A comprehensive patient guide — from types of procedure and surgical approaches through to implant selection, complications, and recovery.
Medical Disclaimer: The information on this page is for general guidance only and does not constitute medical advice. Always discuss your individual circumstances with a qualified orthopaedic surgeon or GP.
Hip replacement (total hip arthroplasty, or THA) is a surgical procedure in which a damaged or arthritic hip joint is replaced with an artificial implant. The procedure aims to relieve chronic pain, restore mobility, and return patients to everyday activities. Most commonly performed for osteoarthritis, it is one of the most common and successful operations in modern medicine — around 100,000 are performed each year in the UK.
Your doctor may recommend a hip replacement if:
The most common procedure. Both the femoral head (ball) and the acetabulum (socket) are replaced with artificial components — typically a metal or ceramic ball on a metal stem, fitting into a plastic, ceramic, or metal cup.
Only the femoral head is replaced, not the socket. Usually performed for hip fractures in elderly patients rather than for arthritis.
Instead of removing the femoral head, the bone is reshaped and capped with a metal covering. Better suited to younger, active patients with good bone quality who want to preserve more native bone.
One of the most important decisions in hip replacement surgery is how the surgeon physically accesses the joint. Each approach has genuine advantages and trade-offs — the best choice depends on your anatomy, your surgeon's expertise, and your clinical situation.
The surgeon accesses the hip from the back and side of the joint. This is the most widely used technique worldwide because it provides excellent visibility of the joint and carries a lower risk of nerve injury to the major nerves near the hip. The trade-off is that the short external rotator muscles are cut during the approach, which carries a slightly higher short-term dislocation risk. Patients are typically given "hip precautions" — avoiding bending the hip past 90 degrees — for the first 6–12 weeks. With modern large-diameter implant heads, the practical dislocation risk has fallen significantly.
The surgeon accesses the hip from the front of the joint, working between the natural planes between muscles rather than cutting through them. This muscle-sparing technique often leads to quicker early recovery, less post-operative pain, and fewer movement restrictions — many patients require no formal hip precautions. The main trade-off is a small risk of numbness along the outer thigh from the lateral femoral cutaneous nerve, which runs near the incision site. It also requires specialist positioning equipment and a learning curve for surgeons transitioning to this approach.
The hip is accessed from the outer side. This approach offers a balanced profile — lower dislocation risk than the posterior approach and no risk of anterior nerve numbness — but requires splitting or detaching part of the abductor muscle group. This can cause temporary weakness of the hip abductors, leading to a temporary limp during the early weeks of recovery while the muscle reattaches and strengthens. Most patients recover full abductor strength with appropriate physiotherapy.
There is no single "best" surgical approach — each has a strong evidence base when performed by an experienced surgeon. The most important factor is your surgeon's expertise and case volume with their chosen technique. Discuss the approach your surgeon recommends and the reasoning behind it.
Hip implant choices are tailored to your age, bone density, weight, and activity level. Your surgeon will select the combination most likely to give you the best long-term function and longevity.
The implant is secured to the bone using polymethyl methacrylate (PMMA) — commonly called bone cement. The implant is immediately stable after surgery, allowing full weight-bearing from day one. Cemented fixation has the longest track record of any fixation method and performs extremely well across all age groups.
The implant has a highly porous, textured outer surface — often titanium — that encourages the patient's own bone to grow into it over 4–6 weeks, creating a biological bond. This osseointegration provides superior long-term fixation and avoids potential issues with cement degradation over decades. Patients still weight-bear early, but the definitive bond takes weeks to establish.
Combines both methods — typically a cemented femoral stem with a cementless acetabular cup (or vice versa). This allows surgeons to optimise fixation for the specific characteristics of each bone surface, and is commonly used when bone quality differs between the two components.
The bearing surface is where the ball and socket components meet and move against each other. The choice affects wear rate and longevity.
A highly polished cobalt-chromium or titanium alloy ball articulates against a highly cross-linked polyethylene (XLPE) liner. Modern XLPE is vastly more durable than older polyethylene and has an exceptional track record. This is the most widely used combination globally and is suitable for the vast majority of patients.
A ceramic (alumina or zirconia) ball articulates against a cross-linked polyethylene liner. Ceramic generates less wear debris than cobalt-chrome, reducing the risk of particle-related tissue reaction. Offers an intermediate option between standard metal-on-poly and full ceramic bearings.
Both the ball and the liner are ceramic. This combination offers the lowest wear rates of any bearing surface currently available, making it preferred for young, highly active individuals who need the implant to last decades. Historically associated with a small risk of a harmless mechanical squeaking sound — modern ceramic formulations have substantially reduced this occurrence.
Hip replacement is a safe and routinely successful procedure, but like all surgery it carries risks. Understanding these — alongside the specific measures used to prevent them — allows you to make a fully informed decision.
The most serious complication of joint replacement. Deep infection can require further surgery, including removal and replacement of the implant. Prevention is multi-layered: laminar-flow operating theatres (ultra-clean air), pre-operative antibacterial skin wash with chlorhexidine, mandatory intraoperative intravenous antibiotics given before incision, and antibiotic-impregnated cement where applicable.
Deep vein thrombosis (clot in the leg) and pulmonary embolism (clot in the lungs) are inherent risks of any lower-limb orthopaedic surgery. Standard prevention includes sequential compression devices (pneumatic leg sleeves) during surgery, early walking from Day 0 or 1, and chemical blood thinners — aspirin, rivaroxaban, or low-molecular-weight heparin — continued for 2–6 weeks after discharge.
Dislocation occurs when the ball component pops out of the socket, most commonly in early recovery before the soft tissues have healed. Modern large-diameter femoral heads (36mm and above) and dual-mobility cup designs have dramatically reduced this risk compared to earlier generations of implants. Following post-operative movement restrictions — particularly with the posterior approach — further reduces risk during the healing phase.
Modern hip implants are highly durable, with registry data showing the majority still functioning well at 20 years. Over time, mechanical wear of bearing surfaces can generate microscopic particles that cause bone loss around the implant (osteolysis), potentially requiring revision surgery. This is why bearing surface choice — particularly in younger patients — is an important long-term consideration.
Contact your surgical team or go to A&E immediately if you experience any of the following after your hip replacement:
Most patients stand and take their first steps on the same day as surgery with a physiotherapist. Typical recovery milestones:
For a detailed physiotherapy exercise programme, recovery phase guidance, and home safety checklist, visit our dedicated Rehabilitation Guide.
Hip replacement surgery in North Wales is provided through the Betsi Cadwaladr University Health Board (BCUHB). You will typically need a GP referral to an orthopaedic consultant, who will assess your suitability and add you to the surgical waiting list if appropriate. Services are provided at Wrexham Maelor Hospital, Ysbyty Gwynedd (Bangor), and Glan Clwyd Hospital.
Private hip replacement surgery is also available at independent hospitals in the region, which may offer shorter waiting times and more choice over your surgical team.
Have questions about hip replacement? Contact us and we'll help point you in the right direction.