Sunshine Coast Orthopaedic Group

Procedure · Hip · Arthroplasty

Total hip replacement.

Replacing the worn ball and socket of the hip with an implant. It is one of the most reliable operations in orthopaedics for pain from hip arthritis, and in this practice it is most often performed through the anterior approach.

Call (07) 5493 8038 How it is performed
Reviewed by Professor Daevyd Rodda Orthopaedic Surgeon · MBBS, Dip. Surg Anat, FRACS, FAOrthA Last reviewed: 21 August 2026
Type
Major joint arthroplasty
Anaesthetic
Spinal or general
Hospital stay
1 to 3 nights
Walking
Day of surgery, with aids
Driving
About 2 to 6 weeks
Implant survival
About 90% at 20 years (AOANJRR)

What it is.

The hip is a ball and socket joint. The ball is the head of the femur, the thigh bone, and the socket is the acetabulum, part of the pelvis. Both surfaces are lined with articular cartilage, which is smoother than anything manufactured and allows the joint to move under load without pain.

In osteoarthritis that cartilage thins and eventually wears through, so bone moves against bone. That is what produces the deep groin pain, the stiffness putting on shoes and socks, and the limp that people usually describe long before they describe pain.

A total hip replacement removes the worn femoral head and replaces it with a stem fixed into the femur carrying a new ball. The socket is prepared and a shell is fixed to the pelvis, with a bearing surface inside it. The result is a new articulation between two manufactured surfaces, most commonly a ceramic or metal head against highly cross linked polyethylene.

It is worth being clear about what the operation does and does not do. It is very reliable at relieving arthritic pain. It is less predictable at restoring the last few degrees of movement in a hip that has been stiff for years, and it does not make the hip into a normal hip. Most people describe it as a joint they stop thinking about, which is the realistic goal.

How it is performed.

Professor Rodda most often uses the direct anterior approach. The hip is reached from the front, through an interval between muscles rather than through them. No muscle is detached from bone to gain access. The alternative approaches, posterior and lateral, reach the joint by taking down and then repairing muscle or tendon.

The sequence of the operation itself is the same whichever approach is used:

  • The joint is exposed and the worn femoral head is removed.
  • The acetabulum is reamed to a hemisphere and the socket component is fixed, usually by press fit, sometimes with screws.
  • A bearing liner is inserted into the socket.
  • The femur is prepared and the stem is fitted, either press fit or cemented depending on bone quality and age.
  • A trial reduction checks leg length, offset and stability through a range of movement, and is adjusted before the final components go in.
  • The wound is closed in layers, usually with an absorbable subcuticular suture.

Leg length is measured intraoperatively and checked against the pre-operative plan. The anterior approach allows a radiograph to be taken on the table with the patient supine, which is one of its practical advantages.

Most hip replacements in this practice are done under spinal anaesthetic with sedation rather than general anaesthetic, which is associated in the literature with less nausea and earlier mobilisation. The anaesthetist makes that decision with you.

Recovery timeline.

These are typical timings. They are not promises, and the range between individuals is wide, particularly for people who were less mobile before surgery.

  • Day of surgery. Up and walking with a frame or crutches, usually within a few hours. Full weight bearing is allowed unless you are told otherwise.
  • Day 1 to 3. Discharge home once you can walk safely, manage stairs and your pain is controlled on tablets. Some patients go home the same day.
  • Week 1 to 2. Crutches or a stick. Short, frequent walks rather than long ones. Wound reviewed at about two weeks.
  • Week 2 to 6. Most people are off aids somewhere in this window. Driving once you can perform an emergency stop without hesitation and are off strong analgesia, which for a right hip is typically nearer six weeks.
  • Week 6 to 12. Return to desk work is often earlier, around two to four weeks. Manual work is usually eight to twelve weeks. Swimming once the wound is fully healed.
  • 3 to 12 months. Continued gain in strength and endurance. Most of the improvement is in the first three months, with the remainder accruing slowly.

Outcomes.

The Australian Orthopaedic Association National Joint Replacement Registry follows every hip replacement performed in Australia. Its published data reports a cumulative revision rate for primary total hip replacement performed for osteoarthritis of approximately 5% at 10 years and approximately 10% at 20 years, meaning roughly nine in ten implants remain in place at twenty years.

