A detailed guide to total hip replacement for advanced hip arthritis, including benefits, alternatives, risks and recovery.
01
Why might this treatment be considered?
Total hip replacement may be considered when advanced hip arthritis causes substantial pain, stiffness, disturbed sleep or reduced mobility, and appropriate non-surgical treatment is no longer giving acceptable relief. The aim is to improve pain and function—not simply to treat an X-ray.
02
What does the procedure involve?
The hip is a ball-and-socket joint. During total hip replacement, the damaged femoral head is removed and replaced with a stem and ball. The worn socket is prepared and replaced with an artificial cup and bearing. Implant type, bearing surface and fixation are selected for the individual patient. An artificial hip cannot reproduce a normal joint, but the aim is a stable, comfortable and durable reconstruction.
Total hip replacement. The damaged ball and socket are replaced by an acetabular cup and bearing, together with a femoral head and stem. Original patient-education illustration.The implant components. The femoral stem and head articulate with a liner seated inside the acetabular shell. Original patient-education illustration.
03
Potential benefits
Substantial relief of arthritic pain for most appropriately selected patients
Improved sleep when night pain has been a problem
Improved walking, mobility and ability to perform everyday activities
Better function, independence and quality of life
04
Reasonable alternatives
Physiotherapy and an individual exercise programme
Activity modification and pacing
Weight optimisation where appropriate
Pain relief or anti-inflammatory medication when medically suitable
A walking stick or other mobility aid
A hip injection in selected circumstances
Delaying or deciding not to have surgery
05
Important risks and limitations
Every procedure carries risk. The likelihood and importance of each risk vary between individuals.
Blood clots in the leg (DVT), which can travel to the lungs as a pulmonary embolus (PE) and may be life-threatening
Bleeding that may require transfusion
Postoperative pain, deep bruising or a haematoma; evacuation is occasionally required
Superficial or deep infection, which may require antibiotics, washout or staged revision surgery
Wound-healing problems
Hip dislocation; this can sometimes be reduced without an operation but persistent or recurrent dislocation may require further surgery
A difference in leg length
Wear or loosening of the replacement over time, with possible revision surgery
Fracture of the bone during component insertion or after surgery
Nerve injury, particularly to the sciatic nerve, causing altered sensation or weakness that may be temporary or permanent
Injury to blood vessels around the hip, which may require vascular repair
Ongoing pain, stiffness or less improvement than hoped
Anaesthetic and medical complications including chest infection, heart attack or stroke, and a very small risk of death
06
Recovery and expectations
Early mobilisation usually begins soon after surgery with support from the ward and physiotherapy teams.
Pain, swelling, bruising and tiredness are expected initially and improve at different rates.
Physiotherapy and adherence to the early rehabilitation plan help restore strength and movement and reduce complications, including dislocation risk.
The length of stay, walking aids, precautions and return to driving, work and exercise are personalised.
Recovery continues over several months; progress is influenced by pre-operative mobility, muscle strength and general health.
Shared decision-making
This information is a starting point for shared decision-making. During consultation, you will have time to ask questions and discuss the benefits, material risks, alternatives and the option to delay or decline surgery before deciding whether to proceed.
National Joint Registry evidence
Outcomes and revision surgery
The National Joint Registry (NJR) records joint replacement outcomes across the UK. Revision means a further operation in which part or all of the implant is removed, exchanged or added to.
Measure
Published NJR evidence
What this means
Modern hip replacement longevity
About 92% surviving at 30 years
A 2026 NJR-supported international study estimated that modern bearings could remain unrevised for at least 30 years in 92% of patients.
Well-performing implant combinations
Less than 2% revised at 10 years
The 2025 NJR report identified numerous cemented, uncemented, hybrid and reverse-hybrid combinations below this level.
Deep infection
Typically less than 1%
The NJR describes infection as uncommon, although an individual patient’s risk depends on their health and circumstances.
Important context
These are population and implant-level figures, not a prediction for one person. Age, general health, diagnosis, implant choice and other factors affect individual risk. The 30-year figure is a modelled estimate based on contemporary implants and long-term registry evidence rather than 30 years of direct follow-up for every implant.
Your diagnosis, expected benefit, material risks, alternatives and recovery plan will be discussed individually. You can take time to ask questions and may delay or decline treatment.
