Hip replacement surgery typically takes 60 to 90 minutes from incision to closure, performed under spinal anaesthesia with sedation in most cases. The surgeon removes the worn ball and socket of the hip joint, prepares the bone surfaces, and fits a new metal stem in the thigh bone with a new cup in the pelvis. Recovery on the ward begins within an hour of the operation finishing.
How Long Does Hip Replacement Surgery Take?
The operation itself usually takes 60 to 90 minutes from the first incision to the final stitch. A complex revision, a very large patient, or a particularly stiff hip can extend this to two hours or longer. Mr Hussain plans the case based on the pre-operative scans and explains the expected duration at your pre-op consultation.
The wider block of time in the operating department is longer than the operation itself. You arrive at the theatre suite around 30 minutes before surgery, spend about 15 minutes in the anaesthetic room while the spinal or general anaesthetic is set up, then 60 to 90 minutes in the operating theatre, then about an hour in the recovery room before returning to your ward. From arrival in the operating department to returning to your bed, expect around three hours.
What Happens Just Before the Operation?
Mr Hussain marks the operative leg with a marker pen on the ward, before you are brought down to the theatre suite. This double-check is part of standard surgical practice across all three hospitals where Mr Hussain operates.
Once you are in the anaesthetic room, three things happen before any anaesthetic is given.
- A thin cannula is placed into a vein in the back of your hand or your forearm. This is the route for anaesthetic drugs, fluids, and any intravenous medications during and after surgery.
- A dose of prophylactic antibiotics is given. This single dose, typically given within 60 minutes of incision, significantly reduces the risk of surgical site infection.
- A surgical safety checklist (the WHO checklist) is run by the team. Your name, date of birth, allergies, the planned operation, and the operative side are read aloud and confirmed against your wristband.
If you would like a fuller picture of the wider pre-operative process, including pre-op assessment, home setup, what to pack, and the Sip Till Send fluid protocol, see the companion article on preparing for hip replacement surgery.
The Anaesthetic
Most hip replacements at the Royal Orthopaedic Hospital, Priory Hospital Edgbaston, and Harborne Hospital are performed under spinal anaesthesia with light sedation. A small needle places anaesthetic between the bones of your lower back, numbing the legs and pelvis for two to four hours. A sedative is given through your cannula so you sleep through the operation without dreaming and remember nothing of it.
General anaesthesia is the alternative for patients who are not suitable for spinal, or who prefer it. The two approaches have different recovery profiles and the right choice is made jointly by you and the anaesthetist.
The full comparison is covered in the article on spinal vs general anaesthetic for hip and knee replacement. Read it before your pre-op consultation if you have not already.
The Surgical Approach: Anterior, Posterior, or Lateral?
The surgical approach is the direction from which Mr Hussain reaches the hip joint. Three approaches are commonly used.
Posterior approach
The most widely used approach worldwide. The incision is on the outer back of the hip. It gives excellent visibility of the femur and the socket and works well for most patients including complex cases.
Anterior approach
The incision is at the front of the hip, between two muscle groups rather than through them. This can speed early recovery in selected patients. Not every patient is a candidate; soft-tissue anatomy and bone shape both matter. The dedicated page on anterior approach hip replacement explains the approach and which patients suit it.
Lateral approach
The incision is on the side of the hip, through part of the gluteus muscle. Less commonly used in modern practice but appropriate for particular anatomical situations.
The right approach is the one that suits your hip, your bone quality, your soft tissues, and your goals. Mr Hussain will discuss the recommended approach with you at your consultation.
Step by Step, What the Surgeon Does
Once you are asleep or sedated and the operative leg is prepared with antiseptic and sterile drapes, the operation proceeds through a defined sequence.
The incision
A skin incision of around 10 to 15 centimetres is made over the hip in the line dictated by the chosen approach. The exact length depends on body size and anatomy; larger patients typically need a slightly longer incision than slim patients.
Reaching the hip joint
Mr Hussain dissects through the layers of soft tissue beneath the skin, controlling small bleeding vessels with diathermy as he goes. The joint capsule (the tough envelope around the hip) is opened to give access to the joint itself.
Removing the worn ball and socket
The femoral head, the ball of the joint, is dislocated out of the socket and removed with a saw. The remaining acetabular cartilage, which is usually worn down to bare bone in osteoarthritis, is cleared from the pelvic socket.
Preparing the femur
The femur (thigh bone) is hollowed out to accept the new metal stem. Mr Hussain uses progressively larger broaches to shape the inside of the femur to the contour of the implant. This step determines how snugly the stem will fit and is one of the most important parts of the operation for the long-term stability of the joint.
Preparing the acetabulum
The pelvic socket is reamed with a hemispherical cutter to produce a clean, even bone surface that matches the size and shape of the new cup. The depth and angle of reaming are carefully controlled.
Trial reduction and balancing the new joint
Before the final implants are fitted, trial components are placed and the hip is tested. Mr Hussain checks leg length, the tension in the surrounding muscles, and the stability of the joint through a full range of movement. If anything is not right at this stage, trial sizes can be changed before the permanent implants go in.
