Hip pain: when is it time to think about a hip replacement?

Most hip arthritis is managed without surgery at first. Here's what helps, and when an orthopaedic surgeon may suggest a replacement.

Hip pain has many causes. Pain felt deep in the groin or front of the thigh is often from the hip joint itself, commonly osteoarthritis. Pain on the outside of the hip is often from the tendons and bursa around it. Pain in the buttock may come from the lower back. Your GP can help work out which it is.

Hip osteoarthritis usually develops slowly. You may notice stiffness, trouble putting on shoes and socks, a limp, or pain that wakes you at night.

Treatments to try first

For most people, the first steps are:

• A strengthening and mobility program with Physiotherapy or Exercise physiology
• Staying active with walking, cycling, swimming or water exercise
• Managing weight if needed, to reduce load through the joint
• Pain relief your GP or pharmacist recommends for you
• A walking stick in the opposite hand, which can take a surprising amount of load off the hip

Many people improve enough with these to put off surgery for years, or avoid it altogether.

When a hip replacement may be considered

Your GP may refer you to Orthopaedic surgery if the pain is severe, you've tried non-surgical treatment and it's no longer enough, and the hip is limiting your walking, sleep, work or independence. X-rays usually show how much the joint has changed, but the decision is based mostly on how you are going day to day.

Hip replacement is a common and generally successful operation. The surgeon replaces the worn joint surfaces with an artificial ball and socket. Most people are up and walking with help soon after surgery, then do several weeks to months of rehab with a physiotherapist.

Questions worth asking the surgeon:

• What are the risks for someone like me?
• How long will I be in hospital, and will I need rehab as an inpatient?
• When can I drive, work and return to my usual activities?
• What is the total cost, including the surgeon, anaesthetist and hospital?

Public or private, and costs

Hip replacement is done in both public and private hospitals. Public waiting times depend on your urgency category and local demand (see What do Category 1, 2 and 3 referrals mean?). In the private system you choose your surgeon, but there are usually out-of-pocket costs even with private health insurance. Always get a written quote. On Spec Book you can compare who has the soonest consultation, and your GP can send the referral with the booking.

When to get urgent help

Call 000 or go to an emergency department if you have a fall and can't stand or put weight on your leg, if the hip is hot and very painful with a fever, or if you have a hip replacement and develop sudden severe pain, a fever, or the leg looks shortened or turned out.

General information only, not medical advice. Everyone's situation is different, so check with your GP or the provider. In an emergency call 000.