Total Hip Replacement Surgery
Groin pain that has taken your walking, your sleep and your ability to put on your own socks responds better to hip replacement than almost any other operation in surgery. Our orthopaedic surgeons use modern bearings and minimally invasive approaches. Most patients stand on the day of surgery and walk without support within six weeks.
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What is Hip Replacement Surgery?
A total hip replacement replaces a hip joint destroyed by arthritis or bone death. The worn ball at the top of the thigh bone is removed and replaced with a metal or ceramic head on a stem fixed into the femur, and the socket in the pelvis is resurfaced with a cup and a smooth bearing liner. It is consistently rated among the most successful operations in all of surgery, with patient satisfaction higher than for almost any other procedure.
A point that causes real confusion first: hip arthritis usually hurts in the groin, not on the side of the hip. Pain on the outer side of the hip is more often bursitis or gluteal tendon problems. Hip pain also refers commonly to the thigh and the knee — and it is not unusual for someone to be investigated for a knee problem for months when the source is the hip. If you have knee pain with a normal knee X-ray, ask about your hip.
The commonest cause is osteoarthritis, cartilage wearing away until bone grinds on bone. But in India a strikingly large share of hip replacements are for avascular necrosis — the ball of the hip losing its blood supply and collapsing. It affects a much younger population, often in the thirties and forties, and its major associations are long-term steroid use, heavy alcohol intake, sickle cell disease and previous hip trauma. Inflammatory arthritis, hip dysplasia and fractures of the femoral neck in older patients account for most of the rest.
As with the knee, this is an operation for when other things have failed — weight management, physiotherapy focused on the hip abductors, analgesia and activity modification all deserve a proper trial first. The distinction from knee replacement is that hip arthritis often becomes intolerable faster, and hip replacement produces such reliable relief that surgeons are generally less hesitant once the joint space is genuinely gone.
Two honest points. First, a replaced hip feels more natural than a replaced knee — this is a consistent finding, and patients who have had both usually say so. Most walk without a limp, sleep without pain and forget the joint is artificial. Second, the specific thing to understand about hips is dislocation. For the first six to twelve weeks, before the soft tissues around the new joint heal and tighten, the ball can come out of the socket if the hip is put in certain positions — deep bending, crossing the legs, or twisting inwards. Following the precautions during that window is not fussiness; it is what prevents a return to theatre. For Indian households this needs a practical conversation before surgery: floor-sitting, squatting toilets and low seating all need alternatives arranged in advance.
Treatment information
| Condition | Hip Osteoarthritis / Avascular Necrosis / Femoral Neck Fracture |
|---|---|
| Procedure | Total Hip Arthroplasty |
| Duration | 60 to 120 minutes |
| Treated by | Orthopaedic Joint Replacement Surgeon |
| Anaesthesia | Spinal anaesthesia, usually with sedation |
| Success rate | 95–98% at 10 years |
| Recovery time | 6 to 12 weeks |
| Hospital stay | 2 to 4 days |
Signs you may need Hip Replacement Surgery treatment
- Groin pain — the classic location for hip arthritis, often mistaken for a muscle strain
- Pain referred to the thigh, and frequently to the knee
- Pain on standing up from a chair and on the first few steps
- Stiffness in the morning that eases with movement
- Difficulty putting on socks, shoes or cutting toenails
- Trouble getting in and out of a car
- A limp, or a rolling gait that others notice before you do
- Reducing walking distance measured in shrinking minutes
- Grinding or clicking within the joint
- Pain at night that disturbs sleep, particularly lying on that side
- The affected leg feeling shorter than the other
What causes it?
- Osteoarthritis — progressive cartilage wear, the commonest cause overall
- Avascular necrosis of the femoral head, disproportionately common in Indian patients and in younger people
- Rheumatoid arthritis and ankylosing spondylitis
- Developmental dysplasia of the hip, causing abnormal loading from childhood
- Fracture of the neck of the femur, particularly in older patients with osteoporosis
- Post-traumatic arthritis after a fracture involving the joint surface
- Perthes disease or slipped upper femoral epiphysis in childhood
- Femoroacetabular impingement causing progressive cartilage damage
- Previous hip infection that destroyed the cartilage
Who is more likely to be affected
- Age above 55 for osteoarthritis; much younger for avascular necrosis
- Long-term corticosteroid use — a major and often preventable cause of avascular necrosis
- Heavy, sustained alcohol intake
- Sickle cell disease and other haemoglobinopathies
- Obesity, which raises joint loading substantially
- A family history of hip arthritis or dysplasia
- Previous hip injury or fracture
- Occupations involving heavy lifting or prolonged standing
- Osteoporosis, which raises fracture risk in older patients
- Smoking, which impairs bone blood supply and healing
When to see a doctor immediately
- Groin pain that persists for more than a few weeks
- Hip pain that wakes you at night or is present at rest
- Difficulty putting on socks or shoes, or getting into a car
- A limp that has developed gradually
- Walking distance that has reduced steadily over months
- Knee pain with a normal knee X-ray — the hip may be the source
- Hip pain in a younger person on long-term steroids, which needs assessment for avascular necrosis
- Sudden severe hip pain and inability to bear weight after a fall — go to hospital the same day
- A hot, painful hip with fever, which needs urgent assessment to exclude infection
How it is diagnosed
Clinical examination
Range of movement, particularly internal rotation, which is the first movement lost in hip arthritis. Gait, leg length, and provocative tests to distinguish hip pathology from spinal or bursal causes of similar pain.