Fitting the final implants
The final cup is fitted into the acetabulum. The final stem is fitted into the femur. A new ball, ceramic or metal depending on the bearing surface chosen, is attached to the stem and the hip is reduced (the ball is put back into the socket).
Closing the wound
The capsule and surrounding tissues are closed in layers with dissolving stitches. The skin is closed with dissolving stitches or skin clips. A waterproof dressing is applied over the wound.
How the Implants Are Chosen
The implant choice is decided before the operation, based on your age, bone quality, anatomy, and activity level. Two big decisions are made.
Cemented or uncemented fixation
The stem and the cup can either be press-fitted into prepared bone (uncemented) or held in place with bone cement (cemented). The choice depends on your bone density and other patient-specific factors. The dedicated page on cemented vs uncemented hip replacement covers this decision in detail.
The bearing surface
The ball-and-socket surfaces that move against each other can be ceramic on ceramic, ceramic on polyethylene (plastic), or metal on polyethylene. Each combination has trade-offs in wear, longevity, and patient-specific factors such as age and activity. A separate patient information article on hip replacement implants will cover this decision in detail.
The Recovery Room: The First Hour After Surgery
When the operation is finished and the dressing is on, you are transferred to the post-anaesthetic care unit, often called the recovery room. A specialist nurse looks after you while you wake up.
If you had a spinal, you wake quickly and feel comfortable; your legs will still be heavy and warm for a couple of hours until the spinal wears off. If you had a general anaesthetic, you wake a little more slowly and may feel groggy for the first 15 to 30 minutes.
Your blood pressure, oxygen saturation, heart rate, breathing rate, and pain level are monitored constantly. Pain relief is given as needed. Most patients are comfortable enough to be transferred back to the ward within 60 minutes.
Back on the Ward: The First Night
Once you arrive back on the ward, the nursing team takes over your care. Observations are done every 15 to 30 minutes for the first few hours, then less frequently.
- A physiotherapist will see you on the same day, often within a few hours of surgery, to help you sit up, stand, and walk a few steps with a frame or crutches. Early mobilisation lowers the risk of blood clots and speeds recovery.
- Pain is managed with a combination of oral painkillers, occasional anti-inflammatories where safe, and a small dose of opioid if you need it. Modern hip replacement pain protocols aim to keep you comfortable enough to mobilise, not pain-free at the cost of being too drowsy to move.
- You can eat and drink normally as soon as the anaesthetic has worn off enough. A light meal is usually offered within a few hours of returning to the ward.
- A blood-thinning injection or tablet is started the same day to reduce the risk of deep vein thrombosis.
- Your wound dressing stays on; the team only checks underneath if there is a reason to.
Most patients sleep reasonably well on the first night, helped by a small amount of pain relief and the relief of the operation being behind them.
The Wound, Scar, and Dressing
A modern hip replacement wound is around 10 to 15 centimetres long. The skin is closed with dissolving stitches or skin clips beneath a waterproof dressing.
The dressing stays on for around 10 to 14 days unless soiled or leaking; you can shower with it on. Skin clips are removed at a wound check around the same time. Dissolving stitches dissolve on their own and need no removal.
The scar fades over six to twelve months. It begins pink, becomes purple over a few weeks, and gradually pales. Most patients find the final scar is faint and easily hidden by clothing. Sun protection on the scar for the first year reduces the risk of permanent darkening.
Frequently Asked Questions
Will I feel anything during hip replacement surgery?
No. Whether you have spinal sedation or general anaesthesia, you will not feel anything during the operation. With spinal sedation, you sleep through the procedure and remember nothing of it.
How big is the scar after hip replacement?
Most hip replacement scars are 10 to 15 centimetres long. Body size and the chosen surgical approach both influence the exact length.
When will I see Mr Hussain after hip replacement surgery?
Mr Hussain reviews you on the ward the morning after surgery, then sees you in clinic at around six weeks. Earlier review can be arranged through Wendy Richards if there is any concern.
Will I have a urinary catheter after hip replacement?
Not usually. Most patients pass urine normally after the spinal has worn off. A catheter is placed only if you cannot pass urine, which is uncommon.
What if I need a blood transfusion during hip replacement?
Modern hip replacement rarely requires transfusion. Tranexamic acid, a drug given during surgery to reduce bleeding, has lowered transfusion rates to under 2 percent in most centres. If a transfusion is needed, you would be told and consented.
When can I eat after hip replacement surgery?
Most patients can drink water on returning to the ward and eat a light meal within a few hours of arriving back from the operating theatre.
Who looks after me overnight after hip replacement surgery?
Trained nursing staff on the orthopaedic ward provide your immediate care, with the on-call anaesthetist and orthopaedic team available if needed. Mr Hussain is contactable for urgent issues; routine concerns wait for his ward round the next morning.
Mr Shakir Hussain
Consultant Hip and Knee Surgeon at the Royal Orthopaedic Hospital Birmingham. Specialist in hip resurfacing, hip replacement, robotic knee replacement, and complex revision surgery.