Hip Replacement

This is the main guide to primary hip replacement. Assessment, preparation, implants, surgery, rehabilitation, return to activity and safety are covered in one place. Separate articles develop specific questions without repeating the entire guide.

When is hip replacement considered?

The most common reason is advanced symptomatic hip osteoarthritis. Replacement may also be needed for advanced femoral head osteonecrosis, selected consequences of injury and other conditions causing permanent joint damage.

The main considerations are pain and stiffness, walking and daily activity limitations, quality of life, examination and joint changes. NICE recommends considering referral when symptoms substantially affect quality of life and non-operative treatment is ineffective or unsuitable. Assessment should be clinical rather than based only on a single numerical score.

If the source of pain remains uncertain, start with the broader guide: Hip Pain — Causes and Diagnosis (in Polish).

What should be considered before deciding on surgery?

Not every patient with hip osteoarthritis needs surgery. Depending on the clinical situation, treatment may include education, activity modification, exercise, medication and selected injections. Weight loss in overweight people may reduce symptoms and improve overall risk. The AAOS guideline supports NSAIDs in suitable patients, allows physiotherapy or exercise particularly for mild to moderate disease, and short-term benefit from intra-articular corticosteroid in selected patients. AAOS does not recommend hyaluronic acid for symptomatic hip osteoarthritis.

This does not mean repeating ineffective treatments indefinitely. ACR/AAHKS timing guidelines apply to patients with moderate or severe symptomatic disease who have already received appropriate non-operative treatment and have been selected for replacement. In this group they conditionally recommend not delaying surgery solely to try more physiotherapy, NSAIDs, walking aids or injections. Evidence quality is low or very low, so decisions remain individual.

Assessment and preoperative tests

Assessment begins with history and orthopaedic examination, including pain characteristics, motion, contractures, gait, strength, function and possible alternative sources. X-rays are the basic imaging investigation in typical advanced osteoarthritis. CT or MRI is selected for a specific diagnostic question or surgical plan rather than performed routinely for everyone.

General health also requires assessment. Laboratory and other tests depend on age, comorbidities, medicines, anaesthesia and the centre’s protocol. Anticoagulation, diabetes, anaemia, heart or lung disease and active infection may require particular planning. An active infection may require postponing elective implantation until controlled. Do not stop medication yourself. Before admission, prepare a current list of medicines, allergies and previous operations; report fever, infection, skin wounds or urgent dental problems; and agree how to take anticoagulants, antiplatelets, diabetes medicines and immunosuppressants with the team. Plan help after discharge, safe routes through the home, a resting place and walking aids.

Implants and fixation

A total hip replacement consists of an acetabular component, liner, head and femoral stem. Designs differ in construction, bearing materials, size and fixation. No single model suits everyone. Selection should consider established implant systems, outcome data and the team’s experience; technological novelty alone does not imply clinical superiority.

Stems may be cementless or cemented. Selection depends on bone quality, anatomy, biological age and fracture risk. AAOS highlights considering cemented stems in patients at increased fracture risk. Read Cemented or Cementless Hip Replacement? (in Polish).

Surgical approach and procedure

Hip replacement can be performed through posterior, lateral, anterolateral or anterior approaches, among others. Each has benefits, limitations and possible complications. The AAOS guideline does not identify one preferred approach for all patients with hip osteoarthritis. Anatomy, previous surgery, implant planning and team experience matter.

The damaged femoral head is removed, the acetabulum and femoral canal are prepared, and the selected components inserted. Stability, limb length, tissue tension and component position are checked. Stability-enhancing designs such as dual mobility may be used selectively. In higher-risk instability, constrained liners may also be considered, more often in difficult revision situations. Their use should address the identified cause of instability rather than be routine.

Robotics and navigation

Navigation and robotic systems can support planning and implant positioning, improve repeatability of selected steps and help reproduce planned alignment. They are tools, not separate treatments. Use should reflect the system, indications and team experience. Technology alone does not guarantee a better clinical outcome for every patient.

The first days after surgery

The aims after surgery are safe mobilisation, pain control, complication prevention and preparation for independence. Weight-bearing depends on the procedure, bone quality, implant stability and any intraoperative events. Individual discharge instructions take priority over a universal timetable. Venous thromboembolism prevention is tailored to individual risk. Discharge depends on general condition, pain control, safe walking, home circumstances and the follow-up plan, not just days since surgery.

Useful detailed resources: when to stop using crutches (in Polish), how to use stairs safely (in Polish) and leg swelling after surgery — what is normal and when is urgent assessment needed (in Polish).

Rehabilitation and return to activity

Recovery is a process, not a single date. Its pace depends on preoperative function, strength, comorbidities, surgery and healing. Rehabilitation should restore safe walking, limb control, strength and gradually the activity the patient needs.

There is no universal date for returning to driving, work or sport. Functional criteria and activity demands guide decisions. Read driving (in Polish), return to work (in Polish) and sport after joint replacement (in Polish).

