A total hip replacement is a surgical procedure in which the arthritic or damaged joint is removed and replaced with an artificial joint (prosthesis).

Although an artificial hip will never be better than a healthy joint, in the vast majority of cases, surgery will alleviate pain and stiffness and allow you to return to general daily activities, including sports and moderate physical work.

Hip replacements have been performed for over 50 years and remain among the most successful surgical procedures. At least 50,000 hip replacement operations are carried out in the UK each year, with a success rate of 97%. Around 94% of hip replacements last 20 years, and it is likely that around 92% will last 30 years.

At The London Hip Unit, we have been using either ceramic-on-ceramic or ceramic-on-highly cross-linked polyethene bearing couples for over 20 years, with excellent results.

Primary (first time) uncomplicated total hip replacement surgery at The London Hip Unit can be performed using minimally invasive techniques, and computer-aided navigation or robotic-assisted surgery may be used in certain cases.

Surgery is carried out through a single incision of 6-10cm (compared to 20-30cm in conventional surgery), and is practised by only a limited number of experienced surgeons in the UK. At The London Hip Unit, we also perform hip replacement surgery through the direct anterior approach (DAA) in suitable patients.

The benefit of these techniques is that less supporting tissue is disrupted during surgery. This results in less blood loss and reduces surgical pain. The final scar will also be much less noticeable.

When first developed, hip replacements were generally cemented in. With improved technology, the use of uncemented prostheses has superseded cemented replacements except in a few rare circumstances. Now, the majority of implants performed in the USA and Europe are uncemented.

At The London Hip Unit, we’ve been dedicated advocates of the cementless technique for over 20 years and currently perform almost exclusively cementless primary and revision hip replacements.

In an uncemented hip replacement, the arthritic head of the femur (the ball) and the lining of the acetabulum (the socket) are removed. A femoral component is inserted into the healthy section of the patient's thighbone and a hemispherical socket is inserted into the pelvis. 

The surface of the artificial hip prostheses is textured and coated with a compound that stimulates the bone to grow onto its surface using the same mechanism that occurs when a broken bone heals itself, so the patient is essentially making their own glue.

Once the bone has grown into the prosthesis, an extremely firm bond is made, which virtually eliminates any loosening, a major cause of failure of hip replacement surgery.

A wide variety of prostheses are available from various manufacturers. Your surgeon will choose the one that best fits your anatomy, bone strength and level of activity.

The ball and socket of the new joint can be made from a variety of materials. All prostheses used by our surgeons incorporate the latest developments. These offer much harder surfaces and reduce the possibility of wear, a major reason for needing revision surgery.

The London Hip Unit also has significant experience with custom-made hips. These are tailor-made, computer-designed prostheses that are now used only occasionally when a patient's anatomy does not fit any ready-made hips.

You'll likely need walking aids for the first four to six weeks after surgery. This may initially be a walking frame, before moving on to one or two crutches. We'll assess your recovery and advise you on which option is most suitable for you. In most cases, patients can walk unaided from six to twelve weeks.

Typically, most people are ready to drive again after six weeks. However, this will depend on your age, overall health and recovery. We can advise you when it'll be safe to resume driving.

Further information can be found at:

The National Institute for Clinical Excellence gives guidelines on single mini-incision surgery.

The National Joint Registry provides an annual report on the performance of hip replacements.

The British Medical Journal provides patient information leaflets based on best practice.

The London Hip Unit offers patients hip resurfacing surgery. This is a procedure where the femoral head (the ball) is resurfaced rather than replacing the entire head of the thigh bone.

Hip resurfacing surgery in its current form has been performed since 1997. Initially hailed as a procedure which could supersede total hip replacement, it was widely practised. Problems have arisen if the bone is not sufficiently strong, and there are problems with metal-on-metal wear.

The problems with metal wear have been exaggerated by poor prosthesis placement and some inferior designs, such as the ASR prosthesis. At The London Hip Unit, we offer ceramic-on-ceramic and metal-on-metal hip resurfacing. We find that it can improve function in athletes and, in the appropriate patient group, provide a long-lasting solution with excellent function. 

Because most of the bone of the femur is preserved, it is relatively easy to convert to a total hip replacement if it fails in the long term. There is also less likelihood of dislocation, and patients can continue with more vigorous sporting activities.

