Before considering surgery, all efforts should be made to manage the symptoms of hip arthritis through non-surgical measures. This should include pain management, lifestyle modifications, physiotherapy and mobility aids. Despite these interventions, for some patients the pain persists and has a significant negative impact on their daily quality of life. At this stage a joint replacement could be considered. While it is expected to significantly reduce pain, the artificial joint will not provide a complete solution to arthritis.

The most significant risks associated with the procedure include the potential for death and amputation. Additionally, there is a risk of severe disability, such as from heart attacks, strokes, pneumonia, kidney impairment, or thromboembolism (blood clots in the legs and lungs, also known as deep vein thrombosis and pulmonary embolism), which are among the most common causes. There is also the risk of temporary or permanent morbidity from less severe events.

The risk of deep infection is approximately 1 in 100. If infected, the joint may require removal. Multiple complex surgeries are frequently necessary, and the patient may be left with permanent disability or chronic infection.

I would recommend thrombo-embolic prophylaxis, specifically low molecular weight heparins and postoperative oral agents, as well as early mobilisation. There is a balance between risk reduction of blood clots in the legs and lungs vs. bleeding, wound leakage and infection.

The other complications include dislocation (1 in 30 lifetime risk), leg length discrepancy, peri-operative fracture, and blood vessel and nerve injury in the limb. Damage to the main sciatic nerve (1:2000 risk) can lead to a foot drop and difficulty walking. Patients may occasionally experience a discrepancy in leg length due to the pursuit of optimal hip replacement stability. All complications can lead to temporary or permanent deficit and can affect the ability to carry out activities of daily living or specific tasks based on hobbies or interests.

There can be a general deterioration of existing medical conditions, such as heart, brain, kidney, and lung diseases. Patients with memory problems or dementia may experience worsening of symptoms, permanent changes in their personality and reduced ability to function daily. Other medical complications include chest and urinary tract infections. Rarely, there can be a slowing down in bowel movements, leading to a pseudo-obstruction that can be serious. These conditions are more prevalent in older patients.

The satisfaction rate for hip replacements is approximately 90%. However, this statistic does imply that in 10% of cases, patients are dissatisfied with the surgical outcome, even if the procedure was performed competently and complications were absent.

Hip replacements primarily serve as pain-relieving devices and does not guarantee an enhancement in mobility as other problems may hinder mobilisation. This may include back and knee pain or long standing muscular weakness or pre-existing nerve damage.  Nevertheless, when individuals experience reduced pain, they tend to be more capable of performing various activities.

Hip replacements alleviate pain from the hip joint alone and do not address pain originating from other sources, such as back pain, bursitis or knee problems.

A complete recovery from a hip replacement typically takes a year. While initial improvements may be noticeable in the early stages, the full year is often required for the patient’s condition to fully improve. Much of this relates to maturing of the scar tissue around the hip and the strengthening of muscles.

Finally, artificial hips may wear out or become loose. It is anticipated that there will be approximately 15 years of satisfactory function from a hip, although this duration is contingent upon usage and age. Subsequently, more intricate surgery, such as a revision total hip replacement, may be necessary. There is a correlation between the elevated risk of revision surgery and the younger age of the patient at the time of their initial operation.