In a hip replacement the damaged parts of the joint are replaced with metal, plastic or ceramic parts [1]. It may be recommended when hip pain and stiffness are having a big effect on life and other treatments have not worked; the most common reason is osteoarthritis [6]. Recovery can take several months [2]; according to an analysis of registry data, a hip replacement can be expected to last 25 years in about 58% of patients [7].
What is a hip replacement?
In hip replacement surgery (arthroplasty) the damaged parts of the hip joint are removed and replaced with metal, plastic or ceramic parts [1][4]. The hip is a ball-and-socket joint: the socket is in the pelvis and the ball is at the upper end of the thigh bone [4]. The most common type is a total hip replacement, in which both are replaced [1].
The parts are fixed to the bone with cement (cemented) or by a tight press fit that allows the bone to grow onto the part (uncemented); the choice depends on factors such as the quality and strength of the bone [4]. The parts of the implant are [4]:
- Stem: a metal part placed inside the thigh bone
- Head: a metal or ceramic ball fitted to the top of the stem
- Cup: a metal part fitted into the socket in the pelvis
- Liner: a plastic, ceramic or metal part that gives a smooth gliding surface between the head and the cup
Who is it considered for?
Surgery is not the first option. According to the NHS, a hip replacement may be recommended if hip pain and stiffness are having a big effect on life and other treatments have not worked; the most common reason is osteoarthritis, and rheumatoid arthritis and damage to the hip after a fall or injury are among the other reasons [6]. OrthoInfo also lists arthritis that develops after a fracture and loss of blood supply to the head of the thigh bone (avascular necrosis) [4].
There is no absolute age or weight limit; the recommendation is based on pain and disability rather than age. People who benefit from the operation often have [4]:
- Hip pain that limits everyday activities such as walking and bending
- Pain that continues at rest, by day or by night
- Stiffness that limits the ability to move or lift the leg
- Too little benefit from anti-inflammatory medicines, physiotherapy or walking supports
Assessment and getting ready
At assessment you are asked about your general health and how the pain affects everyday activities, the hip is examined and X-rays are taken; tests such as an MRI scan are needed occasionally [4]. The surgeon discusses the alternatives to replacement and the possible risks with the patient [4]; NICE likewise stresses that patients need specific information about the treatment options available to them [5].
A general medical examination and tests such as blood and urine tests and an ECG may be requested before the operation; the doctor says which medicines to stop, and major dental treatment is best completed beforehand [4]. According to NICE, preoperative rehabilitation should include advice on exercises to do before and after surgery and on lifestyle [5]. Arranging help at home for the first weeks, fitting handrails and a raised toilet seat, and removing loose rugs make things easier [4].
The operation and hospital stay
The operation is done under a spinal anaesthetic (numb from the waist down) or a general anaesthetic (asleep) and usually takes 1 to 2 hours [1][4]. NICE states that regional and general anaesthesia are equally effective for hip replacement and recommends that the patient is offered a choice [5].
According to NICE, rehabilitation should start within 24 hours of surgery, ideally on the day of surgery [5]; the first steps are taken with crutches or a walking frame [2]. Blood-thinning medicines, compression stockings and early movement may be advised to reduce the risk of blood clots [3][4].
Length of stay varies: the NHS states that people who are generally fit and whose surgery went well can usually go home after around 1 to 3 days [2]; according to OrthoInfo some patients go home the same day while others stay in hospital for at least one night [4].