In hip resurfacing, the femoral head is gently reshaped and covered with a metal or ceramic cap, preserving most of the bone. This is different from a total hip replacement, where the entire femoral head and part of the thigh bone are removed and replaced.

The hip socket is lined with a matching metal or ceramic cup. The resurfaced joint still uses the body's natural synovial fluid to form a lubricating layer between the surfaces, helping reduce friction and allowing smooth movement.

The main difference is how much natural bone is preserved and which patients the procedure is best suited for.

Hip resurfacing conserves more femoral bone and is often considered for younger, active patients with good bone quality. Total hip replacement removes the femoral head and replaces it with an implant, making it suitable for a wider range of patients.

Your surgeon will recommend the most appropriate option based on your anatomy, bone strength and long-term goals.

Ceramic-on-ceramic hip resurfacing is a modern resurfacing technique that uses advanced ceramic materials for both the femoral cap and the socket lining. Traditional hip resurfacing has typically used metal-on-metal bearings.

It aims to reduce wear and eliminate metal ion release, while still preserving the bone-conserving benefits of resurfacing. Ceramic materials are highly durable and biocompatible, and are designed to work smoothly with the body's natural joint lubrication.

No, it may not be suitable for everyone. Careful patient selection is essential to achieve good long-term outcomes. You may be considered for ceramic-on-ceramic hip resurfacing if: 

• You have good bone quality 
• Your femoral head is sufficient in size 
• You're physically active and medically fit for surgery
• You do not have advanced joint deformity

At The London Hip Unit, we'll assess your anatomy, bone health and lifestyle to recommend the most appropriate option.

As with all surgery, there can be risks, but they are very uncommon. The risks include:

• Infection 
• Femoral neck fracture 
• Implant loosening

We'll explain everything to you and take the time to listen to your concerns and answer your questions, so you can make informed decisions about your treatment.

Revision hip surgery is carried out when a failed artificial hip joint is replaced with a new one. Although total hip replacement and hip resurfacing surgery now last much longer than previously, most artificial joints can't be expected to last forever. Hip replacements can wear out during an individual's lifetime or become loose. In a small number of cases, a hip replacement fails due to infection or a fracture.

In a revision hip replacement, one or both parts of the artificial hip joint (prosthesis) must be removed and a new prosthesis fitted. Revision hip surgery is often more complex, and recovery can sometimes be slower and the scar larger than for first time hip replacements. Often, these operations are longer and carry a higher complication rate.

Revision surgery needed because of infection is usually performed in two stages. The first stage involves removing the infected prosthesis and inserting an articulating antibiotic spacer for six to 12 weeks. The second stage is the insertion of a new prosthesis.

Revision surgery is considerably more complex than primary surgery, and a higher level of experience and skill is required.

We may recommend revision hip surgery if your existing hip implant has failed or is causing pain or other symptoms. Common reasons for revision hip surgery are:

• Implant becomes loose or wears over time
• Persistent pain or reduced mobility 
• Infection in or around the joint 
• Dislocation or instability 
• Fracture around the implant 

We'll investigate the cause of your symptoms with tests and scans to get a clear picture before recommending revision hip surgery.

The duration of revision hip surgery varies depending on the complexity of your case, but typically it takes around two to three hours. More complex revisions may take longer; we'll explain everything to you at your consultation, so you know exactly what to expect at each stage.

Each person's recovery journey is unique, but it can sometimes be longer than a primary hip replacement. You can expect to stay in hospital for several days before being discharged home.

We'll arrange for physiotherapy to aid your recovery, and you will see gradual improvements over a course of weeks and months. Full recovery and return to your usual activities can take several months.

For most patients, revision hip surgery significantly reduces pain and improves function. Outcomes depend on factors such as the reason for revision, bone quality and overall health. We'll discuss outcome expectations with you so you know what to expect after surgery.

A periacetabular osteotomy is a surgical procedure used to re-orientate the hip socket.  It is most commonly used to treat hip dysplasia, a condition where the hip socket does not fully cover the ball of the joint, as well as acetabular retroversion, where the hip sockets do not point as far forward as they should. During the operation, the surgeon uses a minimally invasive approach and then carefully cuts the bone around the hip socket and repositions it to improve the mechanics of the hip joint.

The socket is then fixed in its new position with screws to allow the bone to heal. The aim is to improve stability, reduce pain and protect the joint from further damage.

