Complex Hip Replacement in Birmingham
If your hip has been affected by dysplasia, bone loss, deformity or old metalwork, a standard replacement may not be enough. Mr Shakir Hussain, a consultant hip surgeon at the Royal Orthopaedic Hospital in Birmingham, plans each complex hip replacement in detail to give you a stable, pain-free joint.
Medically reviewed by Mr Shakir Hussain, MBBS MRCS FRCSEd (Tr & Orth), Consultant Orthopaedic Surgeon · Last reviewed: June 2026 · Next review due: June 2029
In Short
Complex hip replacement is a first-time (primary) hip replacement made technically demanding by abnormal anatomy, significant bone loss, deformity, or metalwork left from earlier surgery. It relies on detailed CT-based planning, a wider range of standard and custom implants, and a surgeon who manages difficult hips every week. The operation typically takes 1.5 to 3 hours, most patients stay 1 to 3 nights, and all-inclusive self-pay packages start from £17,850, with the final price confirmed after consultation and templating. Mr Shakir Hussain performs complex hip replacement at the Royal Orthopaedic Hospital, Birmingham.
Also known as: complex primary total hip arthroplasty, difficult primary hip replacement. This page covers first-time replacement of a complex hip; if a previous hip replacement has failed and needs redoing, see hip revision surgery.
On This Page
What Is Complex Hip Replacement Surgery?
Complex hip replacement is a primary hip replacement made technically demanding by abnormal anatomy, significant bone loss, deformity, or metalwork left from earlier surgery. It calls for detailed planning, a wider range of implants, and a surgeon who regularly manages difficult cases.
Most hip replacements are straightforward, and a total hip replacement with a standard implant works extremely well. A smaller group are not, because the shape of the hip has been changed by a developmental condition, a previous injury, or earlier surgery. These hips often cannot be reconstructed with a standard implant alone.
Mr Hussain performs these reconstructions at the Royal Orthopaedic Hospital, drawing on advanced fellowship training and a high-volume practice of over 5,000 procedures. Where a worn or failed implant needs renewing rather than a first-time reconstruction, hip revision surgery is the related pathway. Where both hips need reconstructing, the two operations are planned together as a bilateral hip replacement.
- Abnormal anatomy - dysplasia or a shallow, poorly formed socket
- Bone loss - cysts, collapse, or protrusio reducing bone stock
- Deformity - from previous fracture, malunion, or childhood conditions
- Retained metalwork - nails, plates, or screws needing removal
- Altered mechanics - after spinal fusion, affecting hip stability
Any one of these can turn a routine hip replacement into a complex reconstruction that benefits from specialist planning.
What Makes a Hip Replacement Complex?
A hip replacement becomes complex when the standard approach is not enough. You may need specialist input if any of the following apply to you:
Hip Dysplasia
Hip dysplasia leaves a shallow or poorly formed socket that needs specialised reconstruction and careful implant choice.
Avascular Necrosis
Avascular necrosis causes loss of blood supply and collapse of the femoral head, often in younger patients.
Previous Fracture or Malunion
An old hip or thigh fracture that healed in an abnormal position, or post-traumatic arthritis, alters the normal anatomy.
Retained Metalwork
Nails, plates, or dynamic hip screws from earlier surgery often need removing at the same time as the hip replacement.
Severe Protrusio & Bone Loss
A socket pushed inward, or significant loss of bone stock, may need bone grafting, augments, or specialised fixation.
Spinal Fusion & Metabolic Bone Disease
Previous spinal fusion changes pelvic mechanics, while Paget's disease and other conditions weaken or distort bone.
When Should You Consider Complex Hip Replacement Surgery?
Anatomy explains why a hip is complex. Your symptoms explain why it is time to do something about it.
Most patients reach this point after months or years of a hip that has slowly narrowed what they can do, and after non-surgical treatment has stopped making a difference. It is worth discussing surgery if:
- Hip or groin pain disturbs your sleep, or is there when you are resting
- Your walking distance has shortened, and stairs, socks or shoes have become a struggle
- Getting out of a chair or a car needs planning
- The hip feels stiff, catches, or gives way underneath you
- Painkillers, physiotherapy, weight management or injections no longer control the pain
- You have been told elsewhere that your hip is too difficult, too deformed, or that you are too young for replacement
That last point deserves emphasis. Complex does not mean untreatable. Many of the hips Mr Hussain reconstructs were declined or deferred elsewhere, and a specialist assessment often finds that a well-planned replacement is entirely possible.
Why Complex Hips Need a Specialist Centre
Complex reconstruction depends on detailed planning, the right implant for the anatomy, and the support of a specialist centre.
Every complex case starts with detailed pre-operative planning. Mr Hussain reviews x-rays and, where needed, CT or MRI scans to template the reconstruction and anticipate problems before surgery.
That level of planning only pays off where the resources match it. A tertiary centre keeps the full range of implants, augments and custom solutions on the shelf rather than ordered in, sees complex and referred hips on the operating list every week, and has the anaesthetic and medical support that higher-risk patients need. Those are the things that turn a good plan into a good result.
