Hip Replacement: questions and answers

In detail

Hip arthritis is the most common reason for replacement, causing pain, stiffness, and loss of movement. Displaced femoral neck fractures in healthy elderly patients may be treated with total hip arthroplasty instead of hemiarthroplasty.

Avascular necrosis results from loss of blood supply to the femoral head. The surgeon reviews your history, examines the hip, and checks imaging to see if the joint surfaces are worn out or broken. Studies show total hip arthroplasty provides better function than hemiarthroplasty for displaced fractures in suitable patients.

In detail

The most common symptoms that lead to hip replacement are severe hip pain, stiffness, and reduced movement. Pain often worsens with activity and may disturb sleep. Stiffness makes it hard to rotate the leg or bend the hip.

Many patients report a limp or need a cane. In studies, the average baseline pain score was 6.5 on a 10 cm scale. These symptoms usually develop over years, with a median of 6.6 years since osteoarthritis diagnosis. If pain and stiffness stop you from doing routine tasks, an orthopaedic opinion is appropriate.

In detail

A displaced femoral neck fracture from a fall causes sudden severe pain, inability to stand, and the leg may appear shortened and turned outward. This is a surgical emergency.

Similarly, a native hip joint that becomes acutely infected presents with fever, severe pain at rest, and inability to move the hip. Septic arthritis can destroy the joint rapidly.

Post-operative patients must seek urgent care for sudden wound swelling, increasing redness, discharge, or fever, which may indicate deep infection or dislocation. Evidence shows that early surgery for displaced fractures and prompt treatment of infection improve outcomes. Routine OPD is for chronic arthritis symptoms that have developed over months.

In detail

The surgeon compares the affected hip with the other side, checks range of motion, leg length, and muscle strength. You may be asked to walk so the surgeon can observe your gait. Evidence shows that pre-operative evaluation includes assessing fitness for anaesthesia and surgery.

The surgeon explains the diagnosis, whether hip replacement is appropriate, and which type of procedure may suit you — total hip replacement, hip resurfacing, or anterior approach. Risks such as dislocation, infection, nerve injury, and fracture are discussed.

You will learn about the typical hospital stay of three to five nights, walking with aids in one to two days, and recovery to normal activity in six to twelve weeks. The typical cost range in India is two to four lakh rupees.

In detail

Evidence shows that pre-operative evaluation aims to optimise safety for spinal or epidural anaesthesia and surgery. The surgeon reviews your medicines, allergies, and past illnesses. If you have cardiac, respiratory, or metabolic conditions, relevant specialist opinions or investigations are requested.

Imaging beyond X-rays, such as CT or MRI, is ordered only when the X-ray does not give enough detail for surgical planning.

The goal is to identify and correct anaemia, infection, or uncontrolled diabetes before surgery, reducing the risk of complications such as wound healing problems or cardiac events. Tests are not routine for every patient; they are tailored to your risk profile.

In detail

Evidence shows that pre-operative optimisation reduces complications. If blood tests reveal anaemia, iron therapy or transfusion may be given before surgery. Uncontrolled blood sugar will need medication adjustment to lower infection risk. Abnormal kidney or liver function may alter the choice of antibiotics or painkillers.

Cardiac or respiratory abnormalities may need a cardiologist or pulmonologist review and could change the anaesthesia plan from spinal to general, or require intensive care standby. If imaging shows unexpected bone loss or deformity, the surgeon may plan a different implant or approach.

Each result is weighed against the urgency of your hip condition — fracture surgery cannot wait long, while elective arthritis surgery allows time for optimisation.

In detail

Guidelines recommend trying non-surgical treatments first. Oral NSAIDs, topical diclofenac, and physiotherapy can reduce pain and improve function. Opioids are generally avoided due to high adverse event rates. If conservative care fails, surgical options are discussed.

Total hip replacement replaces both the femoral head and acetabulum. Hip resurfacing conserves bone and suits younger, active patients. The anterior approach may offer faster early recovery but has a learning curve. Cementless implants rely on bone ingrowth. The surgeon matches the technique to your age, bone quality, activity level, and anatomy.

In detail

Evidence supports a step-wise approach. Topical diclofenac provides effective pain relief with minimal systemic exposure. Oral NSAIDs such as etoricoxib or diclofenac are effective but carry higher adverse event rates.

Opioids are not recommended for chronic osteoarthritis pain due to high dropout rates from side effects and risks of dependence, fractures, and cardiovascular events. Physiotherapy strengthens hip muscles, improves gait, and can delay surgery. Weight reduction lowers joint load. Walking aids offload the painful hip.

