The hip is a ball-and-socket joint. The rounded head of the thigh bone, or femur, fits into the acetabulum, a socket in the pelvis. Smooth articular cartilage cushions the surfaces; the synovial membrane produces lubricating fluid. A capsule and ligaments help hold the joint stable while allowing movement. Muscles around the hip contribute to walking and balance.

In osteoarthritis, cartilage becomes thinner and joint tissues change as the body attempts repair. This can lead to pain and stiffness, although changes in a joint do not always cause symptoms. In rheumatoid arthritis, immune-driven inflammation can damage joint tissues. Hip pain can also have causes outside the joint, so a painful area alone does not confirm the diagnosis.

Hip replacement may be considered when pain, stiffness or loss of function substantially affects daily life and non-surgical management has not helped enough or is unsuitable. Osteoarthritis is the usual reason for planned surgery; inflammatory arthritis, damage after injury and loss of blood supply to the femoral head are other possible reasons. This guide focuses on a first, planned replacement in adults. A fracture after a fall can need urgent treatment and a different operation and timetable.

The assessment includes your symptoms, sleep, walking, work and daily tasks, medical history and an examination of hip movement and strength. NICE says typical osteoarthritis can often be diagnosed clinically without imaging in people aged 45 or over with activity-related joint pain and either no morning stiffness or stiffness lasting no more than 30 minutes. Unusual features or another possible diagnosis may need investigation. A surgical assessment can use X-rays to understand damage and plan treatment; an image is interpreted alongside symptoms, not in isolation.

NICE advises considering referral for joint replacement when osteoarthritis substantially affects quality of life and non-surgical treatment is ineffective or unsuitable. Its guidance says not to exclude a person from referral solely because of age, sex or gender, smoking, other conditions or body mass index. These factors can still affect the risks and need an individual discussion.

For osteoarthritis, NICE identifies tailored therapeutic exercise and, when appropriate, weight management as core treatments. A physiotherapist can help adapt strengthening and aerobic activity to your ability. A walking aid may reduce load and improve stability. If an agreed plan is not helping, ask for a review rather than assuming that worsening function must simply be endured.

Medicines may support activity but need a safety review. NICE advises considering an oral anti-inflammatory when topical treatment is unsuitable or ineffective, taking account of heart, kidney, liver and gastrointestinal risks, other medicines and pregnancy, and offering stomach protection. An injection of corticosteroid into the joint may be considered when other medicines are unsuitable or ineffective, or to support exercise; NICE describes its benefit as short term. Discuss options with a clinician, especially if you take anticoagulants or have other conditions.

Surgery is a choice made around your goals and circumstances. Ask what improvement is realistic, what might remain difficult, the risks of surgery and the consequences of continuing the present plan. Valid consent is voluntary and informed; a person with capacity can change their mind before the procedure. The NHS England hip osteoarthritis decision aid can help organise these questions.

In a primary total hip replacement, the surgeon removes the damaged femoral head and prepares the pelvic socket. A stem sits in the thigh bone, a new ball attaches to it, and a replacement socket with a bearing surface is fitted into the pelvis. The ball moves against the socket or its liner. The rest of the leg and pelvis remain; the implant replaces the damaged joint surfaces rather than growing a new natural hip.

A partial replacement changes the ball but leaves the existing socket; it can be used in some serious injuries or frail patients and has a different purpose from routine elective total replacement. Resurfacing is another operation in which the ball is capped rather than removed. Suitability depends on the person and their bone, and it should not be assumed interchangeable with a total replacement.

The surgical approach describes the route into the hip, not the type of implant. NICE recommends considering posterior or anterolateral approaches for primary elective replacement. It could not make recommendations for direct anterior, direct superior or SuperPATH approaches on the evidence it reviewed. Ask why a particular approach is proposed, what movement guidance follows it and how your own anatomy affects the choice.

An implant may use a metal or ceramic ball with a plastic or ceramic bearing surface. Fixation is a separate decision: bone cement can secure a component; an uncemented component is fitted so bone can grow onto or into its surface. A hybrid can combine a cemented stem with an uncemented socket. Bone quality and the design matter; ask about the specific implant and the evidence for its performance, rather than assuming one material suits everyone.

Some older implants have a metal ball and metal socket. NHS England advises regular checks for people with a metal-on-metal implant and contacting the care team for new pain, reduced mobility or clicking. Ask what implant you will receive and keep its details for future care.

