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Complex reconstructive hip surgery · UK

Open reduction and hip reconstruction, at a specialist UK tertiary centre.

Complex acetabular fixation, periacetabular osteotomy for adult DDH, protrusio reconstruction and complex revision hip replacement - delivered by high-volume reconstructive hip surgeons, with an MDT and an ITU behind them.

See indicative pricing
A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Indicative pricing

What complex hip reconstruction costs privately in the UK.

Indicative ranges across our partner tertiary centres. NHS funding is available at specialist centres.

In short

£15,000–£25,000, hospital five to seven days.

Procedure Indicative range
Complex acetabular ORIF (Letournel) £18,000–£35,000
Periacetabular osteotomy (PAO / Ganz) £15,000–£25,000
Complex revision THR (bone loss / PJI) £22,000–£40,000
Protrusio reconstruction with graft + ring £20,000–£32,000
Ganz surgical dislocation (FAI / AVN) £14,000–£22,000
MDT consultation + imaging review £350–£600

Prices vary by centre, by the complexity of the case, by implants and grafts required, and by ITU or HDU length of stay. Two-stage revision for prosthetic joint infection sits at the top of the range.

The problem

The right surgeon, the right centre, the right approach.

Complex hip reconstruction is not a procedure to have at a low-volume unit. Outcomes are strongly tied to surgeon volume, MDT strength and post-op infrastructure. We fix all three before you commit.

  • Not sure surgery is right?

    A specialist opinion before you consent - sometimes the answer is conservative management, sometimes a smaller operation like arthroscopy, sometimes a straight replacement.

  • Worried about the centre?

    High-volume tertiary units only. A named surgeon whose weekly list looks like your case, not a rare one.

  • Want it planned properly?

    Full imaging, templating, MDT sign-off and 3D-printed guides where they earn their keep - not booked in blind.

When it helps

When open reduction and hip reconstruction is the right step.

The situations we see most, from acute acetabular fractures through to complex revisions - plus the one red flag that is a 999 call, not a clinic booking.

  • Complex acetabular fracture

    A displaced fracture of the hip socket - Letournel pattern. Open reduction and internal fixation via a posterior, ilioinguinal or Stoppa approach.

  • Adult DDH (developmental dysplasia)

    A young adult with a shallow socket, groin pain and a preserved joint. Periacetabular osteotomy - the Ganz - reorients the socket and delays a hip replacement.

  • Post-traumatic reconstruction

    Malunion, non-union or avascular necrosis after an earlier hip fracture. Corrective osteotomy - or a total hip replacement when the joint is beyond salvage.

  • Complex revision THR

    A failed hip replacement with bone loss, aseptic loosening, periprosthetic fracture or a two-stage revision for deep infection (PJI).

  • Protrusio acetabuli

    A socket that has migrated inwards into the pelvis. Reconstruction with structural graft and a support ring at the time of hip replacement.

  • Femoroacetabular impingement (FAI)

    Most cases go to arthroscopy. Complex or revision cases go to an open surgical dislocation - the safe Ganz approach - for full access to the joint.

  • Paediatric hip disease

    DDH in children, Perthes disease and slipped upper femoral epiphysis (SUFE) - closed or open reduction, pelvic osteotomy (Salter, Pemberton, Dega) or femoral osteotomy under a paediatric ortho team.

  • Red flag: an acute hip fracture

    A displaced hip fracture after a fall is an emergency - 999 or A&E, not a clinic booking. Best outcomes come from surgery within thirty-six hours.

Surgical approaches

The approach is chosen for the pattern - not the surgeon’s habit.

What each approach on the table actually involves - and which problem it is designed to solve.

  • Kocher-Langenbeck (posterior)

    The workhorse posterior approach for posterior column and posterior wall acetabular fractures. Sciatic nerve at risk - protected throughout.

  • Ilioinguinal approach

    Anterior access to the pelvic brim for anterior column and both-column acetabular fractures. Long-established, extensile.

  • Modified Stoppa (intra-pelvic)

    A newer intra-pelvic approach that reaches the quadrilateral plate through a low midline. Increasingly the default for many anterior patterns.

  • Ganz surgical dislocation

    The safe way to open the hip fully - for complex FAI, protrusio and selected AVN cases. Preserves the blood supply to the femoral head.

  • Periacetabular osteotomy (PAO)

    The Ganz osteotomy for adult DDH - four cuts around the socket to reorient it. Bikini incision at experienced centres. UK availability is limited.

  • Direct anterior (DAA) for THR

    A muscle-sparing anterior approach for primary and selected revision total hip replacement. Not right for every case - the surgeon chooses.

  • Watson-Jones anterolateral

    A classic anterolateral approach for hemiarthroplasty, primary THR and some proximal femoral work.

  • Paediatric osteotomies

    Salter, Pemberton or Dega pelvic osteotomies; varus derotational femoral osteotomy - for DDH, Perthes and SUFE under a paediatric orthopaedic team.

Safety and recovery

What to expect afterwards - honestly.

These are major operations with real complication rates. Outcomes are variable by indication and are best when the surgery is done at a high-volume centre with a full MDT.

  • Significant blood loss is expected

    These are major reconstructive operations. Blood is cross-matched, TXA is given, and cell-salvage is on standby. A transfusion is possible and consented for.

  • Sciatic and femoral nerve at risk

    The posterior approach puts the sciatic nerve at risk; the anterior approach the femoral. Both are protected, monitored where indicated, and injuries are uncommon but real.

