Hip arthritis + total hip replacement

Understanding hip arthritis

Your hip is a ball-and-socket joint. The surfaces are covered in smooth cartilage that lets the joint glide; osteoarthritis is the gradual loss of that cartilage until, in the end, bone moves on bone. It is common, it tends to progress slowly, and it is not caused by anything you did wrong. Age, genetics, previous injury and hip shape all play a part.

A note from me: an X-ray showing arthritis is not, by itself, a reason to operate. I treat people, not X-rays. Plenty of people with worn-looking hips live comfortably for years. We treat the hip when the symptoms, not the picture, demand it.

Symptoms + when to seek help

What does hip arthritis feel like?

Most people feel it in the groin or the front of the thigh, sometimes referred down to the knee. Stiffness after sitting, difficulty with socks and shoes, a shrinking walking distance and night pain are the classic pattern.

When is it worth seeing a surgeon?

When pain wakes you at night, when you are organising your life around the hip, or when the simple measures below have stopped working. An assessment gives you answers either way; it does not commit you to surgery.

Investigations

A standing X-ray of the pelvis and hip is usually all that is needed to make the diagnosis. MRI is occasionally helpful when the diagnosis is unclear or another cause is suspected. Bring any imaging you already have to your appointment, including the reports.

Treatment without surgery comes first

Surgery is never the first recommendation. Depending on where your hip sits on its journey, genuine relief can come from:

• Activity modification: swapping impact for cycling, swimming or walking on softer ground, without giving up on being active. Keeping moving matters.
• Strengthening: a physiotherapy program targeting the gluteal muscles and core measurably improves pain and function in hip arthritis.
• Weight optimisation: every kilogram lost takes several kilograms of load off the joint with each step.
• Simple analgesia: paracetamol and short courses of anti-inflammatories, used sensibly with your GP.
• Walking aids: a stick in the opposite hand offloads the hip more than most people expect.

When these measures no longer hold the line and the hip is running your day, it is reasonable to talk about replacement.

The operation

Total hip replacement removes the worn ball and socket and replaces them with an implant: a socket liner and a stem with a new ball. The operation usually takes around 60 to 90 minutes, under spinal or general anaesthetic, with most people spending one to three nights in hospital and standing on the new hip the same day or the next morning.

There are several surgical approaches, including the direct anterior and posterior approaches. Each has advantages and trade-offs, and I will explain which I recommend for your anatomy and why. I am fellowship-trained and certified in Stryker MAKO robotic-assisted hip replacement, which uses a CT-based plan to guide implant position; it is a tool I use where it serves your result. Modern implants are excellent: Australian registry data shows the large majority of hip replacements are still functioning well beyond 15 years.

Honest risks

Hip replacement is one of the most reliable operations in modern surgery, and serious complications are uncommon. But no honest surgeon calls any operation risk-free. The ones we plan around:

• Infection: roughly 1 in 100. We use antibiotics, meticulous technique and clean-air theatres to keep it rare; a deep infection can require further surgery.
• Dislocation: around 1 in 100, most often in the early months before the soft tissues heal. Precautions depend on the approach used.
• Blood clots (DVT / PE): reduced with blood thinners, early walking and calf pumps.
• Leg length difference: small differences are common and usually unnoticed; meaningful differences are uncommon with careful planning.
• Nerve or blood vessel injury: rare, but can affect strength or sensation.
• Wear or loosening over time: implants are mechanical parts; a small proportion need revision surgery down the track.
• Anaesthetic and medical risks: assessed individually, with the anaesthetist involved early for anyone with significant medical history.

Recovery, week by week

Every recovery is individual, but this is the shape of a typical one:

Frequently asked questions

How long will my hip replacement last?+

Australian joint replacement registry data shows most modern hip replacements are still working well beyond 15 years, and many considerably longer. Age, activity, weight and implant factors all play a part; I will give you an estimate that is honest for your situation rather than a one-size-fits-all number.

▶ Video answer coming

Am I too young (or too old) for a hip replacement?+

There is no fixed age limit in either direction. The decision weighs how much the hip is costing you now against the likelihood of needing revision surgery later in life. Fit patients in their 80s do well; younger patients sometimes wait, and sometimes should not.

▶ Video answer coming

Anterior or posterior approach: does it matter?+

Both are excellent operations in experienced hands, and long-term results are similar. The differences are mainly in the early weeks and in which precautions apply. I will recommend the approach that suits your anatomy and explain the reasoning, not just the fashion.

▶ Video answer coming

When can I drive, work and travel?+

Driving: when you can perform an emergency stop and are off strong pain medication, commonly week 4 to 6. Desk work: often from week 3 to 6. Physical work: usually closer to 3 months, planned individually. Flying: short flights from about 6 weeks, long-haul better after 3 months; we plan clot prevention around any earlier travel.

▶ Video answer coming

Downloads

• Preparing for hip replacement (pre-operative guide)PDF coming
• Hip replacement rehabilitation protocol (for you and your physio)PDF coming