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Health condition · Clinically reviewed

Hip complications, from infection to revision - and how they are diagnosed and treated.

Most hip replacements do very well. When problems appear - pain, wound issues, instability, a new limp - the diagnosis needs to be precise, and the pathway belongs in a specialist commissioned revision hip service.

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Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Checked against BOA, NICE, MHRA and specialist commissioned revision-hip standards you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK practice including specialist commissioned MDT revision hip pathways at Oxford, the Nuffield and other tertiary centres.

Key facts

Hip complications at a glance.

The essentials, in plain English - what can go wrong, why it matters, and where specialist commissioned revision hip services fit in.

  • What it is

    The cluster of problems that can follow hip replacement or hip surgery - infection, dislocation, fracture, loosening, wear and nerve or vascular injury.

  • PJI

    Prosthetic joint infection - early, delayed or late. Managed by DAIR, one-stage or two-stage revision in specialist commissioned centres.

  • Dislocation

    The commonest early mechanical complication - anterior or posterior. Recurrent instability may need dual-mobility or revision.

  • Periprosthetic fracture

    Intraoperative or postoperative fracture around the implant - Vancouver classification guides fixation or revision.

  • Loosening

    Aseptic (wear and osteolysis) or septic - a common late reason for revision surgery.

  • Metal-on-metal

    MHRA-monitored - metal ions, pseudotumour and ALVAL may warrant revision under specialist commissioned follow-up.

Why this guide matters

A precise diagnosis, a specialist commissioned pathway.

Hip complications are uncommon but consequential. Getting the diagnosis right - and the surgeon right - shapes everything that follows.

  • Infection is the diagnosis to miss last

    PJI can be subtle. A single normal CRP does not exclude it - trend the bloods, aspirate the joint and think in weeks, not hours.

  • The Vancouver system guides fractures

    Periprosthetic fractures are classified by location and stem stability - Vancouver A, B1, B2, B3 and C each has a defined operative approach.

  • Revision belongs in a specialist unit

    Complex hip revision - infection, bone loss, metal-on-metal - is a specialist commissioned MDT decision at a BOA-aligned tertiary centre.

How the diagnosis is made

From new symptoms to a specialist plan.

The steps a UK orthopaedic team will normally take, in order - so you know what to expect and why.

  1. 01

    Assessing

    History and red flags

    Timing since surgery, fever, night sweats, wound issues, pain pattern, mechanical symptoms, giving way and any recent dental or urinary source.

  2. 02

    Assessing

    Focused examination

    Wound, sinus, warmth, effusion, leg length, gait, range of motion, provocation for instability and a neurovascular check.

  3. 03

    Assessing

    Inflammatory bloods

    CRP, ESR and FBC - trends matter more than a single value, particularly beyond six weeks from surgery.

  4. 04

    Confirming

    Plain radiographs

    AP pelvis and lateral hip - looking for lucencies, component position, osteolysis and periprosthetic fracture patterns.

  5. 05

    Confirming

    Hip aspiration for suspected PJI

    Image-guided aspiration with prolonged specialist commissioned microbiology culture - the cornerstone of infection diagnosis.

  6. 06

    Confirming

    Advanced imaging

    MRI with metal artefact reduction, CT for bone loss, and nuclear imaging - bone scan, labelled WBC scan or PET where diagnosis remains uncertain.

  7. 07

    Planning

    Specialist commissioned MDT review

    Revision-hip MDT at a BOA-aligned tertiary centre plans the operative and rehabilitation strategy.

Typical timeline: assessment and imaging in days to weeks, MDT plan shortly after.

Complication patterns

What hip complications actually look like.

Infection, dislocation, fracture, loosening, wear reactions, nerve injury and leg length discrepancy - and the features that mean it is time to escalate. There is also a small group of failed hip arthroscopy patients whose problems overlap and are managed alongside these.

  • Prosthetic joint infection

    Persistent or recurrent pain, warmth, wound issues or a discharging sinus - early, delayed and late presentations all exist.

