic, or metal). Modern uncemented (press-fit) fixation achieves biological ingrowth into porous implant surfaces, providing durable long-term fixation.
Bearing surfaces determine wear characteristics and longevity. Ceramic-on-polyethylene and ceramic-on-ceramic bearings produce the least wear and are preferred in younger, active patients. Metal-on-metal bearings have fallen out of favour due to concerns about metal ion release and adverse local tissue reactions. The surgical approach (posterior, anterior, lateral, or direct anterior) influences dislocation risk and the specific restrictions given after surgery.
Resurfacing arthroplasty - replacing only the surface of the femoral head rather than the entire neck and head - was popular in younger men but has declined following concerns about metal-on-metal bearing complications. Hip replacement remains the treatment of choice for end-stage hip arthritis, with implant survival rates exceeding 90% at 20 years for well-performed procedures with modern uncemented implants.
Common causes
- Primary hip osteoarthritis (most common)
- Secondary osteoarthritis (DDH, Perthes, SCFE, FAI)
- Rheumatoid and inflammatory arthritis
- Avascular necrosis of the femoral head
- Hip fracture (hemiarthroplasty or THR)
- Failed previous hip surgery
Who is at risk? Advanced age, obesity, and significant medical co-morbidities influence the risk and outcome of hip replacement.
Symptoms
Symptoms vary depending on the severity and duration of the condition. Common symptoms include:
- Severe deep groin or hip pain limiting walking to less than 100-200 metres
- Pain at rest and at night disrupting sleep
- Inability to perform basic daily activities without significant pain
- A limp that has worsened progressively
- Failed response to adequate non-operative management
When to seek help: Hip replacement is considered when pain and functional limitation are severe and non-operative measures have been fully exhausted. BMI optimisation and pre-operative physiotherapy improve outcomes.
How is it diagnosed?
Your surgeon will take a detailed history and examine the joint. The following investigations may be arranged to confirm the diagnosis:
- X-ray - AP pelvis and lateral hip views showing end-stage joint space loss
- CT scan - for pre-operative planning in cases of significant deformity or previous surgery
- MRI - for avascular necrosis assessment or when diagnosis is uncertain in younger patients
The NICE guideline recommends offering THR when pain is severe, quality of life is significantly affected, and non-surgical management has been tried and has not provided adequate relief. BMI over 40 is associated with significantly higher complication rates.
Treatment pathway
Treatment is tailored to the severity of the condition, your age, activity level, and overall health. Most conditions are treated in a stepwise fashion, starting with the least invasive options.
Total hip replacement (uncemented)
A porous-coated metal acetabular shell is press-fitted into the acetabulum. A ceramic femoral head articulates with a polyethylene or ceramic liner. A cementless femoral stem is inserted into the femoral canal. Immediate full weight-bearing is permitted. Implant survival exceeds 90% at 20 years.
Cemented total hip replacement
Components are fixed with acrylic bone cement. Provides immediate fixation regardless of bone quality. Preferred in elderly patients with osteoporosis or when press-fit fixation is unreliable. Equally durable with excellent long-term results.
Hemiarthroplasty
Replacement of the femoral head only, leaving the native acetabulum. Used for displaced intracapsular hip fractures in elderly patients where the speed of surgery and reduction of operative complexity is prioritised.
Recovery
Recovery after total hip replacement is generally rapid. Most patients walk independently within 4-8 weeks. Specific post-operative precautions (hip precautions) to prevent dislocation depend on the surgical approach and implant design - the surgical team will advise specifically. Low-impact activities such as swimming, cycling, and golf are encouraged after 6-12 weeks.
- After surgery: mobilise day 1:
- Walking with stick: 2-4 weeks
- Walking unaided: 4-8 weeks
- Return to driving: 6-10 weeks
- Full recovery: 6-12 months
What results can I expect?
Total hip replacement is one of the most successful operations in modern surgery. Over 95% of patients report significant pain relief and improved quality of life. Patient-reported outcomes measured with the Oxford Hip Score consistently show large, durable improvements maintained at 10+ years.
