Hip Replacement Surgery

What is hip replacement surgery?

  • Hip replacement surgery involves a complete replacement of the ball and socket joint, typically as a result of wear and tear in the hip joint that has led to pain and stiffness becoming unmanageable.

How common is hip replacement surgery?

  • Hip replacement surgery is a very common operation.
  • 32,715 hip procedures were completed in the NHS alone in 2020, with 101,651 replacement procedures recorded in 2015 both in the NHS and private settings (2).

Should I worry?

  • No.
  • When required, hip replacement surgery is a common procedure with success rates reported of approximately 95% (1).

Who is most likely to suffer from hip replacement surgery?

  • People aged 60+, however, it is becoming more common in younger, more active patients (3).
  • In 2016, osteoarthritis was recorded as the main indication for surgery in 90% of hip replacement patients (3).

What are the common symptoms?

Typical symptoms leading to surgery include:

  • Hip pain – general pain in your groin that can refer to the front of your thigh and/or buttock.
  • Difficulty walking.
  • Stiffness and limited movement in your hip.

Typical symptoms post-surgery include:

  • A short period of pain around the surgical site from the procedure.
  • You will be mobile on the same day.
  • The movement will be restricted initially but this will typically improve quickly.

What can I do?

  • Physiotherapy can significantly improve symptoms before and after surgery to help with mobility and strength (9).
  • Modifying your activity.
  • Keeping active.
  • Occupational health – advice around potential workplace adaptations.
  • If you are overweight, losing weight may help.

How long will it take to recover?

  • Recovery post hip replacement will vary.
  • Speed of recovery can be influenced by age, how long you have had your hip pain, the condition of your joints/muscles, your general fitness levels and the job or activities you do (10).
  • Typically, you will be able to return to normal daily activities within 3 months and a complete recovery can be experienced within 6 months.

1. Introduction

Hip replacement surgery is a common operation where a damaged joint is replaced with an artificial one. Joint replacements are nearly always carried out because of pain that cannot be controlled by other methods such as painkillers, physiotherapy or other surgery. It is major surgery, therefore is only recommended when physiotherapy has not helped to reduce the pain and improve mobility and it is affecting the quality of life.

Hip replacements are either completed under general anaesthetic or, more frequently, an epidural injection (numbs from the waist down). The surgery usually takes 1-2 hours to complete.

There are different types of implants and materials that can be used, depending on your age and the condition of your joint, as well as differing techniques. Your surgeon will be able to best advise you on this (3).

Any surgery comes with risks and therefore the decision to follow through with surgery is not taken lightly. These are considered low risks due to how common the operation is and include: infection (less than 1%), risk of dislocation, deep vein thrombosis (DVT), leg length discrepancies and damage to the nerves/tissues (2).

The final decision to have an operation or not remains with the patient. It will be based on the risks and benefits of having a hip replacement or choosing not to; these choices should be made clear. It may be that other options are available including, but not limited to, medication, physiotherapy, weight loss or other lifestyle changes.


2. Signs & Symptoms

3. Causes

The most common reason for hip replacement surgery is a damaged hip joint through age-related changes called osteoarthritis. In 2016, osteoarthritis was recorded as the main indication for surgery in 90% of hip replacement patients. You are more likely to have the condition if there is a family history of it (3).

Estimates suggest that up to 8.5 million people in the UK are affected by joint pain that may be attributed to osteoarthritis. The second most common cause is rheumatoid arthritis (an autoimmune inflammatory disease that affects the synovial lining of joints). Around 400,000 people in the UK have rheumatoid arthritis (6).


4. Risk Factors

This is not an exhaustive list, but these factors may increase the likelihood of someone requiring a total hip replacement as they can all directly affect and damage the joint. It does not mean everyone with these risk factors will develop symptoms.


5. Prevalence

Hip replacement surgery is a very common surgical procedure whereby 32,715 hip procedures were completed in the NHS alone in 2020. A total of 101,651 hip replacement operations were reported to the National Joint Registry in 2016 (2).