  • Dislocation and instability

    Sudden pain with a shortened, rotated leg after a provoking movement - see our guide on hip dislocation for detail.

  • Periprosthetic fracture

    Sudden pain and inability to weight-bear after a fall - classified by the Vancouver system to guide fixation or revision.

  • Aseptic loosening

    Start-up thigh or groin pain, worsening over months to years - radiographic lucency and osteolysis on follow-up films.

  • Metal-on-metal reaction

    Rising cobalt and chromium ions, pseudotumour on MRI or ultrasound and ALVAL - monitored under MHRA guidance.

  • Nerve injury

    Sciatic (foot drop, posterior thigh numbness) or femoral (quadriceps weakness) - most improve, some do not.

  • Leg length discrepancy

    A limp, back pain and a persistent sense of unevenness - measured clinically and radiographically.

  • Red flag - suspected deep infection

    Fever, rigors, wound breakdown or a discharging sinus around a prosthesis - urgent orthopaedic and infection review.

Other patterns worth naming: impingement and squeaking with ceramic-on-ceramic bearings, postoperative haematoma and wound complications, postoperative delirium in older patients and the small group of patients seen after a failed hip arthroscopy whose symptoms overlap with early osteoarthritis. See our related guides on hip dislocation and deep vein thrombosis for detail on those specific problems.

Treatment

How hip complications are treated in the UK.

The right operation, at the right centre, with a structured rehabilitation plan - revision surgery, prolonged rehabilitation and specialist commissioned MDT oversight.

  • DAIR for early PJI

    Debridement, antibiotics and implant retention - best chance within roughly three weeks of symptom onset in a stable implant.

  • One-stage revision

    Removal and re-implantation at one operation in selected patients - specialist commissioned centres with dedicated microbiology support.

  • Two-stage revision

    The traditional benchmark for chronic PJI - spacer, prolonged targeted antibiotics, then re-implantation. Specialist commissioned pathway.

  • Suppressive antibiotics

    Long-term oral suppression where revision is not feasible - agreed with infection specialists as a considered compromise.

  • Dual-mobility bearings

    For recurrent dislocation or high instability risk - a bearing option that reduces further dislocation rates.

  • Fracture fixation or revision

    Vancouver A, B and C periprosthetic fractures are treated by ORIF, revision stem or combined approaches at specialist commissioned units.

  • Metal-on-metal revision

    Symptomatic pseudotumour, ALVAL or rising ions on MHRA-guided monitoring may prompt revision to a modern bearing.

  • Heterotopic ossification prophylaxis

    Indomethacin or single-fraction radiotherapy for high-risk patients - specialist commissioned decision.

Alongside surgery, revision hip patients usually need prolonged rehabilitation - graded weight-bearing, physiotherapy, sometimes bracing and, for infection, weeks to months of tailored antibiotics agreed with a specialist commissioned microbiology team. The whole pathway is coordinated by a BOA-aligned revision hip MDT.

What this guide is based on

The sources behind every claim on this page.

UK national guidance, specialist society standards and international consensus, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your orthopaedic team knows your implant, your imaging and your history and can tell you which parts apply to you. If in doubt, get seen.

  • British Orthopaedic Association (BOA). Standards for revision hip surgery and PJI care.

  • NICE. Joint replacement (primary): hip, knee and shoulder (NG157) and related quality standards.

  • MHRA. Metal-on-metal hip implants - all metal-on-metal (MoM) hip replacements: updated advice.

  • National Joint Registry (NJR). Annual reports on revision indications and outcomes.

  • International Consensus Meeting on Musculoskeletal Infection. Definition and management of PJI.

Red flags

When a hip complication needs urgent attention.

Some problems can wait for a routine clinic - these cannot. Any of the situations below deserves a same-day route into orthopaedic care.

  • Suspected deep infection

    Fever, rigors, wound breakdown or a sinus tracking to the joint - urgent orthopaedic assessment and specialist commissioned microbiology input.