X-rays of the pelvis and hip
The essential imaging. Anteroposterior pelvis and lateral views show joint space narrowing, osteophytes, cysts and the shape of the femoral head. In avascular necrosis they show the characteristic changes and whether the head has collapsed — which determines whether the joint can still be saved.
MRI
The key test for early avascular necrosis, detecting it long before X-rays change. This matters enormously, because early avascular necrosis can sometimes be treated with joint-preserving surgery instead of replacement. MRI also assesses the labrum and surrounding soft tissue.
Assessment for the cause of avascular necrosis
A steroid, alcohol and trauma history, sickle cell screening and a coagulation profile where relevant. Identifying the cause matters both for the other hip, which is affected in a large proportion of cases, and for preventing recurrence.
Blood tests and infection screen
Full blood count, sugar, kidney and liver function, vitamin D and inflammatory markers. Dental and urinary infection screening, because bacteria seeding a new implant is the complication everyone works hardest to avoid.
Cardiac and anaesthetic assessment
ECG, echocardiogram where indicated, and a formal anaesthetic review. Optimising other medical conditions before surgery measurably reduces complications, particularly in older patients.
Templating and implant planning
Digital planning on calibrated X-rays determines implant size, position and the correction needed for leg length. Careful templating is what prevents the leg length discrepancy that patients notice and dislike.
How the options compare
| Feature | Cemented Implant | Uncemented Implant |
|---|---|---|
| Fixation | Bone cement fixes the implant immediately | Bone grows into a porous surface over weeks |
| Immediate stability | Full, straight away | Good, with bone ingrowth developing over time |
| Best suited to | Older patients, osteoporotic bone | Younger patients with good bone quality |
| Operating time | Slightly longer — cement must set | Shorter |
| Weight bearing | Full immediately | Usually full, sometimes protected early |
| Long-term loosening | Cement can debond over decades | Durable where ingrowth is achieved |
| Revision surgery | Cement removal makes revision harder | Generally easier to revise |
| Cost | Lower | Higher |
Types of treatment
Non-surgical treatment
Weight reduction
Forces through the hip are several times body weight during walking, so weight loss has an outsized effect on symptoms. It also reduces surgical and anaesthetic risk if you eventually need replacement.
Physiotherapy
Strengthening the hip abductors and core, and maintaining range of movement. It will not reverse arthritis but it reduces pain, improves gait and — importantly — produces a better and faster recovery if surgery follows.
Analgesia
Paracetamol and, where safe, anti-inflammatories. Used sensibly and reviewed, particularly in older patients with kidney or stomach concerns.
Walking aid
A stick held in the opposite hand reduces load through the affected hip substantially. Many patients resist it for appearance and are surprised by how much it helps.
Activity modification
Switching from high-impact activity to swimming and cycling maintains fitness while reducing joint loading. Cycling in particular is well tolerated by arthritic hips.
Joint-preserving surgery
Core decompression
For early avascular necrosis before the femoral head has collapsed. Channels are drilled into the head to relieve pressure and stimulate new blood vessel growth, sometimes with bone graft or stem cells. It can delay or avoid replacement in a young patient — but only if the disease is caught early, which is why MRI matters.
Hip arthroscopy
Keyhole surgery for femoroacetabular impingement and labral tears in younger patients with preserved cartilage. It addresses a mechanical cause of damage before arthritis becomes established.
Osteotomy
Realigning the femur or the pelvis to shift load onto healthier cartilage. Used in selected young patients with dysplasia or localised damage, preserving the natural joint entirely.
Replacement surgery
Total hip replacement
Both the ball and the socket are replaced. The standard operation for advanced arthritis and for collapsed avascular necrosis, and one of the most reliably successful procedures in surgery.
Hemiarthroplasty
Only the ball is replaced, leaving the natural socket. Used mainly for femoral neck fractures in older, less mobile patients, where it is quicker and carries a lower dislocation risk.
Minimally invasive and direct anterior approach
The joint is reached between muscle planes rather than by detaching muscle, which can mean less pain, faster early recovery and a lower dislocation rate. It requires specific training and is not suitable for every patient or every body type.