Patient reported outcomes are consistently strong. In registry and trial data the majority of patients report a substantial reduction in pain and improvement in function at six and twelve months compared with before surgery.

Risk should be stated as plainly as benefit. The recognised complications include infection, dislocation, leg length difference, blood clot, fracture around the implant, nerve injury, and loosening or wear over time. Their individual likelihood depends on your own circumstances, and they are discussed with you specifically before you consent. See understanding the risks for how common each one is.

Rehabilitation.

Hip replacement rehabilitation is less protocol driven than knee replacement. The priority in the first six weeks is walking normally rather than building strength.

  • Weeks 0 to 2. Walking little and often. Ankle pumps. Avoid sitting for long periods in one position.
  • Weeks 2 to 6. Progressive walking distance, weaning off aids as your gait allows. Gentle range of movement and glute activation.
  • Weeks 6 to 12. Strength work, stationary cycling, hydrotherapy.
  • Beyond 12 weeks. Return to golf, cycling, doubles tennis and similar. High impact running is generally discouraged, not because the implant will fail immediately but because it increases bearing wear over decades.

Physiotherapists can request the written protocol through For Physiotherapists.

Questions worth asking at your consultation.

Every one of these is a fair question and none of them should be awkward to ask. Print them or bring them on your phone.

  • Am I a good candidate for total hip replacement, and what would make me a poor one?
  • What are the alternatives, including doing nothing for now?
  • How many of these do you perform in a year?
  • What does the Australian registry say about the implant you would use for someone my age?
  • What does a realistic result look like for me specifically, and what will I still not be able to do?
  • What is your plan if it does not go well?

Frequently asked questions.

How painful is a hip replacement?

Pain after hip replacement is managed with a combination of medications, local anaesthetic given during surgery and early mobilisation. Most people describe the pain as significant for the first few days and then steadily improving. The majority find that the arthritic pain they had before surgery is gone immediately, and that what remains is surgical soreness, which settles over several weeks.

How long will I be in hospital?

Most people stay between one and three days after a total hip replacement. Discharge depends on being comfortable on oral pain relief, being able to walk safely with an aid and being able to manage stairs if there are stairs at home. Some patients are suitable for discharge the day after surgery, and this is assessed individually rather than set in advance.

When can I drive again?

Most people return to driving between two and six weeks after hip replacement, once they can control the vehicle safely, perform an emergency stop and are no longer taking medication that affects alertness. Return is often earlier after a left hip replacement in an automatic car. Check with your insurer, as policies differ on cover after surgery.

Will I set off airport security scanners?

Modern hip replacements sometimes trigger airport metal detectors, though many do not. No implant card or documentation is required in Australia, and security staff are familiar with joint replacements. If a scanner is triggered, telling the officer you have a hip replacement is sufficient.

Can I kneel, cross my legs or bend down after a hip replacement?

After a direct anterior approach hip replacement there are generally no movement restrictions, and bending, crossing the legs and reaching the floor are permitted straight away as comfort allows. After a posterior approach, bending the hip beyond ninety degrees and crossing the legs are usually avoided for around six weeks to reduce the risk of dislocation.

What is the difference between a total and a partial hip replacement?

A total hip replacement replaces both the ball and the socket. A partial hip replacement, or hemiarthroplasty, replaces only the ball and leaves the natural socket in place. Partial replacement is used mainly for certain fractures of the hip in older patients, rather than for arthritis, where the socket is also affected.

Will one leg be longer than the other afterwards?

Restoring equal leg length is a goal of the operation and is planned before surgery and checked during it. Small differences of a few millimetres are common and are usually not noticeable. Occasionally a larger difference results, which can be managed with a shoe raise. A limb that felt shorter before surgery due to arthritis may feel different once the hip is corrected.

References.

  1. Australian Orthopaedic Association National Joint Replacement Registry. Annual Report. Adelaide: AOA.
  2. Learmonth ID, Young C, Rorabeck C. The operation of the century: total hip replacement. Lancet. 2007;370(9597):1508-1519.
  3. Evans JT, Evans JP, Walker RW, et al. 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.

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.