Although patients having total hip replacements are becoming younger, consultants are cautious of performing a hip replacement too early due to the risk of requiring further surgery later on in life. Over time, implants can wear and need to be revised, often due to loss of function or pain. The need to require a revision of implants for patients aged 50–54 years is estimated to be 29%, but only 5% in patients aged 70 years and above (4).

Other reasons for revision surgeries can be due to infection, fracture/dislocation and implant loosening (10).

6. Assessment & Diagnosis

Favourable outcomes can be expected with appropriate physiotherapy treatment both pre-operatively and post-operatively, positively influencing pain, physical function and quality of life (6, 8, 9).

A physiotherapist can provide an accurate and timely diagnosis by obtaining a detailed history of symptoms. A series of physical tests might be performed as part of the assessment to rule out other potentially involved structures and gain a greater understanding of your physical abilities to help facilitate an accurate working diagnosis.

Your physiotherapist will want to know how your condition affects your day-to-day life so that treatment can be tailored to your needs and personalised goals can be established. Intermittent reassessment will ascertain if you are making progress towards your goals and will allow appropriate adjustments to your treatment to be made.

With mild symptoms, particularly in those with a more recent onset of symptoms, further investigations are not normally required as symptoms of hip osteoarthritis are often easily identifiable and can be managed well with good physiotherapy management and advice. Persistent cases that have not responded to appropriate physiotherapy input may require further investigations to confirm the diagnosis and severity with an X-ray and a referral for a surgical opinion to orthopaedics through your GP practice.

Condition-specific exercise forms a pivotal element of the treatment plan to ensure optimal recovery to improve mobility and strength around your hip. (6, 8, 9).

7. Self-Management

There are certain things you can try to help you self-manage your condition, or whilst you await surgery. These may include the following:

  • Medication to manage your pain and thereby impacting how much you are able to do.
  • If you are overweight, losing weight might have a positive impact on your hip symptoms and your overall general health.
  • Activity modification (avoiding or modifying activities of daily living, inclusive of work, that aggravates symptoms).
  • If you work for an organisation that has an Occupational Health department and your symptoms are aggravated by work, it would be advisable to seek their input. They will be well placed to suggest work placed adaptations to facilitate continued working whilst best managing symptoms.
  • Keeping active as much as you are able to, helps keep the joints strong and mobile.

8. Rehabilitation

Recovery post hip replacement will vary. Speed of recovery can be influenced by age, how long you have had your hip pain, the condition of your joints/muscles, your general fitness levels and the job or activities you do (10). Typically, you will be able to return to normal daily activities within 3 months and a complete recovery can be experienced within 6 months.

You will be mobilising and weight-bearing on your new hip as soon as your spinal/general anaesthetic has worn off. The physiotherapists on the ward will guide you and give you a walking aid to start. They will progress walking and complete stairs if required to ensure that you are safe to return home. You will return home generally between 12 hours-5 days. It is normal at this point to have pain around your surgical wound, with swelling and bruising into your hip and leg. The swelling should be managed by elevating the leg when lying down flat and you may find you also need to elevate the leg overnight to help the swelling go down.

Over the next few days and weeks, you should gradually build up the amount of walking you do, slowly weaning from your walking aids as you feel able to. You should feel that you are able to do more activities around the home in the next few weeks. You may have been given some standing exercises to do to improve your mobility and strength in your new hip.

You will be able to return to driving after 6 weeks (this may vary depending on your consultant’s instructions). Generally, you will be able to return to light duties at work for 6 weeks. If you do a manual job, you may want to return slowly and gradually build up to your normal duties from 3 months.

You may or may not get a follow-up from a physiotherapist post-operatively in an outpatient setting therefore you may feel that you want a follow-up to progress your rehabilitation and mobility. Our musculoskeletal physiotherapists will be able to guide you through this to achieve your goals.