Possible complications

Hip replacement is major surgery requiring discussion of expected benefits and risks. Complications include infection, dislocation, periprosthetic fracture, thromboembolism, nerve or vessel injury, wound problems, limb length difference, persistent pain, loosening and wear. Individual risk depends on health and the procedure. Infection risk reduction includes treating active infections before elective surgery, skin preparation, antibiotics according to the centre’s protocol, asepsis and appropriate wound care.

After discharge, sudden breathlessness or chest pain, rapidly increasing limb pain or swelling, inability to bear weight after a new injury, marked wound deterioration or signs of infection requires urgent assessment. A separate resource discusses signs of prosthetic joint infection and diagnosis (in Polish).

How long does a replacement last?

No single lifespan applies to every implant and patient. Later revision risk is influenced by age at surgery, diagnosis, activity, implant type, fixation and other factors. Long-term registry data show that many replacements function for well over a decade, but population outcomes are not an individual guarantee. Detailed data are discussed in How Long Does a Hip Replacement Last? (in Polish).

When is revision surgery considered?

Further surgery may be required for loosening, infection, instability, periprosthetic fracture, wear or component damage. However, not every pain after replacement comes from the implant. Before revision, the likely cause must be identified and investigations planned. Revision replacement has its own guide.

Questions to discuss with an orthopaedic surgeon

Are X-rays alone enough to qualify for surgery?

No. Imaging must be considered with symptoms, examination, function and previous treatment. Marked radiographic changes with minor symptoms are not an automatic indication for replacement.

Does age or BMI automatically exclude surgery?

They should not automatically prevent consideration of replacement. They may affect risk and preparation. NICE recommends not refusing referral solely because of age, sex, smoking, comorbidities, overweight or obesity.

Is MRI always needed before surgery?

No. Clinical assessment and radiographs are usually the basis of planning in typical advanced osteoarthritis. MRI or CT is used for an additional diagnostic question or detailed planning.

Does everyone need the same rehabilitation?

No. Exercise, walking aids and progression should reflect preoperative condition, the operation, balance, strength and patient goals.

Consultation and practical information

Current consultation locations and registration details are available under Clinics and Contact. Local information on assessment and surgery in Warsaw remains on a separate practical page without duplicating the medical guide.

References and standards

1. Konarski W, Derczyński M, Poboży K, Domańska-Poboża J, Poboży T. Tranexamic Acid Use in Total Hip Arthroplasty for Avascular Necrosis: A Single-Center Experience. Journal of Clinical Medicine. 2025;14(10):3399. DOI: 10.3390/jcm14103399. Discussion in Polish.
2. National Institute for Health and Care Excellence. Osteoarthritis in over 16s: diagnosis and management. NICE guideline NG226. Recommendations 1.6.1–1.6.4. NICE.
3. Hannon CP, Goodman SM, Austin MS, et al. 2023 ACR/AAHKS Clinical Practice Guideline for the Optimal Timing of Elective Hip or Knee Arthroplasty for Patients With Symptomatic Moderate-to-Severe Osteoarthritis or Advanced Symptomatic Osteonecrosis With Secondary Arthritis for Whom Nonoperative Therapy Is Ineffective. Arthritis Rheumatol. 2023;75:1877–1888. DOI: 10.1002/art.42630.
4. American Academy of Orthopaedic Surgeons. Management of Osteoarthritis of the Hip. Evidence-Based Clinical Practice Guideline. Published December 1, 2023. AAOS.
5. Evans JT, Evans JP, Walker RW, Blom AW, Whitehouse MR, Sayers A. How long does a hip replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up. Lancet. 2019;393(10172):647–654. DOI: 10.1016/S0140-6736(18)31665-9.

This material is educational and does not replace an individual consultation or assessment for treatment.

After the video: a consultation worksheet

The video series introduces the stages of treatment. Use this worksheet to connect them with your daily activities and prepare a practical plan.

Name the activities you want to recover

Is the main difficulty walking, putting on socks, getting into a car, sleeping or working? Record where pain occurs and what brings it on. Lateral hip pain, groin pain and symptoms referred from the spine need to be distinguished. Bring available X-rays, reports and a short account of previous treatment.

Compare implant proposals clearly

Ask separately about fixation, bearing surfaces and any design intended to improve stability. What feature of your bone, anatomy or health makes the proposed option suitable? Ceramic bearings, a short stem and dual mobility describe different characteristics; they are not three mutually exclusive choices or a simple quality ranking.

Prepare one medication list

Include prescribed medicines, over-the-counter products and supplements. Note previous clots, infections, anaesthetic problems and drug reactions. Ask who will give your individual preoperative instructions and when. Do not stop treatment because a general video mentions a particular timetable.

Plan your first days at home

Consider the route to the bathroom, stairs, meals, shopping and help with daily tasks. Before discharge, ask the team to demonstrate transfers and write down any restrictions that apply to your operation. A surgical approach or an additional repair may change the advice: another patient’s rules may not apply to you.

Leave with a clear next step

Record the diagnosis, proposed treatment, alternatives, expected benefits, main risks and a contact for questions. Discuss what safe return to your particular work or activities requires. The plan should still make sense when you read it at home.

Additional reading: AAOS — preparing for joint replacement.