The first year is about recovery. Everything after it is about living with the hip, and that phase lasts decades, so it is worth setting out properly.
What you can do.
More than most people expect. Walking, swimming, cycling, golf, doubles tennis, hiking, dancing, gardening, skiing and most gym work are all reasonable after a hip replacement, and there is no need to negotiate for permission on any of them.
The general position is that a hip replacement is a better platform for activity than a knee replacement. Range of movement returns more completely, the joint feels more like a normal joint, and the operation is more forgiving of load.
What is worth avoiding, and why.
Two categories, and they are not the same thing.
Impact and volume. Distance running and repetitive high-impact sport accelerate wear of the bearing surface. Wear is what determines how long an implant lasts, so this is not a rule about safety on the day; it is a trade against years at the far end. Occasional running for a bus is not the issue. A marathon programme is.
Extremes of position. Deep flexion combined with rotation, the position you reach when you get into a low sports car or sit on the floor and twist, is where a hip replacement is least stable. After an anterior approach this is much less of a concern than after a posterior one, and it is a caution rather than a prohibition.
If a specific activity matters to you, ask about that activity rather than accepting a general answer. The honest response is often more permissive than the general one.
How long it should last.
A systematic review of case series and national registry data with more than fifteen years of follow-up estimated that about 58 per cent of hip replacements last twenty-five years.1 The Australian registry reports the cumulative percent revision for every implant and every combination used in this country, updated annually.2
Two things are worth understanding about those figures. They describe implants put in fifteen to twenty-five years ago, so they are a floor rather than a forecast for a hip implanted today with a modern cross-linked bearing. And they are population figures: your own outcome depends on your age, your weight, your activity and a measure of luck. How long does a joint replacement really last goes into this properly.
What to watch for over the years.
A hip replacement that is working does not need monitoring beyond your twelve month review, but three things are worth knowing.
- New pain in a hip that had been comfortable, particularly groin or thigh pain on starting to walk, is the presentation of loosening. It is worth an X-ray rather than waiting.
- Any suggestion of infection, at any time, in a joint replacement is urgent. That includes a hip that becomes painful during or after an illness elsewhere, because bacteria can seed a prosthetic joint through the bloodstream. See infection in a joint replacement.
- A change in leg length or a new limp that develops years later.
Otherwise, no routine surveillance is required for most implants, and a hip that feels normal almost always is.
The questions everyone asks.
Airport security. Some implants set off detectors, some never do, and it depends as much on the machine as on the implant. Implant cards are no longer required. Telling the officer you have a hip replacement is the whole procedure.
MRI. Modern hip implants are not ferromagnetic and are safe in an MRI scanner. Tell the radiographer, because the metal distorts the image locally and the sequences may be adjusted.
Dental treatment. Routine dental work is fine. Australian guidance does not support routine antibiotic prophylaxis before dental procedures for most patients with a joint replacement. Discuss it with your dentist.
The other hip. Having one hip replaced does not cause the other to wear out, although a hip that has been compensating for years often declares itself once the first one stops hurting. If both need doing, see both sides, together or staged.
Will I set off the metal detector at the gym, feel the cold in it, know it is there? Most people stop noticing the hip entirely, which is the single biggest difference between hip and knee replacement in how patients describe them afterwards.
References.
- 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.
- Australian Orthopaedic Association National Joint Replacement Registry. Hip, Knee & Shoulder Arthroplasty Annual Report. Adelaide: AOA.
Common questions.
Can I run after a hip replacement?
It is generally advised against, not because the hip will fail on the day but because impact accelerates wear of the bearing surface, and wear determines how long the implant lasts. Walking, cycling, swimming, golf, hiking and skiing are all reasonable.
How long does a hip replacement last?
A systematic review with more than fifteen years of follow-up estimated that about 58 per cent of hip replacements last twenty-five years (Evans et al, Lancet 2019). That describes implants put in decades ago, so it is a floor rather than a forecast for a modern bearing.
Do I need antibiotics before dental treatment?
Australian guidance does not support routine antibiotic prophylaxis before dental procedures for most patients with a joint replacement. Discuss it with your dentist rather than assuming either way.
Will my hip replacement set off airport security?
It might. Some implants do, some never do, and it depends as much on the detector as on the implant. Implant identification cards are no longer required. Telling the officer you have a hip replacement is enough.
What should make me call about a hip replacement years later?
New groin or thigh pain on starting to walk, in a hip that had been comfortable, which is how loosening presents. Any suggestion of infection at any time, which is urgent. And a new limp or a change in leg length that develops years later.
This page provides general information about a medical condition and a surgical procedure. It is not individual medical advice and does not replace consultation with a qualified practitioner. Outcomes vary between individuals and all surgery carries risk. A referral is needed for a consultation with Professor Daevyd Rodda; without one, you can start with the practice nurse practitioner, who can provide it.