Activity modification avoids movements that worsen pain. For early avascular necrosis or mild arthritis, observation with regular review may be appropriate. For displaced fractures, non-surgical treatment is rarely an option.

The surgeon assesses your symptom severity, imaging findings, and functional impairment to decide if non-surgical care should continue or if surgery is now indicated.

In detail

Hip replacement is usually considered a last resort after medication, physiotherapy, and walking aids have failed to reduce joint pain and inflammation. Evidence shows that conditions damaging the hip joint, with osteoarthritis being the most common cause, lead to this decision.

For displaced femoral neck fractures in healthy elderly patients, total hip arthroplasty may be a better alternative to hemiarthroplasty. The surgeon will compare your affected hip with the other side, assess your range of motion, and review imaging before recommending surgery.

In detail

Recovery follows a stepped pattern. In studies, patients using the direct anterior approach had lower pain scores on the first post-operative day and more were climbing stairs normally at six weeks. However, there were no significant differences between surgical approaches at later time points.

The Harris hip score and WOMAC scores typically improve steadily over the first three months. Regular walking and prescribed exercises are essential for long-term strength and movement. People over seventy sometimes take longer to recover, and everyone's recovery is unique.

In detail

Complications are rare but can include hip instability, dislocation, abductor insufficiency, fracture, or nerve injury.

Evidence shows dislocation occurred in about 4.7% of total hip arthroplasty patients in one study, and serious adverse events occurred in over 40% of patients in a large trial, though many were medical rather than surgical.

The direct anterior approach carries specific risks such as fractures and nerve damage, which decrease with surgeon experience.

You should also avoid crossing your legs, bending the hip beyond ninety degrees, sitting on low chairs, and lifting heavy objects during early recovery to protect the new joint.

In detail

Guidelines advise avoiding sitting in low chairs, crossing legs, bending the hip past 90 degrees, and exercises with jumping or high fall risk while the hip heals. Most people regain the ability to walk, climb stairs and do daily activities once fully recovered.

Long-distance travel may be uncomfortable initially due to swelling; sitting still for long periods should be avoided. Your surgeon will advise when specific activities are safe based on your progress.

In detail

Recovery is a major part of the treatment. Before discharge, a physiotherapist or occupational therapist will teach you how to manage daily activities, use walking aids, and do your home exercises. Evidence shows regular walking and early exercises improve long-term strength and movement.

You will need help with cooking, cleaning, bathing, and shopping initially. Stitches or clips are removed around ten days. Swelling in the legs and feet is common and improves with elevation and regular movement. Painkillers will be prescribed for the first few weeks.

In detail

Hip replacement is usually considered a last resort when other treatments have failed. Evidence shows healthcare providers suggest medication, physical therapy, or a cane before surgery.

The surgeon will compare your affected hip with the other side, check your range of motion, and review X-rays or other scans. Fitness for anaesthesia and surgery is also evaluated.

Age alone is not a barrier; patients over seventy can benefit, though recovery may take longer. Your general health, bone quality, and ability to participate in rehabilitation are key factors.

In detail

Evidence indicates etoricoxib 60 mg/day and diclofenac 150 mg/day are the most effective oral NSAIDs for osteoarthritis pain and function. Topical diclofenac at 70 to 81 mg/day is effective and safer.

Opioids have high dropout rates from adverse events (up to 83%) and any adverse event rates up to 90%. Guidelines focus on harm reduction for opioids. Physiotherapy and weight management also help. Your surgeon will review what you have tried and what may still help before advising surgery.

In detail

Total hip replacement replaces both the femoral head and acetabulum. Cementless fixation allows biological bonding for long-term durability, often preferred in younger, active patients with strong bone. Cemented fixation may suit older patients or those with softer bone.

Hip resurfacing conserves bone and may suit younger, high-demand patients. The direct anterior approach is muscle-sparing and linked to faster early recovery, though it has a steep learning curve and specific risks like fracture and nerve injury. Posterior and lateral approaches are also used.

Evidence shows no single approach proves superior in the long term. Implants typically last many years, and many people keep them for life.

In detail

Our usual protocols for this service describe four techniques: total hip replacement, hip resurfacing, anterior approach total hip replacement, and cementless implant fixation.

The evidence notes that the direct anterior approach has a steep learning curve and that new instruments have made it more accessible, but it does not mention robotic assistance.

Because the hospital's standard techniques are defined, any potential benefits such as precision or limitations such as longer operating time or cost for robotic systems are not part of the current service description. Your surgeon can explain the advantages of the available approaches based on your anatomy and needs.

In detail

Our usual protocols specify spinal or epidural anaesthesia, operation time of one and a half to two and a half hours, and a hospital stay of three to five nights. Modular operation theatres are listed among the hospital facilities.