9. Hip Replacement Rehabilitation Plans

Early Plan

This programme focuses on exercises to promote a range of movement in the hip and to start the process of getting muscles to re-engage after surgery. Pain should not exceed 4/10 on your perceived pain scale whilst completing this exercise programme.

Early Plan  - Rating

Intermediate Plan

This is the next progression. Here we begin to challenge the muscles around the hip more to increase the strength of these muscles. Pain should not exceed 3/10 on your perceived pain scale whilst completing this exercise programme.

Intermediate Plan  - Rating

Advanced Plan

This programme is a further progression with the aim of returning to more normal strength levels and regaining the ability to do day-to-day tasks. Pain should not exceed 3/10 on your perceived pain scale whilst completing this exercise programme.

Advanced Plan  - Rating

10. Return to Sport/Normal Life

For patients wanting to achieve a high level of function or return to sport, we would encourage a consultation with a physiotherapist as you might require advanced rehabilitation. As part of a comprehensive treatment approach, your physiotherapist may use a variety of other pain-relieving treatments to support symptom relief and recovery.

Whilst recovering, you might benefit from a further assessment to ensure you are making progress and to establish the appropriate progression of treatment. Ongoing support and advice will allow you to self-manage and return to full fitness. Your consultant will also advise you on when you are able to return to certain activities however, generally, you will be able to return to most sports from 3–6 months.

11. Other Treatment Options

Alongside exercise and appropriate advice, your physiotherapist might utilise various forms of hands-on treatment skills in the form of joint mobilisations, soft tissue techniques and acupuncture. These techniques can be useful to restore function and alleviate symptoms whilst you continue to strengthen and mobilise the limb.

12. Links for Further Reading


Book an Appointment

Please book an appointment with one of our physiotherapists if you think you are suffering from this condition and would like to find out more.

We have Pure Physiotherapy clinics across the country including Norwich, Great Yarmouth, Manchester, Stockport, Sheffield and Rotherham. Please view our clinics to find the closest physiotherapy clinic for you.


  1. Learnmouth et al. (2007). The Operation of the Century: Total Hip Replacement. The Lancet. [https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(07)60457-7/fulltext]
  2. National Joint Registry. (2020). NJR Stats Online. https://www.njrcentre.org.uk/njrcentre/Healthcare-providers/Accessing-the-data/StatsOnline/NJR-StatsOnline.
  3. National Joint Registry. (2017). Public and Patient Guide to NJRs 14th Annual Report in 2017. Hip Replacement Edition. https://www.njrcentre.org.uk.
  4. Evans et al. (2019). 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. The Lancet. https://www.sciencedirect.com/science/article/pii/S0140673618316659
  5. Sodhi, N. & Mont, M. (2019). Survival of Total Hip Replacements. The Lancet. https://www.sciencedirect.com/science/article/pii/S0140673618318592#bib9.
  6. Ibrahim et al. (2013). Enhanced Recovery in Total Hip Replacement: A Clinical Review. The British Editorial Society of Bone and Joint Surgery. https://online.boneandjoint.org.uk/doi/epub/10.1302/0301-620X.95B12.31303
  7.  NICE. (2014). Total Hip Replacement and Resurfacing Arthroplasty for End-stage Arthritis of the Hip. National Institute for Health and Care Excellence. https://www.nice.org.uk/guidance/ta304/chapter/2-Clinical-need-and-practice
  8.  NICE. (2020). Osteoarthritis: Care and Management. National Institute for Health and Care Excellence. https://www.nice.org.uk/guidance/cg177/chapter/1-Recommendations
  9.  Czyżewska et al. (2014). Effects of Preoperative Physiotherapy in Hip Osteoarthritis Patients Awaiting Total Hip Replacement. Archives of Medical Science. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4223143/
  10.  NHS Website: Hip replacement. (2019). Hip Replacement. https://www.nhs.uk/conditions/hip-replacement/recovery/
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