  • Acute dislocation

    A shortened, rotated leg after a fall or provoking movement - urgent A&E reduction under sedation or anaesthesia.

  • Periprosthetic fracture

    Sudden severe pain and inability to weight-bear after a fall - urgent radiographs and orthopaedic review.

  • Suspected DVT or PE

    A hot, swollen calf or new pleuritic chest pain and breathlessness - urgent same-day assessment; see our guide on deep vein thrombosis.

  • Vascular injury

    Expanding haematoma, distal ischaemia or absent pulses - a surgical emergency requiring vascular input.

  • Cauda equina overlap

    New saddle numbness, urinary retention or bilateral leg weakness - not a hip complication, but never missed in the differential.

  • Rising metal ions

    Cobalt or chromium above MHRA thresholds with symptoms or pseudotumour - specialist commissioned revision discussion.

  • Postoperative delirium

    New confusion after surgery - screen for infection, electrolytes, hypoxia and medication effects; involve orthogeriatrics early.

  • Non-healing wound

    Persistent discharge beyond a week or dehiscence - assume infection until proven otherwise.

Living with it

A treatable problem, with a specialist plan.

Four habits that make the biggest difference after hip surgery - knowing your warning signs, keeping to precautions, attending follow-up and knowing when to insist on specialist review.

A quiet reminder

Early questions get better answers.

If something does not feel right, ring the operating team. Most calls turn out to be reassurance - the few that do not are exactly the ones we want to see early.

  1. 01 Vigilance

    Know your warning signs

    New pain, warmth, fevers or wound issues after a hip replacement always deserve a call to the operating team.

  2. 02 Movement

    Follow the precautions

    Early hip precautions reduce dislocation risk - your physiotherapist tailors these to the surgical approach used.

  3. 03 Follow-up

    Keep your review appointments

    Registry follow-up and, for metal-on-metal implants, MHRA-guided reviews catch problems before they become urgent.

  4. 04 Escalate

    Insist on specialist review

    Complex hip complications belong in a specialist commissioned revision hip MDT - it is reasonable to ask for that referral.

Frequently asked

Everything we get asked about hip complications.

Quick answers on infection, dislocation, revision surgery and metal-on-metal follow-up.

  • What are the main complications of a hip replacement?

    The most important are prosthetic joint infection, dislocation, periprosthetic fracture, aseptic loosening, leg length discrepancy, bearing wear, metal-on-metal reactions, nerve or vascular injury, DVT and PE, wound and medical complications including postoperative delirium.

  • How is prosthetic joint infection diagnosed?

    By a combination of history, examination, CRP and ESR trends, image-guided hip aspiration with prolonged specialist commissioned microbiology culture, and advanced imaging - MRI with metal artefact reduction, CT and, where uncertainty remains, nuclear imaging including labelled white cell scans or PET.

  • What is the difference between DAIR, one-stage and two-stage revision?

    DAIR is debridement with antibiotics while keeping a stable implant, used for early infection. One-stage revision removes and re-implants the prosthesis in a single operation. Two-stage revision uses an antibiotic spacer, a prolonged targeted antibiotic course, and delayed re-implantation - the traditional benchmark for chronic infection in specialist commissioned centres.

  • Do I still need to worry about metal-on-metal hips?

    Yes. MHRA guidance requires ongoing follow-up for metal-on-metal hip implants with clinical review, metal ion levels and cross-sectional imaging where indicated. Rising ions, pseudotumour or ALVAL may prompt revision at a specialist commissioned unit.

  • What causes hip dislocation after a replacement?

    A combination of component position, soft-tissue tension, surgical approach, patient factors and provoking movements. Recurrent instability may warrant a dual-mobility bearing or revision - see our guide on hip dislocation for a fuller discussion.

  • Where should complex hip problems be treated?

    In a specialist commissioned revision hip service - a BOA-aligned MDT with revision surgeons, specialist microbiology, musculoskeletal radiology and a structured rehabilitation pathway. Oxford, the Nuffield and other tertiary centres run these programmes.

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