Short answer
A total hip replacement replaces the worn ball and socket of the hip with artificial parts made of metal, plastic or ceramic.5 It is usually considered when hip pain and stiffness, most often from osteoarthritis, have a big effect on life and other treatments have not worked.1 It does not suit every cause of hip pain, and a minority of people still report pain afterwards.13 Implant choice, surgical approach and personal risk factors all need an in-person assessment.
Decision snapshot
| Question | Snapshot |
|---|---|
| Main reason | Osteoarthritis pain and stiffness not helped by other treatment |
| Types | Total replacement, partial replacement (ball only) or resurfacing |
| Operation | Usually 1 to 2 hours, under spinal or general anaesthesia |
| Hospital stay | Usually 1 to 3 days |
| Driving and work | Driving after at least 6 weeks; work after about 6 weeks |
| Long-haul flights | One NHS orthopaedic hospital advises waiting about 3 months |
| Implant survival | About 58% in place at 25 years in registry data from older implants |
On this page
- What a hip replacement is
- What may be causing the hip pain
- Who may be considered
- Alternatives
- Procedure, approaches and anaesthesia
- Recovery and rehabilitation
- How long a hip replacement lasts
- Pain and comfort
- Risks and complications
- How strong is the evidence?
- Bearing surfaces and metal-on-metal
- Cost drivers and quotes
- Frequently asked questions
- Sources
What a hip replacement is
In a total hip replacement, the ball at the top of the thigh bone is replaced with a metal or ceramic ball, and the socket with a plastic or ceramic socket. It is the most common type.5
A partial replacement replaces only the ball and is mainly offered to frail people or after a serious hip injury. Resurfacing caps the ball with metal instead of removing it; it does not work well with weaker bone and may be offered to people around 50 or younger.5
What may be causing the hip pain
Osteoarthritis is the most common reason for hip replacement; rheumatoid arthritis and injury are others.1 Many causes of hip pain are not treated with a new joint:2
- Sprain, strain or tendonitis after intense or repetitive exercise.
- Bursitis, with pain spreading to the thigh and worse when lying on that side.
- Rheumatoid arthritis, with stiffness worse after rest, which needs medical treatment of its own.
- Joint infection or fracture, both urgent.
NICE (the National Institute for Health and Care Excellence) says osteoarthritis can be diagnosed clinically in people aged 45 or over with activity-related joint pain and no, or only brief, morning stiffness.3
What it may change
Pain and stiffness caused by worn bearing surfaces, and the walking and daily-activity limits that come with them.1
What it will not change
Pain from tendons, bursae or elsewhere, and arthritis in other joints. A systematic review found 7% to 23% of people reported an unfavourable long-term pain outcome after hip replacement.13
Who may be considered
NICE advises considering referral when symptoms substantially affect quality of life and non-surgical treatment has not been effective. Age, sex, smoking, other illnesses or body mass index (BMI) alone should not exclude someone from referral.3
When a responsible clinician may advise against it
- When the diagnosis is uncertain or core non-surgical care has not been tried.3
- When there is an active infection, or no plan for rehabilitation and follow-up.
Alternatives
NICE guideline NG226 recommends tailored therapeutic exercise for everyone with osteoarthritis and weight loss for people with overweight. Oral anti-inflammatory medicines may be considered with attention to risks, while paracetamol and weak opioids are not routinely recommended. Steroid injections give only short-term relief (2 to 10 weeks), and hyaluronan injections should not be offered.3
No treatment is a legitimate option
Elective hip replacement can be delayed. Managing symptoms and reviewing the decision later is reasonable when pain is tolerable.
Procedure, approaches and anaesthesia
The operation usually takes 1 to 2 hours, under a spinal anaesthetic (awake, numb from the waist down, sometimes with sedation) or a general anaesthetic.5 NICE recommends a choice of regional or general anaesthesia combined with local infiltration analgesia (LIA, numbing medicine injected around the joint), and tranexamic acid to reduce bleeding.4
Surgical approach. The approach is the route the surgeon takes to reach the joint. NICE advises considering a posterior (from behind) or anterolateral (from the side and front) approach.4 Claims of faster recovery with the direct anterior approach have been tested in trials. A 2020 meta-analysis of 7 randomised trials (600 patients) found less pain on days 1 and 2 and better function at 6 weeks with the anterior approach, but no difference at 3, 6 or 12 months, about 14 minutes longer surgery, and no significant difference in dislocation or overall complications. The authors judged evidence of superiority insufficient.8
Recovery and rehabilitation
NICE recommends starting rehabilitation on the day of surgery if possible, and within 24 hours. People struggling with daily activities, or whose self-directed exercise is not meeting their goals, should be offered supervised outpatient rehabilitation.4
| Milestone | Typical timing |
|---|---|
| Going home | About 1 to 3 days |
| Crutches or frame | Until the physiotherapist says to stop |
| Driving | At least 6 weeks, once fit |
| Work | About 6 weeks, depending on the job |
| Follow-up appointment | Usually 6 to 12 weeks |
| Full recovery | Several months |
Early on, people are usually told not to bend the hip beyond 90 degrees, cross their legs or sit in low chairs, and to avoid jumping, sudden turns and heavy lifting until cleared.6
How long a hip replacement lasts
The NHS says modern hip replacements are designed to last at least 15 years.7 A 2019 meta-analysis of registry data estimated that 89.4% of total hips were still in place at 15 years and 57.9% at 25 years. The 25-year figure came from Finland alone, and some components studied are no longer used in the UK.12
UK registry data on more recent implants look reassuring. The National Joint Registry (NJR) estimates 2.7% cumulative revision at 10 years for hips implanted in 2014, against a NICE benchmark of under 5% at 10 years.9
Pain and comfort
The operation is not felt, because of the anaesthetic.5 LIA, and sometimes a nerve block that does not weaken the leg, eases the first hours and days.4 Pain relief is given in hospital, and staff help people walk soon after surgery.6 Soreness and stiffness are expected for weeks.
