Everything you need to know before your total hip replacement - from your pre-assessment through to your first weeks at home. Hip replacement is one of the most successful operations in modern surgery.
ℹ️ This appointment usually takes place 2-4 weeks before your surgery date. The team will check you are fit for a general or spinal anaesthetic, review your medications, and answer any questions.
Total hip replacement is performed under general or spinal anaesthetic and takes approximately 60-90 minutes. You will typically stay in hospital for 2-3 nights.
Routine investigations to check your general health and fitness for anaesthetic.
All current medications are reviewed. Blood thinners (warfarin, apixaban, clopidogrel, aspirin) must be paused. NSAIDs should be stopped 1 week before surgery.
A nasal and groin swab is taken to screen for MRSA. If positive, decolonisation treatment is given before surgery.
Install grab rails, raise toilet seat, and clear trip hazards before admission. Arrange ground floor living for the first 2-4 weeks if stairs are difficult.
BMI over 40 significantly increases complication risk. Your surgeon may request weight loss before proceeding. Discuss this at your pre-assessment.
ℹ️ You will be given a specific arrival time. Do not eat or drink (other than clear water up to 2 hours before) from midnight the night before. Bring your medication list and any documents sent by the hospital.
You will be admitted to the ward or day surgery unit, change into a gown, and be seen by the nursing, anaesthetic, and surgical teams before theatre.
Your surgeon will confirm the procedure, mark the operative side, and you will sign a consent form before going to theatre.
You will meet the anaesthetist in the anaesthetic room. Once anaesthesia is established, the procedure will begin.
After surgery you will wake in the recovery room where nurses monitor your vital signs until you are stable and comfortable.
Most patients having arthroscopic or day-case procedures go home on the day of surgery. Those having joint replacement typically stay 1–2 nights. Before discharge, the team will check your pain is controlled, give you wound care instructions, and confirm your follow-up appointment.
You will be given oral pain relief before discharge. Take it regularly for the first 48 hours rather than waiting until pain is severe.
A nurse will check the wound before you leave and explain how to keep it clean and dry.
You will receive a letter for your GP and details of your next outpatient appointment - usually at 2 weeks for a wound check.
Arrange for a family member or friend to collect you. You must not drive on the day of surgery if you have had a general anaesthetic or sedation.
⚠️ Important: Contact your surgical team urgently if you develop increasing redness, swelling, warmth, or discharge from the wound, a fever above 38°C, or severe increasing hip pain. Periprosthetic joint infection requires prompt treatment.
Avoid getting the wound wet until it is fully healed - usually 10–14 days. Use a waterproof cover or cling film when showering.
Do not wait until pain is severe before taking medication. Regular simple analgesia (paracetamol, ibuprofen if appropriate) is more effective.
This is usually 2 weeks after surgery. Sutures or clips will be removed if used.
Seek urgent advice if you develop increasing redness, warmth, swelling, discharge from the wound, or a temperature above 38°C - these may indicate infection.
Blood tests, MRSA screen, medication review, anaesthetic discussion. Prepare your home.
Most patients are in theatre for 60-90 minutes. Hospital stay is typically 2-3 nights.
A physiotherapist will get you standing and walking with a frame the day after surgery.
Progress from walking frame to crutches to a stick. Most patients walk unaided by 6-8 weeks.
Most patients return to driving at 6-8 weeks (check with your insurer). Low-impact activities resume.
Most patients go home 2-3 days after total hip replacement. Early discharge on day 1-2 is increasingly offered in enhanced recovery programmes.
Hip precautions are restrictions on movement designed to reduce the risk of dislocation. The specific precautions depend on the surgical approach used. Your surgical team will advise you specifically - there is no universal set of hip precautions.
Most patients return to driving at 6-8 weeks, when they can safely perform an emergency stop. The operated leg must be strong enough and any opioid medication stopped. Check with your insurer.
Yes - a hip replacement will trigger metal detectors. Carry a card stating you have a joint replacement. X-ray scanners at airports will show the implant.
The primary aim of total hip replacement is reliable and durable pain relief. Significant improvement in walking ability, sleep quality, and daily function is expected. Over 95% of patients report significant pain relief.
Under general or spinal anaesthetic, the hip is approached through a posterior, anterior, or lateral incision. The femoral head is removed and the femoral canal is prepared to receive a stem. The acetabulum is reamed and a metal shell is press-fitted (uncemented) or cemented in place. A bearing surface (ceramic or polyethylene) is inserted. The femoral head (ball) is placed on the stem and reduced into the socket. The wound is closed in layers. Takes approximately 60-90 minutes.
Analgesics, physiotherapy, activity modification, and weight loss. Appropriate when symptoms are tolerable and quality of life is acceptable. Intra-articular injections provide short-term relief.
Corticosteroid injection provides short-term relief of several weeks to months. Hyaluronic acid injection may provide longer-lasting benefit. Not a long-term solution for advanced arthritis.
A bone-conserving alternative in younger, active male patients where the femoral head surface is reshaped rather than removed. Concerns about metal-on-metal bearings have reduced its use.
Acceptable if symptoms are manageable. Hip osteoarthritis does not improve spontaneously but progression varies.
The femoral head can dislocate from the socket in the early post-operative period if hip precautions are not observed. Most require manipulation under anaesthetic to reduce. The specific dislocation risk depends on the surgical approach and implant design.
Deep infection of the joint replacement is the most feared complication. May require removal of the implant, prolonged antibiotic treatment, and staged revision surgery. The risk is higher in patients with diabetes, obesity, immunosuppression, or previous hip surgery.
Blood clot in the leg veins (DVT) or lungs (PE). Anticoagulant medication is given for 4-6 weeks after surgery to reduce this risk. Symptoms include calf pain, swelling, breathlessness, and chest pain.
The sciatic nerve (causing foot drop) and femoral nerve are at risk. Most injuries are neurapraxias that recover fully. Permanent nerve injury is rare.
A small difference in leg length is common after hip replacement but is usually minor and not noticeable. Significant discrepancy may require a shoe raise.
All hip replacements may eventually require revision (replacement of the components). Modern uncemented implants have survival rates exceeding 90% at 20 years. Revision surgery is more complex than primary replacement.
Fracture of the femur around the prosthesis can occur during surgery or in the post-operative period. May require further surgery.
Expected in the early post-operative period. Managed with regular analgesia and elevation.
Normal and expected after hip surgery.
The scar may be tender for several months.
Minor clicking is common with some implant designs and is not harmful.
Hip osteoarthritis will not improve spontaneously. Non-operative management can control symptoms for a period but end-stage arthritis causing significant pain and functional limitation is unlikely to respond adequately to conservative measures long-term. Delaying surgery does not affect the outcome of future replacement.