Hip resurfacing
The femoral head is capped rather than removed, preserving bone. Considered in selected young, active men with good bone quality. Its use narrowed considerably after problems with metal-on-metal wear, and it is now a niche option requiring careful selection.
Revision hip replacement
Replacing a worn, loose or infected implant. Technically more demanding, often requiring bone graft, with less predictable results than primary surgery — which is the main argument against replacing a hip too young.
What happens, step by step
- 1
Consultation and decision
45–60 minutes- Assessment of pain, function, walking distance and effect on sleep
- Review of what non-surgical treatment has genuinely been tried
- X-rays and, where avascular necrosis is suspected, MRI reviewed with you
- For younger patients, joint-preserving options discussed explicitly before replacement
- Honest discussion about floor-sitting, squatting toilets and the dislocation precautions
- 2
Pre-operative optimisation
2 to 6 weeks- Blood tests, ECG, cardiac review and anaesthetic assessment
- Dental and urinary infection screening and treatment
- Diabetes control optimised; high sugars markedly raise implant infection risk
- Prehabilitation physiotherapy for the hip abductors and upper body, for crutch use
- Home prepared: raised toilet seat, firm high chair with arms, grab rails, no loose rugs
- 3
The operation
60–120 minutes- Spinal anaesthesia with sedation is usual; general anaesthesia where preferred
- The joint is approached posteriorly, laterally or anteriorly depending on the technique
- The worn femoral head is removed and the socket reamed to accept the cup
- The acetabular cup and liner are fixed into the pelvis
- The stem is inserted into the femur, cemented or press-fit
- The trial head is used to check stability, range of movement and leg length before the final components go in
- Soft tissues are repaired carefully — posterior repair meaningfully reduces dislocation risk
- 4
Early mobilisation
Day 0 to Day 4- Standing and taking a few steps with a walker the same day or the next morning
- Physiotherapy twice daily, with dislocation precautions taught and practised
- A pillow between the knees when lying, and no crossing the legs
- Blood thinners and calf pumps to prevent clots
- Discharge at day two to four, once you can walk, manage stairs and get in and out of bed safely
How to prepare
- Lose weight before surgery if you can — it improves the result and reduces complications
- Start prehabilitation physiotherapy, including upper body work for using crutches
- Get dental problems treated and any urinary infection cleared before the date
- Bring diabetes and blood pressure under good control
- Stop smoking at least four weeks before; it raises infection and wound risk substantially
- Review blood thinners with your cardiologist and surgeon together
- Prepare your home now: raised toilet seat, a firm chair with arms and a high seat, grab rails in the bathroom
- Plan alternatives to floor-sitting and squatting toilets before you come in, not after
- Get a long-handled shoe horn, a sock aid and a grabber — you will not be able to bend to your feet
- Arrange an attendant for at least the first two weeks
Why patients choose this procedure
Pain relief that is close to complete
Hip replacement produces some of the most reliable pain relief in surgery. The groin pain, the night pain and the pain on every first step typically disappear.
A hip that feels natural
Patients who have had both hip and knee replacements almost always say the hip feels more like a normal joint. Most walk without a limp and forget it is artificial.
Independence in daily tasks
Putting on socks and shoes, getting into a car, using stairs and walking to the shops all become possible again — the tasks people miss most.
Leg length corrected
Careful templating and intra-operative checking restore leg length, which improves gait and reduces secondary back and knee strain.
Long-lasting
Over 95% of modern hip implants are still functioning at ten years, and a majority at twenty, with modern bearing surfaces continuing to improve durability.
Sleep returns
Being able to lie on that side without pain, after years of not being able to, is consistently one of the changes patients mention first.
Possible risks and side effects
Dislocation
The complication specific to hips, and highest in the first six to twelve weeks before the soft tissues heal. It is provoked by deep bending, crossing the legs and twisting inwards — which is exactly what the precautions exist to prevent. Modern implants, larger heads, careful soft tissue repair and the anterior approach have all reduced the rate substantially.
Infection of the implant
Occurring in roughly one per cent, and the most serious complication. It can need prolonged antibiotics and sometimes removal and re-implantation. This is why dental and urinary infections are screened and diabetes control is insisted upon before surgery.
Deep vein thrombosis and pulmonary embolism
A recognised risk after major lower limb surgery, reduced by blood thinners, compression devices and early walking. Calf pain or swelling, breathlessness or chest pain must be reported immediately.
Leg length discrepancy
Small differences are common and usually unnoticed; larger ones cause limping and back pain and are the source of real dissatisfaction. Careful templating and intra-operative measurement minimise it, and a shoe raise corrects most residual difference.