Risks and complications
Expected temporary effects: pain, swelling, stiffness and reliance on walking aids for several weeks.6
Recognised complications:7
- Dislocation, which is not common but can happen soon after surgery or years later, and may need another operation.
- Leg-length difference, often too small to notice; a raised heel on the other shoe may help.
- Wound infection, usually treated with antibiotics.
- Blood clots (DVT), reduced with stockings or blood-thinning medicine.
- Nerve, vessel or ligament injury, uncommon.
Rare serious complications: deep joint infection, which may need further surgery and can appear months or years later,14 and pulmonary embolism (PE), a clot in the lungs that can be life-threatening.15
Urgent warning signs
The NHS advises urgent advice for throbbing or cramping hip or leg pain; a high temperature or feeling hot, cold or shivery; oozing or pus from the wound; or worsening redness, swelling or pain. Hip or leg pain and swelling with breathing difficulty or chest pain needs emergency care.7
How strong is the evidence?
| Claim | Vireon assessment | What supports it | Important limitation |
|---|---|---|---|
| Modern hips rarely need revision within 10 years | Strong | NJR registry data9 | Revision misses pain without reoperation |
| Anterior approach gives better long-term results | Insufficient | Meta-analysis of 7 trials8 | Small trials; benefit limited to early weeks |
| Metal-on-metal bearings perform worse | Strong | NJR; MHRA alert911 | Most patients with these hips do well |
| Ceramic-on-polyethylene performs well | Moderate | NJR registry data9 | Observational; patients not randomised |
| Dislocation risk | Uncertain incidence | NHS guidance7 | No verified rate given here |
| Long-term pain in a minority | Moderate | Systematic review13 | Varied measures; missing data |
Registry data show what happens across thousands of patients but cannot fully separate the effect of an implant from the patients and surgeons who use it. Approach trials are small, and surgeons cannot be blinded.8
Bearing surfaces, metal-on-metal and red flags
The bearing surface is the pair of materials that rub together. In NJR data, ceramic-on-polyethylene has performed consistently well and its use is increasing; dual-mobility designs show higher early revision; and metal-on-metal bearings “continue to perform worse than all other options regardless of fixation”.9
In 2017 the Medicines and Healthcare products Regulatory Agency (MHRA) updated its advice on all metal-on-metal hips because some patients develop soft tissue reactions to wear debris, sometimes without symptoms.10 Alert MDA/2017/018 sets follow-up schedules by device type, with blood cobalt or chromium of 7 parts per billion or more prompting closer follow-up and imaging such as MRI with metal artefact reduction (MARS MRI).11 Anyone with such a hip should keep up regular check-ups.7
Red flags include no named implant, claims that one approach is clearly superior, and a long-haul flight planned within days of surgery.16 See medical travel red flags.
Cost drivers and what a quote should include
Cost depends on the implant and bearing, anaesthesia, length of stay and physiotherapy. A quote should name the implant manufacturer, model and bearing surface, and list tests, hospital nights, clot-prevention medicine, physiotherapy, follow-up X-rays and who pays if a complication needs treatment. See what a treatment quote should include.
If you are travelling for treatment
- The cause of pain and fitness for surgery need in-person assessment.
- The Royal Orthopaedic Hospital advises avoiding flights over 4 hours for at least 4 weeks after any surgery, and about 3 months after hip replacement before journeys over 4 hours.16
- On long journeys, move about every hour, drink water and avoid alcohol.15
- Arrange physiotherapy at home in advance and carry implant details. See aftercare at home and DVT and travel.
Questions worth asking a clinician
- Is my pain coming from the hip joint itself?
- Which approach and bearing surface do you use, and why for me?
- What does registry data show for the implant you plan to use?