Hip replacement - what to expect
In numbers
Typical activity timelines for this condition. These are approximate and vary considerably between patients. Always follow the specific guidance given by your surgeon and physiotherapist.
| Activity | Typical timeline | Notes |
|---|---|---|
| Walk with aids | Day of surgery | Patients usually stand and take steps with crutches or a frame the day of surgery or the next day.[2] |
| Off aids | 4-6 weeks | Most patients are off crutches and walking unaided by 4-6 weeks.[2] |
| Drive | 6-8 weeks | When you can react and brake safely. Earlier for left hip if driving an automatic. Inform your insurer.[3] |
| Return to work | 4-12 weeks | Desk work: 4-6 weeks. Standing or manual work: 8-12 weeks. Heavy manual work: 12 weeks or more.[2] |
| Sleep on operated side | Around 6 weeks | Many surgeons advise sleeping on the back or non-operated side for the first 6 weeks; confirm with your team.[4] |
| Swim | After wound has healed | Usually around 4-6 weeks once the wound is fully healed and dry.[2] |
| Return to sport | 3-6 months | Walking, cycling, swimming, golf, and doubles tennis are usually fine. Running and contact sport are typically discouraged.[4] |
| Full final outcome | 6-12 months | Pain relief is rapid; gait, strength, and full confidence continue to improve through the first year.[5] |
Common concerns from patients with this condition or recovering from treatment, and whether they are expected or worth mentioning to your team.
Your questions, answered
Plain-English answers to the things people most often ask, grounded in UK clinical guidance. Tap a question to open it.
About thisWhen should I consider a hip replacement?
A hip replacement is worth considering when arthritis pain and stiffness are limiting your walking, sleep and daily activities, and non-surgical measures are no longer enough. It is a planned operation, so you choose the timing based on how much the hip is affecting your life rather than a scan result alone.
The operationWhat does the operation involve?
The worn ball at the top of the thigh bone and the socket are replaced with an artificial joint made of metal, ceramic and hard-wearing plastic. The result is a smooth, stable joint that should move freely and take your weight comfortably.
AnaestheticWill I be awake or asleep?
Many hip replacements are done under a spinal anaesthetic with sedation, so you are relaxed and pain-free but not necessarily fully asleep. A general anaesthetic is also used. The choice is made with your anaesthetist based on your health.
RecoveryHow quickly will I be moving again?
Most people stand and take a few steps with help on the day of surgery or the day after. Walking aids are used for a few weeks, and many are back to gentle normal activities within six weeks. Full recovery and confidence build over about three months.
Daily lifeAre there movements I must avoid afterwards?
In the early weeks you may be advised to avoid bending the hip too far, crossing your legs or twisting, to protect the new joint while it settles. Your surgeon and physiotherapist will give you specific guidance, as advice varies with the surgical approach used.
How long it lastsHow long does a hip replacement last?
Hip replacements are among the most successful operations in medicine, and the majority last fifteen to twenty years or more. How long yours lasts depends on your age, weight and activity level, which your surgeon can factor into the discussion.
When to worryWhat problems should I report?
Report a wound that is increasingly red, hot or leaking, a fever, or a calf that becomes swollen and painful. A sudden change in leg length, severe pain or inability to weight bear could mean the joint has dislocated and needs urgent assessment.
- 1.National Joint Registry annual report (NJR), hip and knee implant data
- 2.NHS: Hip replacement
- 3.Royal College of Surgeons of England: Recovering from surgery, driving guidance
- 4.British Hip Society: Patient information
- 5.NICE NG157: Joint replacement (primary): hip, knee and shoulder
- 6.Chartered Society of Physiotherapy: Patient information
References are to UK clinical guidance and patient information from recognised organisations. This page is for general information and does not replace personalised advice from your own clinical team.
Preparing for surgery?
Read our step-by-step guide - what to expect before, during, and after your procedure.
How is it diagnosed?
- ✓X-ray - AP pelvis and lateral hip views showing end-stage joint space loss
- ✓CT scan - for pre-operative planning in cases of significant deformity or previous surgery
- ✓MRI - for avascular necrosis assessment or when diagnosis is uncertain in younger patients
Recovery milestones
- ●After surgery: mobilise day 1:
- ●Walking with stick: 2-4 weeks
- ●Walking unaided: 4-8 weeks
- ●Return to driving: 6-10 weeks
- ●Full recovery: 6-12 months