Hip osteoarthritis and joint replacement explained

What happens in the hip

The hip is a ball-and-socket joint, where the top of the thigh bone sits in a cup in the pelvis. The surfaces are coated in smooth cartilage that lets the joint glide and cushions it. In osteoarthritis, this cartilage gradually wears thin and roughens, the bone underneath thickens, and small bony spurs can form. The joint becomes stiffer and more painful, especially with movement and weight-bearing. Osteoarthritis is often described as "wear and tear", but it is really an active process of joint change and attempted repair. Pain is typically felt in the groin or outer hip and can spread to the thigh or knee, and stiffness is often worst after resting.

Who gets it and how it is diagnosed

Age is the biggest factor, and hip osteoarthritis becomes much more common past 50. Being overweight increases the load on the joint, and previous hip injuries, certain hip shapes present from birth, and a family history all raise the risk; heavy manual or high-impact activity over years can contribute too. Diagnosis is usually made from the story and an examination — a clinician checks how far the hip moves and where it hurts. An X-ray can confirm and show how worn the joint is, though how bad an X-ray looks does not always match how much pain someone has. Blood tests are not needed to diagnose osteoarthritis but may be used to rule out other joint conditions.

Managing it without surgery

Most people with hip osteoarthritis are managed without an operation, often for years. Exercise is the cornerstone — it sounds counterintuitive when the joint hurts, but strengthening the muscles around the hip and keeping it moving reduces pain and improves function. Losing excess weight lightens the load on the joint. Pain relief, from simple painkillers to anti-inflammatory tablets or gels used carefully, helps people stay active. Walking aids such as a stick used in the opposite hand can ease pressure, and physiotherapy provides a tailored programme. The aim is to control symptoms and keep people doing what matters to them, escalating only if these measures no longer hold the pain in check.

When a replacement is considered

A hip replacement is considered when osteoarthritis causes pain and disability that significantly affect quality of life and are no longer controlled by exercise, weight management and pain relief. It is a decision made together by the person and their surgeon, weighing how much the hip limits daily life against the risks of surgery. In the operation, the worn ball and socket are removed and replaced with an artificial joint made of metal, hard plastic or ceramic. It is one of the most reliable operations there is: most people get major, lasting relief of pain and a big improvement in movement, and modern hip replacements commonly last many years, often well over fifteen.

Surgery, recovery and risks

A hip replacement usually involves a short hospital stay, and many people are helped to stand and walk with support the same or next day. Recovery is gradual: physiotherapy guides you through exercises to rebuild strength and movement, most people walk more comfortably within weeks, and fuller recovery takes several months. As with any major surgery there are risks — including infection, blood clots, dislocation of the new joint, differences in leg length, and the small chance the implant loosens or wears over many years and needs revising. These are uncommon, and the balance of benefit is strongly positive for most. Your team will explain how to protect the new hip early on and what warning signs to report.