The intended benefits are less pain and better movement and daily function. Most people improve, but results vary and surgery does not guarantee pain-free movement or the same range as a natural hip. Other problems, including pain from elsewhere, may still affect activity. Compare the expected benefit with the demands of recovery and the chance of complications or later surgery.

The PROHIP randomised trial compared total replacement with resistance training in 109 adults aged 50 or over who had severe hip osteoarthritis and an indication for surgery. At six months, those assigned surgery reported greater average improvement in hip pain and function. Some assigned exercise later had surgery, and some assigned surgery had not had it by six months. The result describes these groups at that time, not an individual guarantee or proof that exercise has no value before or after surgery.

Pre-assessment checks your health and may include blood tests, an ECG or imaging. Bring a list of prescribed medicines, non-prescription products, supplements and allergies; tell the team about blood thinners, past anaesthetic problems and any new illness or infection. Ask which medicines to continue or pause and when to restart them. Follow your hospital’s own instructions about eating and drinking before anaesthesia.

NICE recommends advice on exercises before and after surgery, diet, smoking cessation and maintaining independence. Make a practical plan for transport, meals, washing, caring responsibilities and getting around at home. Put frequently used items within reach, remove trip hazards and ask an occupational therapist whether a raised seat, reacher or other equipment would help.

The anaesthetic may be spinal, which numbs the lower body, sometimes with sedation, or general, which makes you unconscious. NICE recommends offering people having primary elective hip replacement a choice of regional or general anaesthesia combined with local infiltration pain relief, with a suitable alternative nerve block considered in some circumstances. The anaesthetist can explain what fits your health and preferences.

The surgeon accesses the joint through an incision, removes the damaged ball, prepares the socket and thigh bone, fits and joins the components, and closes and dresses the wound. The NHS describes the operation as usually taking about one to two hours, though individual circumstances differ. Afterwards the recovery team monitors you and provides pain relief. Ask what happened during your operation and whether the plan changed.

A wound can become infected; a deeper infection around the implant can require further surgery. Other risks include bleeding, fracture, injury to nerves or blood vessels, a difference in leg length and persistent pain. A hip can dislocate when the ball comes out of the socket. A dislocation can sometimes be put back without further surgery, but repeated dislocations may need an operation. These risks are individual, not a prediction for you.

A deep-vein clot can develop in the leg and sometimes travel to the lungs. Your team assesses clot and bleeding risks and may recommend early movement, compression and blood-thinning medicine. Ask how long any medicine or stockings are needed and what to do if you miss a dose or have side effects. Do not stop or change an anticoagulant without the prescribing team’s advice. Warning signs and UK urgent-care routes are at the start of this guide.

A therapist helps you start moving and walking, initially with a frame or crutches. NICE recommends rehabilitation on the day of surgery if possible and within 24 hours, including mobility, daily activities and a home exercise programme. You can usually go home when the wound is healing and you can get around safely. Some people leave on the day of surgery; others need a longer stay.

Pain, bruising and swelling can occur while tissues heal. Before discharge, ask about dressings, washing, wound checks, pain medicines, constipation, clot prevention, follow-up and a number to call. Walk and do the exercises your team prescribes, building up gradually. If pain prevents progress or home exercises do not meet your goals, ask for help: NICE recommends supervised rehabilitation for people with ongoing functional difficulties or unmet rehabilitation needs.

Your team’s instructions on weight bearing and positions take priority because the operation and your circumstances matter. NHS England advises against crossing your legs, bending the hip beyond a right angle or using a low chair or toilet during recovery. Ask how long your own precautions apply and how to get in and out of bed, dress, use stairs and sleep comfortably. Do not force a movement that you have been told to avoid.

Recovery can take several months. NHS England advises waiting at least six weeks before driving and checking with your doctor that you are fit to drive; work and sexual activity also depend on healing and the activity involved. Ask when you can safely make an emergency stop, travel, lift, return to your particular job and resume exercise or sex. Agree a plan for activities involving impact, twisting or falls with your team.

Implants can last many years, but wear or loosening can occur and some people need revision, a further operation to replace one or more components. Infection, fracture and repeated dislocation can also lead to revision. The procedure and recovery depend on the cause and may differ substantially from a first replacement. New or worsening pain, a limp or loss of function later on deserves reassessment; NICE recommends referral to an orthopaedic service for these symptoms.

Ask what follow-up is planned, how to report problems and how to obtain the details of your implant. The National Joint Registry collects and monitors information about replacements; NHS England says patients will be asked about consent to provide their personal and implant details. Follow local arrangements for ongoing checks, including any specific advice for the implant you have.