Hip replacement UK guide: referral, risks and recovery

Hip replacement in the UK is usually considered when hip pain and loss of function remain severe despite non-surgical treatment, and X-rays or examination support advanced joint disease. The decision should not be based only on age, weight or the X-ray, but on pain, sleep, walking, independence, risk and what recovery will realistically involve. The best preparation is to understand the referral route, implant evidence, surgeon experience, waiting list rules and your own recovery plan.

When hip replacement is considered

A hip replacement replaces the damaged ball-and-socket joint with artificial components. The usual reason is osteoarthritis, but rheumatoid arthritis, hip fracture, avascular necrosis, dysplasia, childhood hip disease and previous injury can also lead to replacement. NHS guidance frames the operation around pain, stiffness and reduced mobility that seriously affect quality of life, after other treatments have not worked well enough.¹

The common mistake is to make the decision about one variable: "the X-ray is bad", "I am too young", "I am too old", or "my BMI means no one will operate". NICE takes a broader view. Its osteoarthritis guideline says referral for joint replacement should be based on symptoms, examination, quality of life, comorbidities and expected benefit, not age, sex, smoking, comorbidities, overweight or obesity alone.⁴

That does not mean risk factors are irrelevant. Smoking, poorly controlled diabetes, severe obesity, anaemia, dental infection, skin infection, frailty, low fitness, anticoagulants and certain immune-suppressing medicines can increase risk or affect timing. The point is that risk should be assessed and optimised, not used as a lazy reason to dismiss pain.

A useful threshold is whether your life is shrinking. Are you avoiding stairs, work, sleep, sex, travel, exercise, social life or basic self-care because of the hip? Can you walk far enough to live independently? Are painkillers causing side effects or no longer working? If the answer is yes, it is reasonable to discuss referral even if you have been told to "wait until it is unbearable".

Referral, waiting lists and private care

In the NHS route, the GP usually documents symptoms, examines the hip, considers X-ray or referral rules, treats other causes of pain, and refers to orthopaedics when surgery may be appropriate. Hip arthritis pain is often felt in the groin, buttock, thigh or knee, so a good assessment checks the back, knee and nerves as well.

In England, the NHS Constitution standard is that people should start consultant-led treatment within 18 weeks from referral, unless choosing to wait longer or if it is clinically appropriate to wait.⁹ In practice, local waits can be longer. Ask your GP or hospital whether you can choose another provider with a shorter wait. NHS guidance says people referred for a first outpatient appointment for a physical or mental health condition usually have the legal right to choose the provider and clinical team, as long as the service is suitable.¹⁰

Private care can shorten access to a consultation or operation, but it changes the questions. Does the private package include pre-assessment, implant, anaesthetist, hospital stay, physiotherapy, follow-up, X-rays, complications, readmission and revision if something goes wrong? If you start privately and need NHS care later, make sure records, implant labels and operation notes are easy to transfer.

Whether NHS or private, bring a one-page summary: symptom duration, walking distance, night pain, work impact, falls, medicines, previous injections, physiotherapy, medical conditions, allergies, smoking, alcohol, dental issues and what outcome matters most. Use Start Here to organise the timeline, the health library to understand linked conditions, insights to challenge marketing claims, and the stack builder to list painkillers and supplements before surgery.

Implants, surgeons and registries

Most modern hip replacements work well, but not all implants have the same long-term evidence. NICE's joint replacement guideline says hip prostheses should have revision rates, or projected revision rates, of 5% or less at 10 years.⁵ NICE's technology appraisal on total hip replacement and resurfacing also uses the 5% at 10 years benchmark for prosthesis selection.⁶

ODEP ratings are one way surgeons and hospitals describe implant evidence. The Orthopaedic Data Evaluation Panel rates hip, knee and shoulder implants according to evidence, follow-up duration and benchmark performance.⁸ You do not need to become an implant engineer, but you should be able to ask: what implant do you recommend, what is its track record, and why is it suitable for my age, bone quality, anatomy and activity?

The National Joint Registry is another safety layer. It collects data on joint replacement procedures and outcomes, including revision surgery, across several UK nations and territories.⁷ Registry data cannot tell you exactly what will happen to you, but it helps expose implants or providers with worse-than-expected performance. It also makes the system more transparent than it was in the era of poorly performing metal-on-metal hips.

Metal-on-metal hip replacements are now a special category. MHRA issued updated advice for follow-up of all metal-on-metal hip replacements because some patients can develop soft tissue reactions, raised metal ions or implant failure even without obvious symptoms.¹¹ If you already have a metal-on-metal implant, ask whether you are on the correct monitoring pathway.

Risks and realistic recovery

Hip replacement is common, but it is still major surgery. NHS information lists risks including infection, blood clots, dislocation, leg-length difference, fracture, nerve damage and loosening or wear over time.¹ NHS inform also describes possible complications such as wound infection, dislocation, deep vein thrombosis, pulmonary embolism and the need for revision surgery.³

Recovery starts before the operation. Strengthen what you can, practise stairs if safe, arrange a chair and bed height that work, remove trip hazards, plan food, transport and support, and ask what equipment will be provided. If you live alone, say so early. If you are a carer for someone else, that needs planning too.

NHS recovery guidance says you will usually be encouraged to walk soon after surgery, with a frame or crutches at first, and physiotherapy exercises help strengthen the hip.² Driving, work and sport depend on the side operated on, car, job, pain control, strength, reaction time and surgeon advice. A desk job and a manual job are not the same recovery problem.

Pain after surgery should improve overall, but the early weeks can be uneven. Swelling, bruising, sleep disruption, constipation, wound care, low mood, fatigue and fear of movement are common. Seek urgent advice if you develop chest pain, breathlessness, calf swelling, fever, spreading redness, wound leakage, sudden severe pain, a fall, new leg weakness, or a hip that feels out of place.

How to make the decision

The right time is not the earliest possible date or the latest point you can tolerate. It is when expected benefit outweighs risk and you are prepared for recovery. A good surgeon should explain what they think is causing the pain, what non-surgical options remain, what improvement is realistic, what could go wrong, and how revision risk changes with age and activity.

Be cautious with extreme promises. "Minimally invasive", "robotic", "rapid recovery", "custom", "premium implant" or "muscle-sparing" may be relevant, but none replaces the basic questions: who is operating, how often do they do this operation, what implant is used, what are the local infection and revision rates, and what happens if recovery is not straightforward?

If you are undecided, ask for the decision to be framed around your life. "I can walk 10 minutes, sleep is broken by pain, tablets upset my stomach, and I want to keep working" is more useful than "my hip hurts". If the answer is still unclear, a second opinion can be reasonable, especially if you are young, have complex anatomy, previous surgery, inflammatory disease, severe osteoporosis, infection history or a proposed implant you do not understand.

This article is educational and does not constitute medical advice, diagnosis, or a treatment recommendation. Medication uses described as “off-label” are not licensed for that purpose in the UK and should only be considered under qualified clinical supervision. Always speak to your GP, pharmacist, or a registered specialist before starting, stopping, or changing any treatment. If you have severe or alarm symptoms - unintentional weight loss, blood in your stool, difficulty swallowing, persistent vomiting, a fever, or severe pain - seek urgent medical care.