Recovery and physiotherapy
Recovery can take several months; this varies with age and general health. Before you leave hospital you are told how to manage daily activities and given an exercise programme to follow at home [2]. According to NICE, self-directed rehabilitation and supervised rehabilitation are similarly effective; separate provision should be made for people who would find it difficult to continue on their own [5]. The time frames given by the sources are general figures and vary from person to person:
- Walking: crutches or a walking frame are needed at first; walking every day, as far as is comfortable, is advised [2]
- Daily activities: most light everyday activities can be resumed within 3 to 6 weeks [4]
- Driving: the NHS advises waiting at least 6 weeks and checking with your doctor [2]
- Work: usually after about 6 weeks, depending on the type of work [2]
- Heavy lifting and carrying: avoided until you are told it is safe [2]
Risks and complications
Hip replacement is a common and safe operation; even so, as with any surgery, there are risks [3]. OrthoInfo states that the complication rate is low but that long-term illnesses may increase the risk [4]. The main risks are:
- Dislocation: the ball of the implant can come out of the socket; this is not common. The risk is greatest in the first few months, but it can also happen years later; if it keeps dislocating, further surgery may be needed [3][4]
- Infection: this can develop in the wound or around the implant days, weeks or even years after the operation. Wound infection is usually treated with antibiotics; deep infection may need further surgery [3][4]
- Blood clots: a clot can form in the leg veins (deep vein thrombosis); if it travels to the lungs (pulmonary embolism) the consequences can be serious [3][4]
- Difference in leg length: the operated leg may end up slightly longer or shorter; the difference is usually small, and sometimes a raise in the shoe is needed [3][4]
- Wear and loosening: the implant can wear or loosen over the years; further surgery (revision) may be needed [3][4]
- Injury to a nerve or blood vessel, bleeding, fracture and stiffness: these can occur [4]; the NHS states that nerve and blood vessel damage is not common [3]
How long does a hip replacement last?
With normal use, the material between the head and the socket of every hip replacement wears over time; excessive loading and excess weight can speed this up [4]. The NHS states that modern hip replacements are designed to last for at least 15 years [3]. An analysis published in The Lancet in 2019, which pooled data from the national joint registries of Australia and Finland, concluded that, assuming registry data are less likely to be biased, a hip replacement can be expected to last 25 years in about 58% of patients; in case series the figure was higher (77.6%) [7].
Living with a hip replacement
Most people have much less pain and find everyday activities easier [4][6]. Low-impact activities such as walking, swimming, golf, cycling and dancing are suitable; most surgeons advise against high-impact activities such as running and jumping [4].
To prevent dislocation you may be asked to take certain precautions during recovery; these vary from patient to patient depending on the surgical approach used [4]. Those listed by the NHS include not crossing the legs, not bending the hip more than 90 degrees and not sitting on a low chair [2]. Attending orthopaedic follow-up is advised even when there are no symptoms [4]; NICE recommends that people who have problems with their joint replacement are referred to an orthopaedic service [5].
When not to wait
After the operation, seek care without delay if you have any of the following; they can be signs of infection or a blood clot [3][4]:
- A high temperature, chills or shivering
- Oozing or pus from the wound
- Redness, tenderness, swelling or pain in the hip or leg that is not settling or is getting worse
- Tenderness or redness of the calf, or throbbing or cramping pain in the hip or leg
- Sudden breathlessness or chest pain (a clot may have travelled to the lungs): go to an emergency department or call an ambulance
Frequently asked questions
- Is there an age limit for hip replacement?
- There is no absolute age or weight limit; the recommendation is based on pain and disability rather than age. Most people who have the operation are aged 50 to 80 [4].
- How long will I stay in hospital?
- It varies. The NHS states that people who are generally fit can usually go home after around 1 to 3 days [2], while OrthoInfo notes that some patients go home the same day [4].
- When can I drive?
- The NHS advises waiting at least 6 weeks and checking with your doctor that you are fit to drive [2].
This is a general summary; the restrictions and timing are set by the instructions of the surgeon who operated.
Sources
- How a hip replacement is done. NHS (nhs.uk), 2024. nhs.uk
- Recovering from a hip replacement. NHS (nhs.uk), 2024. nhs.uk
- Complications of a hip replacement. NHS (nhs.uk), 2024. nhs.uk
- Total Hip Replacement. American Academy of Orthopaedic Surgeons (OrthoInfo), n.d.. orthoinfo.org
- Joint replacement (primary): hip, knee and shoulder (NG157): Rationale and impact. National Institute for Health and Care Excellence (NICE), 2020. nice.org.uk
- Why a hip replacement is done. NHS (nhs.uk), 2024. nhs.uk
- How long does a hip replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up. The Lancet (Evans JT, et al.), 2019. pubmed.ncbi.nlm.nih.gov
This article is general information and does not replace an examination or imaging. If you have symptoms, see a doctor.