- How will you check leg length and reduce dislocation risk?
- How will clot risk be managed on the journey home?
Frequently asked questions
Does hip replacement hurt?
The surgery is done under anaesthesia; afterwards, pain and stiffness are expected for weeks and are managed with pain relief.56
When can I drive and work?
Usually after at least 6 weeks for driving and about 6 weeks for work, depending on the job.6
When can I fly home?
This should be agreed with the surgical team; one NHS orthopaedic hospital advises about 3 months before journeys over 4 hours.16
Is the anterior approach better?
Not clearly: trials show slightly easier early recovery but similar results from 3 months onwards.8
Bottom line
Hip replacement has strong long-term registry data, and modern implants rarely need revision within a decade. Trials have not shown that one surgical approach gives clearly better long-term results, while bearing choice has a documented history. Rehabilitation, clot prevention and follow-up at home deserve as much planning as the operation.
Related reading
Sources
- NHS. Hip replacement: why it’s done. NHS website. https://www.nhs.uk/tests-and-treatments/hip-replacement/why-a-hip-replacement-is-done/ Accessed 5 November 2026.
- NHS. Hip pain. NHS website. https://www.nhs.uk/conditions/hip-pain/ Accessed 5 November 2026.
- National Institute for Health and Care Excellence. Osteoarthritis in over 16s: diagnosis and management (NG226). NICE; 2022. https://www.ncbi.nlm.nih.gov/books/NBK588843/ Accessed 5 November 2026.
- National Institute for Health and Care Excellence. Joint replacement (primary): hip, knee and shoulder (NG157). NICE; 2020. https://www.ncbi.nlm.nih.gov/books/NBK561385/ Accessed 5 November 2026.
- NHS. Hip replacement: how it’s done. NHS website. https://www.nhs.uk/tests-and-treatments/hip-replacement/how-a-hip-replacement-is-done/ Accessed 5 November 2026.
- NHS. Recovering from a hip replacement. NHS website. https://www.nhs.uk/tests-and-treatments/hip-replacement/recovering-from-a-hip-replacement/ Accessed 5 November 2026.
- NHS. Complications of a hip replacement. NHS website. https://www.nhs.uk/tests-and-treatments/hip-replacement/complications-of-a-hip-replacement/ Accessed 5 November 2026.
- Peng L, Zeng Y, Wu Y, et al. Clinical, functional and radiographic outcomes of primary total hip arthroplasty between direct anterior approach and posterior approach: a systematic review and meta-analysis. BMC Musculoskeletal Disorders; 2020;21:338. doi:10.1186/s12891-020-03318-x. https://link.springer.com/article/10.1186/s12891-020-03318-x Accessed 5 November 2026.
- National Joint Registry. 22nd Annual Report 2025, chapter 3: Outcomes after joint replacement 2003 to 2024. NJR; 2025. https://www.ncbi.nlm.nih.gov/books/NBK618761/ Accessed 5 November 2026.
- Medicines and Healthcare products Regulatory Agency. All types of metal-on-metal hip implants need regular review. GOV.UK; 2017. https://www.gov.uk/government/news/all-types-of-metal-on-metal-hip-implants-need-regular-review Accessed 5 November 2026.
- Medicines and Healthcare products Regulatory Agency. Medical Device Alert MDA/2017/018: All metal-on-metal (MoM) hip replacements: updated advice for follow-up of patients. MHRA; 2017. https://assets.publishing.service.gov.uk/media/5954ca1ded915d0baa00009b/MDA-2017-018_Final.pdf Accessed 5 November 2026.
- NIHR Evidence. More than 50% of hip replacements appear to last 25 years (summary of Evans JT, et al. How long does a hip replacement last? Lancet 2019;393:647-54). NIHR; 2019. https://evidence.nihr.ac.uk/alert/more-than-50-of-hip-replacements-appear-to-last-25-years/ Accessed 5 November 2026.
- Beswick AD, Wylde V, Gooberman-Hill R, Blom A, Dieppe P. What proportion of patients report long-term pain after total hip or knee replacement for osteoarthritis? A systematic review of prospective studies in unselected patients. BMJ Open; 2012;2:e000435. https://bmjopen.bmj.com/content/2/1/e000435 Accessed 5 November 2026.
- American Academy of Orthopaedic Surgeons. Infection after joint replacement. OrthoInfo. https://www.orthoinfo.org/diseases–conditions/joint-replacement-infection Accessed 5 November 2026.
- NHS. DVT (deep vein thrombosis). NHS website. https://www.nhs.uk/conditions/deep-vein-thrombosis-dvt/ Accessed 5 November 2026.
- The Royal Orthopaedic Hospital NHS Foundation Trust. Travel, surgery and deep vein thrombosis. ROH. https://roh.nhs.uk/services-information/other-info/before-surgery/travel-surgery-and-dvt Accessed 5 November 2026.
Article history
- — First published.