Hip surgery: hip replacement, arthroscopy and what recovery involves

Hip surgery is carried out by consultant orthopaedic surgeons, who train in trauma and orthopaedics and may then specialise in hips or in hip and knee surgery. They work with anaesthetists, specialist nurses, physiotherapists, occupational therapists and radiographers. Operations range from keyhole surgery to repair cartilage or reshape bone, through partial or total joint replacement, to revision surgery when an earlier implant needs to be replaced.

Hip surgery is also performed for injuries. A hip fracture after a fall is usually treated urgently on the NHS and is a different pathway from planned arthritis surgery.

The NHS lists a number of common causes of hip pain and warns not to try to diagnose the cause yourself. The right treatment depends on a clear diagnosis.

For arthritis of the hip, Versus Arthritis and the NHS describe a stepped approach: painkillers, keeping to a healthy weight, exercise and physiotherapy, walking aids, and sometimes a steroid injection into the joint. Exercise is described by the NHS as one of the most important treatments for osteoarthritis whatever your age or fitness. Many areas allow self-referral to community musculoskeletal services for physiotherapy.

Surgery is worth considering when pain and stiffness are having a big effect on daily activities and you can no longer manage symptoms. Versus Arthritis notes there are no upper or lower age limits for hip replacement. For younger people with problems such as femoroacetabular impingement, a labral tear or dysplasia, hip preservation surgery, including arthroscopy, may be considered before replacement.

In a total hip replacement, the ball and socket are replaced with implants. Versus Arthritis says the stem is always metal, and the ball and socket may be metal-on-plastic, which is the most widely used combination, or ceramic-on-plastic or ceramic-on-ceramic, which are often used in younger, more active patients. Components may be fixed with cement or left uncemented so that bone grows onto the surface.

Hip resurfacing is an alternative in which the surface of the thigh bone head is capped instead of being removed, using a metal-on-metal implant. It is used in selected patients, and your surgeon will explain whether it is suitable and the long-term considerations. Hip arthroscopy uses a camera and small instruments through small cuts to treat problems such as impingement or labral tears, and is not a treatment for advanced arthritis.

Most hip replacements are done under a spinal anaesthetic, sometimes with sedation, though a general anaesthetic is an option. You usually start walking with help from a physiotherapist soon after the operation.

Versus Arthritis says pain from the operation should start to ease within the first 2 weeks, that driving is usually possible after about 6 weeks if you can safely control the vehicle and do an emergency stop, and that return to work may take around 6 weeks for a desk job and 3 months or more if your job involves a lot of walking. You need to take care for the first 8 to 12 weeks to avoid dislocating the hip.

Possible risks include blood clots in the leg or lungs, dislocation, infection, loosening or wear of the implant over time, and differences in leg length. Versus Arthritis says a deep infection occurs in about 1 in 100 cases and may require the joint to be removed temporarily. Your surgeon should explain the risks in your case before you consent.

On the NHS, you see a GP, who may refer you to physiotherapy or a musculoskeletal service, and then to an orthopaedic clinic if surgery is being considered. After an assessment and an X-ray, you may be listed for surgery. Waiting times vary across the UK.

Privately, you may see a consultant orthopaedic surgeon directly. Fees depend on the surgeon, hospital, implants, anaesthesia and length of stay, and follow-up physiotherapy. Ask for an itemised quote that shows what happens if complications or revision are needed, and which implants will be used and how they are recorded.

• Ask which operation is being recommended and why, and what the non-surgical alternatives are.

• Ask about the implant type, how long it is expected to last and what the surgeon's experience is with it.

• Bring previous X-rays or scan reports, and a list of medicines, particularly blood thinners and anti-inflammatories.

• Ask for help with planning at home before the operation, such as aids, stairs and transport.

• Seek an urgent GP appointment or NHS 111 advice if you have a hot, swollen hip with fever or severe pain that started suddenly without a fall.

• Call 999 or go to A&E for severe hip pain after a fall or injury, if you cannot put weight on your leg, or for chest pain or sudden breathlessness after surgery.