When Is Hip Replacement Necessary?

What is a hip replacement?

The hip is a ball-and-socket joint. In a total hip replacement, the worn ball at the top of the thigh bone and the damaged socket in the pelvis are replaced with artificial parts. The aim is to relieve pain and improve walking and movement. In some hip fractures, only the ball is replaced; this is called a hemiarthroplasty.

Which conditions lead to hip replacement?

• Osteoarthritis: gradual wear of the joint cartilage, the most common reason.
• Avascular necrosis (AVN): loss of blood supply to the ball of the hip, which can cause it to collapse. Risk factors include steroid use and heavy alcohol use, though sometimes no cause is found.
• Inflammatory arthritis, such as rheumatoid arthritis or ankylosing spondylitis.
• Childhood hip conditions, such as hip dysplasia, that lead to early arthritis.
• Hip fractures in older adults, and arthritis following earlier injury.

Some of these conditions, particularly fractures, are managed alongside fracture care.

Which symptoms suggest it may be time to consider surgery?

Hip arthritis pain is often felt in the groin, and sometimes in the thigh, buttock or even the knee. Signs worth discussing with a specialist include:

• Pain that limits walking distance or wakes you at night.
• Difficulty putting on socks and shoes, or cutting toenails.
• A limp, or one leg feeling shorter.
• Stiffness getting in and out of a car or sitting cross-legged.
• Needing more pain relief to manage daily tasks.

How is the hip assessed?

Assessment begins with your history and an examination of the hip's movement, gait and leg length. The spine and knee are also checked because back problems can cause pain around the hip. X-rays of the pelvis and hip usually show arthritis clearly. An MRI scan is useful for suspected early avascular necrosis or when X-rays do not explain the symptoms.

What can be tried before surgery?

For many people with early hip arthritis, non-surgical care helps for a time:

• Exercise and physiotherapy to keep the hip moving and strengthen the muscles around it.
• Weight management where relevant.
• Pain relief chosen and monitored by your doctor.
• A walking stick held in the opposite hand, and changes to daily activities.
• Injections in selected cases, mainly to help with diagnosis or short-term relief.

In early avascular necrosis, joint-preserving procedures are sometimes discussed. When symptoms remain severe despite these measures, replacement may be considered.

What are the risks of hip replacement?

Hip replacement is a major operation. Risks include infection, blood clots, dislocation of the new joint, a difference in leg length, fracture around the implant, nerve injury and, in the longer term, wear or loosening that may need revision surgery. Your surgeon will explain how your general health affects these risks and what precautions you may need after surgery.

How do you decide the timing?

For arthritis and avascular necrosis, hip replacement is usually a planned decision rather than an emergency. The key question is whether the hip limits your life enough, despite good non-surgical care, to make the risks and recovery of surgery worthwhile. Your surgeon can explain the findings, but the timing is a shared decision.

Some situations may favour not waiting too long. These include rapidly worsening pain, collapse of the ball of the hip in avascular necrosis, increasing shortening of the leg, or stiffness and muscle weakness that could make recovery harder. On the other hand, people with mild symptoms who are coping well can often continue with non-surgical treatment and be reviewed later.

General health matters too. Conditions such as diabetes, heart disease, anaemia and skin infections are usually optimised before planned surgery to reduce risk.

What does recovery usually involve?

After surgery, physiotherapists help you stand and walk with support, often soon after the operation if it is safe. You will learn exercises to strengthen the hip muscles, how to manage stairs and how to get in and out of bed, chairs and cars safely. Depending on the surgical approach and your surgeon's advice, you may be asked to avoid certain positions for a time to lower the risk of dislocation.

Many people reduce their reliance on walking aids over several weeks and continue to improve for months. Low-impact activities such as walking and swimming are commonly encouraged later. These are typical ranges that vary between people. Our article on knee replacement recovery describes a similar staged approach for knees.

When should you see a specialist?

Consider an orthopaedic assessment if hip or groin pain has lasted for several months, is affecting walking, work or sleep, or keeps getting worse despite exercise and simple measures.

When to seek urgent care: go to the nearest emergency department if you cannot stand or walk after a fall, if your leg looks shortened or turned outwards, or if you develop a hot, painful hip with fever.

Discuss your situation with Dr. Karnav Panchal to learn whether hip replacement or another treatment is appropriate for you.

Common questions