Specialist Tertiary Centre
The Royal Orthopaedic Hospital is a national tertiary referral centre and one of the UK's largest specialist orthopaedic hospitals, so complex and referred hip cases are managed here every week.
Multidisciplinary Approach
Complex cases are planned in MDT meetings bringing together orthopaedic, anaesthetic, medical, and specialist nursing expertise.
High-Dependency Care
Harborne Hospital and Priory Hospital Edgbaston both have HDU facilities for cases needing closer post-operative monitoring.
Advanced Implant Options
Access to the full range of solutions including custom-made prostheses, augments, and specialised fixation for challenging anatomy.
Your Operation: Planning, Surgery and Risks
Three parts of the journey, each one opened only if you want it. Tap a row to read more.
Before Surgery
How do you prepare for a complex hip replacement?
Imaging and templating, a pre-assessment clinic, a medication review, and practical arrangements at home.
Preparation for a complex hip carries a little more than a routine one, because the plan has to be built around your particular anatomy before you come into hospital.
- Consultation and examination, including how the hip moves, leg lengths, and how your spine and pelvis behave together
- Imaging and templating, with weight-bearing x-rays and, where the anatomy needs it, CT or MRI to plan implant size and position
- Previous records, including operation notes and implant details where you have existing metalwork, so the right removal instruments are ready in theatre
- Pre-assessment clinic, covering blood tests, ECG where appropriate, MRSA screening and a review with your anaesthetist
- Medication review, including when to stop blood thinners and anti-inflammatories
- Optimising your health beforehand, such as stopping smoking, treating anaemia, dental checks and diabetes control, all of which measurably lower the risk of complications
- Practical arrangements, including a lift home, help at home for the first fortnight, and any equipment you will need
Our full guide to preparing for hip replacement walks through each step in detail, including fasting instructions and what to bring on the day.
In Theatre
What happens during the operation?
A tissue-sparing posterolateral approach, any metalwork removed in the same operation, and the reconstruction built to plan. Usually 1.5 to 3 hours.
A complex hip replacement usually takes between 1.5 and 3 hours, depending on what the reconstruction involves.
- Anaesthetic is given, spinal or general, alongside antibiotics and local anaesthetic infiltration
- Mr Hussain uses a tissue-sparing posterolateral approach to reach the joint
- Any retained nails, plates or screws are removed, and the old screw holes are assessed and protected
- The worn femoral head is removed and the socket is prepared, with bone graft or augments where bone stock is deficient
- Trial components are inserted and leg length, stability and range of movement are checked against the pre-operative plan
- The definitive implants go in, standard or custom, cemented or cementless as planned
- The capsule and soft tissues are meticulously repaired, which is one of the strongest protections against dislocation
- The wound is closed and an x-ray confirms implant position before you go to recovery
For a fuller walkthrough of a hip replacement from admission to discharge, see what happens during hip replacement surgery.
The Honest Conversation
What are the risks of a complex hip replacement?
Modestly higher than a straightforward hip replacement. Every risk is discussed openly with you, along with what is done to reduce it.
Hip replacement is one of the most reliable operations in modern surgery. A complex hip carries a modestly higher risk than a straightforward one, because the anatomy is altered and the operation takes longer. Mr Hussain talks through each of these with you, and what is done to reduce it.
- Infection: around 1 in 100 for a standard hip replacement, and modestly higher when metalwork is removed or bone graft is used. Reduced by antibiotics at induction, laminar-flow theatres and the infection-control protocols of a specialist orthopaedic centre.
- Dislocation: low with modern implants and careful soft-tissue repair, but higher where the hip has been dysplastic or where a previous spinal fusion has stiffened the pelvis. Implant position is planned around your spinopelvic mechanics for this reason.
- Fracture during surgery: the bone can be thin or distorted in complex hips, and a crack occasionally occurs while the implant is seated. It is usually recognised and fixed at the same operation.
- Nerve injury: uncommon, but the risk rises when a short, dysplastic leg is lengthened significantly. Lengthening is planned deliberately and kept within safe limits.
- Leg length difference: usually small. Where one leg has been genuinely shorter for years, some residual difference may be accepted on purpose to protect the nerve and the stability of the hip.
- Blood loss: complex reconstructions can involve more blood loss than a routine hip, and a transfusion is occasionally needed.
- Bone graft healing: where graft or augments rebuild the socket, a period of protected weight-bearing may be advised while it incorporates.
- Blood clots: reduced by blood-thinning medication, compression stockings and walking on the day of surgery.
- Long-term wear and future revision: modern bearings wear slowly, and around 95% of hip replacements are still working at 10 years.
If further surgery is ever needed, Mr Hussain is a revision specialist who performs hip revision surgery in Birmingham, so your care stays in the same hands.
Complex Hip Replacement Case Examples
Real, anonymised x-rays from Mr Hussain's practice showing complex hips reconstructed with a stable, well-aligned replacement. Each case pairs the pre-operative x-ray with the result.
