Total Hip Replacement Surgery

This page is general information intended for patients of Dr. Borshch. Your situation may be different, so please follow the advice of your surgeon and treating team.

A total hip replacement (also called a total hip arthroplasty) is an operation where the damaged joint surfaces of the hip are replaced with metal, and either plastic or ceramic components.
The aim is to:

• reduce pain
• improve walking and daily function
• improve quality of life

The hip is a ball-and-socket joint. In a hip replacement, the worn-out ball (femoral head) and socket (acetabulum) are replaced with artificial parts that move smoothly together.

The most common reason is hip arthritis (usually osteoarthritis), where the smooth cartilage lining the joint wears away and the exposed bone causes pain and stiffness.  Some hip fractures are also treated with a full or partial hip replacement.

A total hip replacement is usually considered when:

• pain affects walking, sitting, sleep, or work
• the hip is stiff and movement is restricted (for example, difficulty putting on shoes or socks)
• pain persists despite other treatments such as medications, physiotherapy, walking aids, activity modification, or injections

Good preparation lowers risk and helps recovery.

• Stop smoking/vaping if possible (smoking increases wound and infection risks).
• If you have diabetes, aim for good blood sugar control.
• Work on fitness and weight where possible—stronger muscles and better general health usually mean smoother recovery.
• Tell the team about any history of blood clots, sleep apnoea, heart/lung disease, or immune-suppressing medications.

• Arrange help for the first 1–2 weeks (meals, shopping, transport).
• Make your home safer: remove loose rugs, organise a stable chair, consider railings, and set up a bed/bathroom plan.
• Prepare icing options and comfortable walking paths.

Your team will advise what to stop or continue (for example, some blood thinners, anti-inflammatories, or supplements). Always check before changing anything.

• Pain control using a multimodal plan (several types of pain relief together).
• Early walking and exercises with the help of an inpatient Physiotherapist.  Learning the hip precautions that help keep the new joint from popping out.
• A blood clot prevention plan (medication and movement), guided by your risk factors.

• You will have your first review back in the office (usually with the nurse), this is mainly to check that the incision is healing well, make sure your pain is controlled and address any other concerns.
• Your walking improves steadily, usually with a walker/crutches early, then a stick, then independently.
• Swelling and bruising is common.
• You’ll do regular exercises to regain movement and strength with the help of an outpatient Physiotherapist.  The main aim is to restore a normal gait.
• Driving is usually not safe until 6 weeks post surgery or when leg strength is close to normal.

• You will have your first review in the office with me, this is mainly to check your gait and resolution of symptoms.
• Most people notice major improvements in daily activities.
• Strength and endurance continue to build.
• Some swelling can still be normal.

• Ongoing improvement in strength, balance, confidence and cosmetic appearance of the incision.
• Some people continue to notice gains up to a year (or longer).

• During surgery the ball and socket are placed separately and then put together towards the end of the operation.  This means that they can separate again (dislocate) in the short term while the scar tissue is forming and sometimes long term if the joint is placed into a “dangerous” position.
• For a Direct Anterior Approach hip replacement, the “dangerous” positon to avoid is usually one where the leg is turned outward, knees apart and leg towards the back.
• For a Posterior Approach hip replacement the “dangerous” position to avoid is usually one where the leg is turned inward, knee too close to the chest and knee crossed over the other leg.
• Hip precautions are ideally practiced for the first 3 months after surgery, but any “extremes” of range of motion or positions of the hip should be avoided life-long.

Most people experience excellent pain relief and significant improvement in function after total hip replacement.

Modern hip replacements are very durable. Large registry and review studies suggest:

• around 85% of hip replacements are still functioning well at 20 years and around 58% at 25 years. (https://pubmed.ncbi.nlm.nih.gov/30782340/)

Hip replacement has one of the highest patient satisfaction rates of any joint replacement surgery.
Most patients return to walking, travel, and low-impact recreational activities.
Some patients may still notice mild stiffness, altered sensation around the scar, or activity limitations.

Contact our office, your GP, or go to hospital urgently if you notice:

• increasing redness, warmth, or swelling around the wound
• worsening pain after initial improvement
• pus or bad-smelling discharge
• fevers or feeling very unwell

(Periprosthetic joint infection after primary hip replacement is uncommon—around 1–2%—but very serious.) (https://pubmed.ncbi.nlm.nih.gov/36047015/)

• new calf pain or tenderness, increasing swelling in one leg
• sudden shortness of breath, chest pain, coughing blood (call emergency services)

• sudden severe hip pain
• inability to move the leg normally
• leg appearing shortened or rotated

This requires urgent assessment.

• leaking through dressings
• opening wound edges
• rapidly increasing bruising or swelling

• worsening numbness or weakness in the leg or foot
• cold or pale foot
• severe escalating pain