Evidence shows that complications such as dislocation, fracture, nerve injury, and instability occur at known rates, and that serious adverse events were reported in around forty percent of patients in large trials.

While the evidence does not detail specific infection or clot prevention measures, standard practice typically includes sterile theatre conditions, antibiotic prophylaxis, mechanical compression devices, and early mobilisation with walking aids within one to two days.

The recovery protocol notes walking with aid in one to two days, which helps reduce clot risk. Your surgeon will explain the specific precautions used for your case.

In detail

Clinical guidelines suggest trying non-surgical measures first. These include weight management, activity modification, oral or topical NSAIDs, and a structured physiotherapy programme.

Evidence indicates that topical diclofenac can be effective with fewer systemic side effects, while opioids carry a high risk of adverse events without clear long-term benefit for osteoarthritis.

If these steps fail and X-rays show advanced joint space loss, osteophytes, or deformity, the surgeon may discuss total hip replacement. The decision also depends on your overall fitness for anaesthesia and surgery, which is assessed during a pre-anaesthesia check-up. Age alone is not a barrier; patients in their seventies and eighties often benefit if they are medically fit.

In detail

Uncemented fixation is often preferred for younger, active patients with good bone stock because it avoids cement-related complications and allows biological fixation that may last decades.

Cemented implants provide immediate stability and are typically chosen for older patients or those with osteoporosis where bone ingrowth is less reliable. Evidence from long-term registries shows excellent survival for both methods when matched to the right patient.

The surgeon will review your DEXA scan if needed, assess bone density on X-ray, and discuss the expected lifespan of each option. There is no single superior method; the decision is individualised.

In detail

Our usual protocols describe the anterior approach as muscle-sparing with faster early recovery.

Evidence shows that direct anterior approach subjects had lower pain scores on the first post-operative day, more were climbing stairs normally and walking unlimited at six weeks, and they had higher symptom scores at three months.

However, there were no significant differences between groups at later time points. The evidence also notes a steep learning curve for this approach, with complications such as fractures and nerve damage that decrease with greater surgeon experience.

Some studies suggest it may be associated with fewer surgical complications or a reduced risk of dislocation, while others find similar complication rates to other approaches. Long-term outcomes appear comparable. Your surgeon will discuss the potential early benefits and the relevance of surgeon experience for your case.

In detail

Evidence from large studies shows that the majority of patients report mild or no pain by three months and regain the ability to climb stairs, walk unlimited distances, and perform daily activities without help. The Harris Hip Score and WOMAC scores typically improve significantly.

Early recovery is supported by a structured physiotherapy programme that begins in hospital and continues at home.

You will need to follow hip precautions such as avoiding crossing legs, bending past ninety degrees, and sitting on low chairs for the first six to eight weeks to protect the new joint.

People over seventy may take a few weeks longer to reach the same milestones. The implants used today are designed to last many years, and most people keep them for life.

In detail

Our usual protocols state that recovery includes walking with an aid in one to two days and normal activity in six to twelve weeks.

Evidence confirms you will need physical therapy for a few months, with stretches and exercises starting as soon as twenty-four hours after surgery. A physiotherapist or occupational therapist will discuss daily activities and home exercise programmes before discharge.

You will need crutches or a walking frame at first. Regular walking every day as far as comfortable is recommended. The evidence does not mention routine brace use after hip replacement. Your surgeon and therapy team will guide you on the specific aids and exercises suited to your progress.

In detail

Our usual protocols list a typical range of two lakh to four lakh rupees for total hip replacement in India.

Evidence from other sources indicates the cost in India varies between one lakh fifty thousand and four lakh eighty thousand rupees for total hip replacement, while partial hip replacement may cost between seventy-five thousand and one lakh seventy-five thousand rupees.

Factors that influence the price include the city tier, surgeon expertise, management of any post-surgical complications such as infection or blood loss which may extend the hospital stay, and the duration and type of rehabilitation required.

Insurance coverage and the specific policy terms also affect the amount you may need to pay yourself. The hospital stay is typically three to five nights. Jaipur Hospital works with schemes such as RGHS, MAA Yojana, CGHS, and a panel of private insurers and TPAs. Your exact estimate will be given after the surgeon reviews your case.

In detail

The overall cost depends on the type of implant chosen, whether cemented or cementless fixation is used, and the surgical approach such as posterior, lateral, or anterior. Evidence shows that implant choice and fixation method influence long-term durability and revision rates.

Complications such as infection, dislocation, or fracture may require additional surgery, a longer stay, or intensive care, which would increase the final bill. Insurance policies under RGHS, CGHS, MAA Yojana, or private TPAs may cover different portions, so the patient share varies.