What Is Recovery Like After a Complex Hip Replacement?
Recovery after a complex hip replacement follows the same pattern as a standard hip replacement, though some patients take a little longer depending on what the reconstruction involved. Most patients are up and walking with the physiotherapy team on the day of surgery or the following morning, and go home once they are safe on crutches, usually within 1 to 3 nights.
Where bone grafting or augments were used to rebuild the socket, Mr Hussain may advise a period of protected weight-bearing to let the graft incorporate, and your physiotherapy plan is adjusted accordingly. If metalwork was removed at the same operation, the old screw holes temporarily weaken the bone, so high-impact activity is reintroduced more gradually.
Most patients walk unaided by 6 weeks, return to driving at around 6 weeks, and feel the full benefit between 3 and 6 months. The choice between a spinal or general anaesthetic is made with your anaesthetist, and higher-risk patients are recovered with high-dependency monitoring where appropriate. You will have a wound review at two weeks and structured follow-up with interval x-rays to confirm the implant position and healing.
How Much Does Complex Hip Replacement Cost in Birmingham?
Mr Hussain's all-inclusive complex hip replacement package at the Royal Orthopaedic Hospital starts from £17,850. Because complex cases vary in what they need, from metalwork removal to bone grafting, augments, or a custom implant, the final package price is confirmed individually after your consultation, imaging review, and templating.
The package covers the surgeon's fee, the anaesthetist, the implant, and your hospital stay. Complex hip replacement is covered by all major private medical insurers, including Bupa, AXA Health, Vitality, WPA, and Aviva. If you are insured, our guide to insurance pre-authorisation for hip and knee surgery explains how to get your treatment approved. Full details for self-pay and insured patients are on the fees and insurance page.
Why Choose Mr Hussain for a Complex Hip Replacement?
Complex hips reward experience. Mr Hussain is a Consultant Orthopaedic Surgeon at the Royal Orthopaedic Hospital with a high-volume hip practice and advanced fellowship training, including a British Hip Society Travelling Fellowship at the ENDO-Klinik in Hamburg, a world-leading centre for complex hip and revision surgery. Because the Royal Orthopaedic Hospital is a tertiary referral centre for complex orthopaedics, he operates on a steady stream of difficult and referred hip cases, building an exceptional depth of experience that routine practice rarely offers.
His results are tracked against National Joint Registry benchmarks. You can review his published hip replacement outcomes, and read about fees and insurance for self-pay and insured patients.
- 5,000+ surgical procedures performed
- 33 peer-reviewed publications
- ENDO-Klinik Hamburg fellowship training
- Royal Orthopaedic Hospital specialist centre
- Doctify Outstanding Patient Experience
Second Opinions on Complex Hips
A large part of Mr Hussain's complex practice arrives as a second opinion, often from patients who have been told their hip is too difficult, or that they should wait several more years. Because the Royal Orthopaedic Hospital is a tertiary referral centre, difficult hips are routine here rather than exceptional.
A second opinion is worth seeking if you have been declined for surgery, if the plan you have been offered has not been explained in a way that makes sense to you, or if you simply want to understand the options before committing.
It helps to bring your x-rays or scans, any previous operation notes, and details of existing implants or metalwork if you have them. Sometimes a second opinion confirms the advice you were already given, and that in itself is a useful answer.
Book a Consultation →Key Takeaways
Complex Hip Replacement at a Glance
- Complex hip replacement is a first-time hip replacement made demanding by dysplasia, bone loss, deformity, retained metalwork, or altered spinopelvic mechanics after spinal fusion.
- Every case is planned in detail before surgery with templating and, where needed, CT or MRI, so problems are anticipated rather than discovered in theatre.
- Retained nails, plates, and screws are removed and the hip replaced in a single operation wherever possible.
- Bone grafting, augments, and standard or custom implants rebuild a stable, well-aligned joint even where bone stock is poor.
- Recovery mirrors a standard hip replacement for most patients: home in 1 to 3 nights, walking unaided by around 6 weeks, full benefit by 3 to 6 months.
- All-inclusive self-pay packages start from £17,850, confirmed after consultation and templating; all major private medical insurers are accepted.
Frequently Asked Questions
References and further reading
- NHS. Hip replacement. nhs.uk/conditions/hip-replacement
- National Joint Registry (NJR). Annual reports and implant performance data. njrcentre.org.uk
- National Institute for Health and Care Excellence (NICE). Joint replacement (primary): hip, knee and shoulder, NG157. nice.org.uk/guidance/ng157
- Evans JT, Evans JP, Walker RW, Blom AW, Whitehouse MR, Sayers A. How long does a hip replacement last? The Lancet, 2019. thelancet.com
Medically reviewed by Mr Shakir Hussain, Consultant Orthopaedic Surgeon. Last reviewed: June 2026. Next review due: June 2029.
Ready to Discuss Your Complex Hip Replacement?
If your hip has been called difficult or complex, Mr Hussain can review your x-rays and explain your options. Book a specialist consultation today.