Nerve injury
The sciatic nerve runs close to the posterior approach and the femoral nerve to the anterior. Injury is uncommon and usually a stretch rather than a division, recovering over months, but foot drop is a recognised complication.
Periprosthetic fracture
Fracture of the bone around the implant, either during insertion or later after a fall. More likely with osteoporotic bone, which is one reason bone health is assessed and treated.
Implant wear and loosening
Over fifteen to twenty years the bearing surface wears and components can loosen, requiring revision. Revision is a bigger operation with less predictable results, which is the main argument against replacing a hip in a very young patient.
Heterotopic ossification
Bone forming in the soft tissue around the joint, which can restrict movement. Usually mild; occasionally needs treatment.
What recovery looks like
Hip replacement recovery is generally faster and more comfortable than knee replacement, but it carries one restriction the knee does not: the dislocation precautions. For the first six to twelve weeks, until the soft tissues around the new joint heal and tighten, certain positions can pop the ball out of the socket. Following the rules through that window is what keeps you out of theatre a second time.
Days 0 to 4: you stand and take your first steps with a walker on the day of surgery or the next morning. Physiotherapy twice daily teaches you the precautions and practises them: no bending the hip beyond 90 degrees, no crossing the legs, no twisting the leg inwards. A pillow between the knees when lying. Discharge at day two to four.
Weeks 1 to 3: walk with the walker or crutches, increasing distance daily. The precautions continue strictly. Use the long-handled shoe horn, sock aid and grabber rather than bending to your feet. Sleep on your back with a pillow between the knees. Wound check and suture removal at around two weeks.
Weeks 3 to 6: progress from walker to a stick. Many patients need no support around the house by the end of this period. Driving usually at four to six weeks, once you can get in and out safely without breaching the precautions and can brake confidently.
Weeks 6 to 12: most precautions are relaxed at your surgeon's direction as the soft tissues heal — but check rather than assume. Walking without support for most patients. Return to desk work at six to eight weeks; physically demanding work at three months or more. Swimming and stationary cycling are excellent now.
Three to twelve months: strength and endurance keep improving through the first year. Most patients report they have stopped thinking about the hip at all.
Long term: walking, swimming, cycling, golf and doubles tennis are encouraged. Running, jumping and contact sport are not. Deep squatting and floor-sitting are usually discouraged permanently, which needs planning in an Indian home. Tell any dentist or surgeon that you have a joint replacement, since antibiotic cover may be advised.
Contact your care coordinator immediately for a sudden pop with severe pain and inability to move the leg — which may be a dislocation — or for fever, spreading redness, wound discharge, calf pain or swelling, breathlessness or chest pain.
What to eat and what to avoid
Recommended
- Protein at every meal — dals, eggs, paneer, fish, chicken — for muscle and wound healing
- Calcium-rich foods: milk, curd, paneer, ragi, til and green leafy vegetables
- Vitamin D, supplemented where deficient — important for bone ingrowth into the implant
- Iron-rich foods to recover haemoglobin after surgical blood loss
- Vitamin C from amla, guava and citrus for collagen and wound healing
- High-fibre foods to prevent constipation from painkillers
- 2 to 3 litres of water daily
Best avoided
- Alcohol, particularly relevant if avascular necrosis was alcohol-related — continuing risks the other hip
- Smoking, which impairs bone blood supply and raises infection risk
- Excess weight gain during the low-activity recovery period
- Excess salt and packaged food, which worsen swelling
- Refined sugar and maida, particularly if you are diabetic
- Skipping meals — undernutrition is a real and often missed cause of poor healing in older patients
Post-operative care, at no extra cost
- Diet and lifestyle consultation with a nutritionist
- Scheduled follow-up calls until you are fully recovered
- Free cab for the follow-up visit
- 24×7 access to your care coordinator for any concern
Hip Replacement Surgery treatment cost
₹2,00,000 – ₹5,00,000
The range depends on the implant and bearing surface chosen — ceramic-on-polyethylene, ceramic-on-ceramic or metal-on-polyethylene — whether the implant is cemented or uncemented, whether both hips are done, your city, the hospital and your room category. Implant prices in India are capped by regulation, which has made costs far more predictable. Hip replacement is covered by most health insurance policies, but joint replacement typically carries a waiting period of two to four years — check yours early rather than at admission. Our insurance desk verifies eligibility and confirms room-rent and implant sub-limits before admission.
Inside the care journey
Hip Replacement Surgery — your questions answered
Because that is where hip joint pain is actually felt. The joint sits deep in the groin, so arthritis typically causes groin pain, often referred down the thigh and to the knee. Pain on the outer side of the hip is usually bursitis or a gluteal tendon problem rather than the joint itself. This confuses a lot of people — and it is why someone with knee pain and a normal knee X-ray should have their hip examined.