Overall the percentage of patients who are satisfied (defined as result being excellent, very good or good) with their hip replacement is 92%. The percentage of patients who considered their hip replacement operation a success (defined as much better or a little better) was 94%. Both figures are from this 2022 publication, click here. The National Joint Registry has an online tool (Patient Decision Support Tool) that can estimate the benefit you personally may gain after surgery, the risk of later revision surgery and the risk of death at one year post surgery, which you may find helpful. To access this, please click here.

The principal reason to have a total hip replacement is pain relief, although an improvement in your ability to perform daily activities can also be expected. The vast majority, if not all, of your pain will go, although if asked closely 13% of people will say they are still aware of some mild discomfort. If you have pain at night that disturbs your sleep, I would expect this to go. I would expect the distance you can walk in comfort to increase and activities such as swimming, cycling, horse riding and going to the gym to be possible. Although some people will run on a replaced hip, most implant surgeons would advise that this is limited as repetitive impact will wear the replaced joint more rapidly.

People often ask how long a new hip will last. Many still think that it is about 10 years. In reality, it is usually much longer. Ninety-five per cent of modern implants will still be in and functioning well 15 years after surgery and perhaps 58% will last 25 years as mentioned in The Lancet.

There are a variety of types of hip replacement made of different materials and fixed in place by different methods. I can discuss what would be the most suitable for you at the time of your consultation. I only use implants with a tried and tested history. Implants quality is defined by an organisation called ODEP.

If you would like to look at the implants that I use, they are as follows:

C-stem AMT 

ML Taper  

Allofit Cup 

Marathon Cup  

If you are otherwise healthy and everything goes well, I would expect you to be in hospital for one or maybe two nights. Occasionally people go home the same day as the operation, but this applies to only a small proportion of hip replacement patients. Before you go home any pain will be under control, you will be walking with crutches and will have practised going up and down stairs with the physiotherapists. The wound dressing will be intact (this stays on for two weeks until your skin clips are removed).

You will then get stronger and more confident over the coming weeks. Most people have discarded their crutches by four to six weeks, but if you used a stick before the operation you may feel you need some support for a little longer.

There used to be some hard and fast rules about what you couldn’t do after a hip replacement (lying on your back and not bending more than 90 degrees etc) but the modern evidence is that these aren’t necessary, and you can gradually resume normal activities as you feel confident.

Depending on the physicality of your work, it will be between two and three months before you can return, sometimes on a phased basis.

Although total hip replacement surgery is very successful, it is still a major operation and complications do occur.

The commonest complications are outlined below:

Deep infection (around 1%): This will be higher if you are diabetic, have an inflammatory arthritis or are taking drugs that affect your immune system e.g. steroids. Although this can sometimes be treated with antibiotics, some people need to undergo further major surgery to remove and exchange the original components.

Blood clots (about 2% in the leg and 0.5% in the lung): The risk will be higher if you have had a clot before; if you are significantly overweight; have a family history of clotting; have an inherited condition that affects your clotting or have certain cancers, even if currently controlled or in remission. Women taking some forms of HRT or oral contraception are also at higher risk and a discussion would take place about whether this should be stopped in the run-up to surgery.

Dislocation (<1%): This happens if you bend and twist the wrong way in the weeks after surgery. It is painful and will require another anaesthetic to allow the hip to be pulled back into joint. Most people only have one episode, but a small number of patients will need a further operation to stabilise the hip. The worst aspect of dislocation is not that it is painful, but that you don’t trust the hip afterwards, and it can take some time to get your confidence back. The risk of dislocation is higher in patients with previous spinal fusion surgery and those with some neurological disorders, but this risk can be mitigated to some degree by implant selection.

Leg length difference (1%): Although every effort is made for you to have both legs the same length after the operation, there is a margin of error, mainly due to the difficulty in assessing soft tissue tension at the time of surgery. Slight differences are well tolerated, and it is only a small number of people who require a raise in a shoe. Patients may have pre-existing differences in their leg length due to previous injury, the severity of the arthritis in the hip or spinal disease and this can be discussed with me at your appointment.

Damage to nerves and vessels (0.1%): This is exceedingly rare in modern hip surgery. The commonest injuries are to the femoral nerve giving numbness and weakness to the thigh or to a part of the sciatic nerve giving a weakness to the foot. Around half of these would be expected to recover fully.

Intraoperative fracture (0.5%): Bone is hard, and hammers and broaches are used as part of the surgical technique. Occasionally there is a crack in the bone. This is often noted at the time of surgery and dealt with immediately, with the replacement then proceeding as planned. Rarely it is noted after the surgery and may need a return to theatre to fix the problem.

Blood Transfusion (less than 5%): Blood transfusion is now uncommon after joint replacement, and in my hands the rate runs at less than 5%. We take steps to optimise your blood count before surgery, as the risk of transfusion is higher in those patients with low haemoglobin levels. A few patients with some chronic conditions  (e.g. kidney disease or rheumatoid arthritis) can’t have their blood count normalised and that would be discussed with you before your surgery.

If you don’t want to receive blood or blood products, that wish would be respected and documented when you consent for the surgery.

Consent form

While the above sections cover the commonest risks associated with the surgery, there are more. Different organisations produce consent forms to cover as much as possible. It is very difficult for any patient to retain and recall all of this information in the time available during a consultation. I have included here a link to the Ramsay Healthcare Hip Replacement consent form. If you are considering total hip replacement surgery, please read this through as it may help you identify any questions to bring to your consultation or your pre-op review appointment.

Mortality after hip replacement surgery: Patients often ask about the risk of death after a big operation. This is often very difficult to be precise about, but the NCEPOD in the UK had a tool that uses age and general health to give an estimate. The general health is described using something called the ASA score. ASA1 is fit and healthy, ASA2 means you have some other condition e.g. diabetes, but it is well controlled, ASA3 means your general health has a greater effect on your quality of life e.g. COPD limiting your mobility or angina and ASA4 means your health is very poor. It would not be possible to perform surgery at Fulwood Hall if you fall into the ASA4 category. The estimate of your ASA status wouldn’t be finalised until you have your pre-op assessment.

The table below gives an estimated mortality at 30 days for patients undergoing hip replacement.

Patients with other medical problems: Many patients will have mild medical problems such as high blood pressure, well controlled on medication. This doesn’t add a significant risk to having major surgery. Some however, will have more serious underlying heart, lung or kidney problems that may increase the risk of complications. This would apply to any major surgery requiring an anaesthetic and are not specifically linked to hip replacement. This can be discussed at your orthopaedic appointment, but if significant would also need to be discussed with the anaesthetist at your pre-op check. Sometimes your surgery would be postponed while further tests or specialist consultations occur. In some circumstances it would not be possible to perform surgery at Fulwood Hall and your care would need to be transferred to the local NHS Trust.

Medication: Some tablets that you take may need to be temporarily stopped in the run-up to your operation. This will be discussed and confirmed with you at your pre-operative check.

Anaesthetic: The operation is usually carried out under spinal (epidural) anaesthetic, with sedation as needed - you do not have to be awake. This will be discussed in more detail, as well any risks involved with the anaesthetist.

A video explaining the process of Hip Replacement Surgery can be found here.

Surgery in the time of Covid-19: The pandemic has caused some changes to be made around planning major surgery. Surgery is safe in fully vaccinated people who test negative. There is no longer a need to isolate or have a routine test prior to your surgery. However if you do contract Covid then you still cannot have surgery for a period of seven weeks from the positive test (accurate as of September 2023).