In hip dysplasia, the socket does not fully cover the ball of the joint. This puts extra strain on the cartilage and soft tissues, which can cause pain and lead to early wear. A periacetabular osteotomy changes the position of the socket so it supports the ball more effectively.

This helps spread weight more evenly across the joint, improving stability and reducing stress. For the right patients, this can ease pain, protect the joint and delay or even avoid the need for a hip replacement.

Most patients stay in hospital for around two to three days after a periacetabular osteotomy. During this time, your pain will be managed, and you'll begin physiotherapy to help you move safely.

Yes, you'll need to use crutches for several weeks following your periacetabular osteotomy. In the early phases of your recovery, weight bearing will be restricted to allow the bone to heal safely. We'll advise you of the steps to take and also arrange any physiotherapy appointments.

Most patients need around eight to twelve weeks off work. If your job involves heavy lifting or prolonged standing, you may need more time before returning to work. Your surgeon will advise what's best for you based on your role and recovery.

No, not immediately after. You shouldn't drive until you can comfortably walk and perform an emergency stop without pain or hesitation. For most patients, this will generally be around eight to ten weeks after your operation. Always check with your surgeon and insurance provider before returning to driving.

Hip arthroscopy is a minimally invasive surgical procedure used to diagnose and treat problems within the hip joint. The operation is performed through small incisions using an arthroscope, a camera that allows us to examine the joint in detail on a screen.

Specialised instruments are used to repair or remove damaged tissue. We may recommend hip arthroscopy if symptoms persist despite physiotherapy, medication and activity changes.

Hip arthroscopy can treat many conditions that cause pain, stiffness and restricted movement of the hip joint. These may include:

• Femoroacetabular impingement 
• Labral tears 
• Localised cartilage damage 
• Loose fragments within the joint 
• Inflammation of the joint lining

It's better suited to patients with clearly defined problems inside the joint with little or no arthritis. We'll review your symptoms, scans, age, activity level and overall joint health to determine if a hip arthroscopy is appropriate and likely to improve your condition.

The length of your operation can vary depending on the complexity of your condition. Typically, a hip arthroscopy will take between 60 and 120 minutes. We'll explain everything to you and answer any questions you have so you have a clear view of each step of the procedure.

Recovery depends on the type of repair performed and how your body heals. Most patients can expect:

• Crutches for one to two weeks 
• A structured physiotherapy programme 
• A gradual return to normal daily activities within four to six weeks

Full recovery, especially for higher-level sport, can take many months. A good rehabilitation programme can aid recovery and help you achieve a good long-term outcome.

You can usually drive once you walk comfortably without crutches and can perform an emergency stop safely. Always check with your surgeon and insurance provider before returning to driving.

A proximal femoral osteotomy is a hip preservation procedure that changes the shape or direction of the upper part of the thigh bone to improve how the hip joint works.

At The London Hip Unit, we may recommend this procedure when the main problem lies in the femur rather than the socket. By correcting alignment, the operation aims to reduce pain, improve movement and slow further joint wear, particularly in younger patients who wish to preserve their natural joint.

In some people with hip dysplasia, the neck of the femur points too far forward increasing stress within the hip joint and contributing to pain. A proximal femoral osteotomy adjusts the angle of the thigh bone so the ball sits more naturally within the socket.

This helps distribute load more evenly, improves stability and reduces strain on cartilage and soft tissues during everyday movement and physical activity.

Most patients stay in hospital for around one to three days after a proximal femoral osteotomy. During this time, we focus on pain control, early movement and physiotherapy. You'll be discharged once you're comfortable, mobile with crutches and able to manage everyday tasks safely at home with appropriate support in place.

Yes, you'll need to use crutches after surgery to protect the bone while it heals. Weight bearing is usually limited at first, then gradually increased under our guidance and your physiotherapist's guidance. Most patients use crutches for several weeks, depending on healing progress, comfort levels and follow-up X-rays during recovery.

Most patients take about eight to twelve weeks off work. If your job is mostly desk-based, you might be able to return sooner. But if your work is physically demanding, you'll likely need more time to recover before going back to full duties.

You shouldn't drive until you can comfortably walk and perform an emergency stop without pain or hesitation. For most patients, this will generally be around six to eight weeks after your operation. Always check with your surgeon and insurance provider before returning to driving.