  • Infection is a serious complication

    Deep infection runs at three to eight per cent for complex reconstructive hip surgery - higher than a simple primary. Antibiotic prophylaxis, laminar-flow theatre and clean rehab all help.

  • VTE prophylaxis for six weeks

    Extended low-molecular-weight heparin for six weeks post-op. Mechanical prophylaxis in hospital. Early mobilisation the day after surgery.

  • Heterotopic ossification

    Extra bone can form in the soft tissues - particularly after acetabular fixation. Some centres use single-dose radiotherapy or indomethacin to prevent it in high-risk cases.

  • AVN, non-union and malunion

    The femoral head can lose its blood supply after certain procedures. An osteotomy can fail to heal (non-union) or heal in the wrong position (malunion). All are discussed before you consent.

  • Fat embolism after long-bone surgery

    A recognised complication of major orthopaedic surgery. Monitored for on ITU or HDU; treated supportively when it happens.

  • Revision may still be needed

    Five to fifteen per cent of complex hip reconstructions need a further operation. The revision rate is honest, not a failing of any one surgeon.

  • Red flags after discharge

    Fever, spreading redness, calf swelling, sudden breathlessness or a fall onto the operated hip are not normal - call the on-call team or 999 the same day.

Reading your operation note

Your operation note in four parts. Read the last one first.

Whichever approach and implants were used, the note the surgeon dictates keeps to the same shape.

A UK consultant hip surgeon reviewing a patient’s operation notes

A quiet reminder

Surgical language is precise and can read coldly - we translate it for you.

If you would like us to talk you through the note before your outpatient review, just ask.

  1. 01 Header

    Indication, side and approach

    Why the operation was done - acetabular fracture pattern, adult DDH, revision THR - which hip, and which approach was used.

  2. 02 Technique

    Implants, grafts and technique

    Plates, screws, cages, cups, stems, grafts (auto-, allo- or structural) and any use of navigation, 3D-printed guides or cement.

  3. 03 Findings

    Intra-operative findings and blood loss

    What was found at surgery, the quality of reduction achieved, estimated blood loss, transfusion given, and any nerve or vessel event.

  4. 04 Impression

    Weight-bearing plan and rehab milestones

    Read this first: your weight-bearing status, precautions, VTE prophylaxis duration, when to drive, when to return to sport, and follow-up X-ray timings.

Recognised by major UK insurers

BupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealix

Cover for complex hip reconstruction is normally available for medically indicated cases - pre-authorisation is required and depends on your policy.

Frequently asked

Everything we get asked about open reduction and hip reconstruction.

Quick answers on approaches, cost, weight-bearing, risk and outcomes.

  • What counts as “hip reconstruction” - and why is it different from a hip replacement?

    Hip reconstruction is an umbrella for complex operations that rebuild the hip when a standard replacement will not do - acetabular ORIF for a fracture, periacetabular osteotomy for adult DDH, protrusio reconstruction, and complex revision THR. It draws on the same surgical family as hip replacement but at a different level of complexity, at high-volume tertiary centres.

  • Which approach is right for me?

    It depends on the indication. Posterior wall or posterior column acetabular fractures - Kocher-Langenbeck. Anterior column and both-column patterns - ilioinguinal or modified Stoppa. Adult DDH - periacetabular osteotomy through a bikini incision. Complex FAI or protrusio - a Ganz surgical dislocation. Revision THR - the approach that gives the safest exposure for your bone loss. The MDT chooses.

  • How much does complex hip reconstruction cost privately in the UK?

    Roughly £18,000–£35,000 for complex acetabular fixation, £15,000–£25,000 for a periacetabular osteotomy, £22,000–£40,000 for a complex revision THR, and £20,000–£32,000 for protrusio reconstruction. NHS funding is available at specialist tertiary centres.

  • How long is the operation, and how long in hospital?

    Three to six hours or more in theatre, twenty-four to forty-eight hours on ITU or HDU, then five to ten days on the ward - longer for revision THR with significant bone loss or a two-stage PJI revision.

  • When can I put weight on the leg?

    Partial weight-bearing for six to twelve weeks, depending on the procedure. Acetabular fractures and PAOs are typically toe-touch or partial weight-bearing early. Full weight-bearing comes after your surgeon has seen the healing X-ray.

  • When can I drive, return to work and go back to sport?

    Driving six to twelve weeks, once you can perform an emergency stop safely. Desk work often four to eight weeks. Heavy or standing work three to six months. Sport six to twelve months - impact sport later than that, and only with your surgeon’s clearance.

  • What are the main risks I should know about?

    Bleeding needing transfusion, nerve injury (sciatic with posterior approaches, femoral with anterior), infection three to eight per cent, DVT or PE despite prophylaxis, non-union or malunion of an osteotomy, avascular necrosis of the femoral head, heterotopic ossification, fat embolism, leg length discrepancy, chronic pain, progressive osteoarthritis eventually needing a hip replacement, and a five to fifteen per cent chance of needing further surgery.

  • How good are the outcomes?

    Variable, and honest: seventy to eighty-five per cent good functional recovery after acetabular ORIF when an anatomic reduction is achieved; eighty to ninety per cent good outcome at ten years after PAO, meaningfully delaying hip replacement; five-year survival of a complex revision THR around eighty-five per cent - lower than a primary. The right operation at the right centre matters more than the choice of implant.

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