Hip Replacement: What Happens Before, During and After Surgery?
A hip replacement, also called hip arthroplasty, is an operation that removes a damaged hip joint and puts in an artificial one. It is one of the most common joint operations in the UK. Its success depends heavily on accurate imaging before surgery, especially of your alignment while you stand and bear weight.
Key takeaways
- Hip replacement surgery replaces a worn or damaged hip joint with artificial parts.
- Osteoarthritis is the most common reason people need a hip operation.
- Standing, weight-bearing imaging shows alignment that lying-down scans can miss. This helps surgeons plan more precisely.
- Recovery usually takes several months, with a gradual return to daily activities.
- EOS imaging uses about 90% less radiation than a standard X-ray, around ten times less.
What is a hip replacement?
A hip replacement is an operation in which a damaged hip joint is removed. It is replaced with an artificial joint made from metal, ceramic or plastic. The operation deals with the ball-and-socket joint where the top of your thigh bone (femur) meets your pelvis. When the cartilage lining this joint wears away, bone rubs on bone, causing pain, stiffness and loss of mobility.
There are two main types. A total hip replacement replaces both the ball and the socket. A partial (or hemi) replacement replaces only the ball. Your surgeon will recommend the right approach based on your imaging and how much the joint is damaged.
How do you know if you need a hip replacement?
You may need a hip operation when hip pain badly affects your daily life and treatments without surgery are no longer working. Common signs include the following.
Hip or groin pain that does not ease with rest or painkillers, especially at night.
Difficulty putting on shoes, getting in and out of a car or climbing stairs.
Walking with a limp, relying on a walking stick, or avoiding activities you used to enjoy.
Knee, lower back or opposite hip pain caused by your body compensating for the damaged joint.
What causes the need for a hip operation?
The most common cause is osteoarthritis. In this condition, the cartilage cushioning the joint slowly breaks down over years. Other causes include the following.
Age-related wear and tear on the cartilage of the hip joint.
An autoimmune condition that inflames and damages the joint lining.
A break in the top of the thigh bone, often from a fall.
Loss of blood supply to the femoral head, causing the bone to weaken.
Why does standing imaging matter before a hip replacement?
Standing, weight-bearing imaging shows your surgeon how your hip, pelvis, spine and legs line up under the real forces of gravity. This is the position your body actually works in. When you lie down for a standard X-ray, CT scan or MRI, your muscles relax and your pelvis shifts. Alignment problems can then be hidden.
Your body works as a connected chain. A worn hip changes how you stand, which tilts your pelvis. This changes the curves of your spine and puts extra load on your opposite knee. A scan of the hip alone can miss this bigger picture. Standing whole-body imaging captures everything from your spine to your ankles in one image, while you are upright and bearing weight.
EOS imaging captures this standing view using about 90% less radiation than a standard X-ray, around ten times less. The result is a detailed, full-length image. Your surgeon can use it to plan the replacement with greater precision, including the correct position and size of the artificial joint.
Would you like to know how standing imaging could support the planning of your hip replacement?
Book a free video consultationWhat happens during hip replacement surgery?
Hip replacement surgery is done under general or spinal anaesthesia. It usually takes between one and two hours. The surgeon removes the damaged bone and cartilage, then fits the parts of the artificial joint. These are shaped to copy the natural movement of the hip.
Precise imaging before surgery helps the surgical team choose the right implant size and plan the angle at which it is placed. It also helps them allow for any pelvic tilt or difference in leg length. These factors directly affect how the new hip feels and works afterwards.
How long does recovery from a hip replacement take?
Recovery from a total hip replacement is gradual. Most people are up and walking with support within a day of surgery. You can usually return to light daily activities within six to twelve weeks, though full recovery can take several months.
After surgery, follow-up imaging can check how the new joint is settling and whether your overall alignment has improved. A standing scan is especially useful here. It shows the implant under real load, not while you are lying on a table.
Before you start treatment, or change the treatment you are on, it is worth getting a detailed diagnosis. Knowing whether the cause lies in the pelvis, the legs or the spine changes what will actually help you.
When is MRI the better choice? EOS shows bones, joints and alignment clearly. For soft tissue, discs or nerves, MRI is usually the better tool. If your surgeon suspects a labral tear or soft-tissue damage around the hip, they may recommend MRI alongside alignment imaging. The two work well together.
- Are thinking about hip replacement surgery or already have a date booked
- Have hip pain along with back or knee problems
- Want an alignment assessment before surgery
- Need low-radiation imaging after surgery
- Have a difference in leg length that you want measured accurately
- Sudden severe hip pain after a fall or injury
- Numbness or weakness in your leg
- Loss of bladder or bowel control
- A hot, red, swollen joint with fever
Contact your doctor straight away or go to the nearest emergency department.
Frequently asked questions about hip replacement
Modern hip replacements are designed to last many years. How long one lasts depends on things like your activity level, your weight and the type of implant used. Your surgeon can give you a realistic idea based on your own situation.
No. At ScanAlign you can refer yourself. You do not need a referral from your doctor or a consultant to book a scan. Many people come to us before or after seeing their surgeon.
Yes. EOS uses about 90% less radiation than a standard X-ray, around ten times less. You can find more detail on our FAQs page.
ScanAlign is a self-pay clinic. The price for patients travelling from abroad is confirmed during the free video consultation, and you can read more on our FAQs page.
Yes. A whole-body standing image captures your full alignment from spine to ankles. It can show how a damaged hip has made your pelvis tilt, putting extra strain on your opposite hip, knee or lower back. Pain in a connected area is often the result of compensation.
A total hip replacement replaces both the ball (femoral head) and the socket (acetabulum). A partial replacement, sometimes called a hemi-arthroplasty, replaces only the ball. Your surgeon recommends the best option based on the damage seen on imaging.
The angle and position of the new joint affect how it works, how long it lasts and whether you feel balanced afterwards. Standing imaging shows your true pelvic tilt and leg lengths under gravity. This gives the surgical team accurate data that lying-down scans may not capture.
The surgery itself usually takes between one and two hours. You will usually stay in hospital for one to three days afterwards, depending on how quickly you recover.
Yes. Standing imaging after surgery is useful for checking the implant position under load. It also helps assess whether your overall alignment has improved. EOS works well with metal implants and uses very low radiation.
You stand still inside the EOS machine for about 20 seconds while it takes a full-length image. There is no enclosed tunnel and no need to undress fully. The whole visit is quick and simple. More details are on our what to expect page.
Thinking about a hip replacement?
A standing alignment assessment can give you and your surgeon the full picture before and after surgery.
Book a free video consultationRelated pages
Written by Abbas Dhami (Specialist Diagnostic Radiographer)
Sources
- National Institute for Health and Care Excellence (NICE). Joint replacement (primary): hip, knee and shoulder. NICE guideline [NG157], 2020.
- NHS. Hip replacement overview. nhs.uk, 2022.
- Lazennec JY, Brusson A, Rousseau MA. Hip-spine relations and sagittal balance clinical consequences. European Spine Journal, 2011;20(Suppl 5):686-698.
This page is general information and not a diagnosis.
ScanAlign is the trading name of CoreMed Solutions Ltd and operates under The Harley Street Hospital's Care Quality Commission (CQC) licence.