Do I Need a Hip Replacement? When to Discuss Surgery

By Emma - The Hip & Knee Physio

Wondering whether you need a hip replacement usually means hip pain has started taking more from your life than you are comfortable giving up.

The decision is not based on one symptom, one X-ray or your age only.

In brief: It may be time to discuss hip replacement when hip pain, stiffness and loss of function are substantially affecting your quality of life, appropriate non-surgical treatment has not provided enough relief, and you feel ready to consider the benefits, risks and rehabilitation involved.

A discussion about surgery does not commit you to having an operation. It helps you understand whether hip replacement is a reasonable option now, something to prepare for later or not yet the right step.

I am Emma Glynn, an APA Titled Musculoskeletal Physiotherapist with more than 13 years of experience. I consult in Camberwell and work with active adults managing hip osteoarthritis, including people considering or preparing for hip replacement.

For a broader explanation of hip arthritis symptoms and treatment, visit my guide to physiotherapy for hip osteoarthritis.

What is a hip replacement?

A total hip replacement removes the damaged surfaces of the hip joint and replaces them with artificial components.

It is most commonly considered for people with substantial hip-joint damage and symptoms that have not been managed adequately through non-surgical care.

Hip replacement can reduce pain and improve mobility and quality of life for many people. It is still major surgery, with potential complications and a period of rehabilitation.

The goal is not to have surgery at the earliest possible opportunity. Nor is it to avoid surgery at all costs.

The goal is to choose it when the likely benefits outweigh the risks and ongoing limitations of your current hip.

Five questions that matter when considering hip replacement

1. How much is your hip affecting your quality of life?

Pain intensity matters, but it is not the only consideration.

Ask what your hip is preventing you from doing.

You may be finding it increasingly difficult to:

• walk around the shops;

• manage stairs;

• put on shoes and socks;

• get in and out of the car;

• sleep comfortably;

• stand long enough to cook or socialise;

• travel;

• play golf;

• exercise at the gym;

• hike or walk with friends;

• complete work or household tasks;

• care for children, grandchildren or family.

A person with moderate pain but severe loss of independence may have a stronger reason to discuss surgery than someone with higher pain who can still do most of what matters to them.

The important issue is not whether your pain has reached someone else’s arbitrary score.

It is whether your symptoms are substantially reducing your life.

2. Is your function steadily declining?

Hip osteoarthritis often fluctuates.

A difficult week does not necessarily mean the joint has suddenly deteriorated or that surgery is urgently required. You may be experiencing a temporary flare caused by changes in walking, exercise, travel, sleep or other load.

Signs of more sustained functional decline may include:

• walking distance gradually reducing;

• needing more frequent rests;

• developing a persistent limp;

• relying increasingly on a walking aid;

• avoiding stairs or leaving the house;

• losing strength because activity has become too difficult;

• being unable to return to your usual baseline after repeated flares;

• progressively restricting work, exercise or social activity.

If your symptoms have changed suddenly, read Hip Arthritis Flare Up: What It Feels Like and What to Do.

If your capacity has been shrinking over months despite a reasonable management plan, that deserves reassessment.

3. Have you tried appropriate non-surgical treatment?

Hip replacement is generally considered after suitable non-surgical management has been ineffective, unsuitable or no longer provides enough benefit.

That does not mean you must complete every treatment ever marketed to a person with a hip.

A reasonable non-surgical plan may include:

• education about hip osteoarthritis;

• an individual exercise and strength program;

• changes to aggravating activity without unnecessary complete rest;

• aerobic exercise within tolerance;

• weight management where relevant and personally appropriate;

• medication advice from your GP or pharmacist;

• a walking aid where useful;

• an injection in selected circumstances;

• treatment of other contributing health conditions.

Exercise is recommended as part of hip osteoarthritis management, but its average effects on hip pain and function are modest and individual responses vary.

A proper exercise trial should be progressive and matched to your presentation. Repeating a few light movements from a generic handout for months does not necessarily constitute a meaningful rehabilitation trial.

My guide to hip arthritis exercises explains what a more structured program may include.

However, physiotherapy cannot guarantee that surgery will be avoided. Some people complete an appropriate program, become stronger and remain substantially restricted by joint pain.

That outcome is useful information, not a personal failure.

4. Does the diagnosis fit hip-joint osteoarthritis?

Not every painful hip requires a hip replacement.

Pain around the hip may also involve:

• gluteal tendinopathy;

• pain referred from the lower back;

• hip-flexor or other tendon pain;

• femoroacetabular impingement;

• hip dysplasia;

• stress fracture;

• inflammatory arthritis;

• another medical condition.

Hip osteoarthritis often causes groin pain, stiffness and reduced movement, with difficulty walking, managing stairs, getting out of a chair or putting on shoes and socks.

Symptoms alone cannot confirm whether replacement is appropriate.

Before making a surgical decision, the diagnosis should reasonably fit the clinical presentation and relevant imaging.

Does your X-ray decide whether you need a hip replacement?

No.

An X-ray can show changes consistent with hip osteoarthritis, including reduced joint space and changes to the bone around the joint.

It cannot show:

• how much the hip affects your quality of life;

• what activities matter to you;

• how strong or physically prepared you are;

• whether another condition is contributing;

• whether you feel ready for surgery;

• how you will respond to the operation.

Some people have substantial changes on imaging but manageable symptoms. Others are considerably limited by symptoms that appear less dramatic on an X-ray.

Imaging becomes particularly useful when the diagnosis is unclear or when injection or surgical decisions are being considered.

The decision should combine:

• symptoms;

• functional limitations;

• clinical assessment;

• imaging;

• treatment history;

• general health;

• your expectations and preferences.

Cartilage has once again refused to issue a legally binding instruction through radiology.

Is night pain a sign that you need surgery?

Night pain can occur with more symptomatic hip osteoarthritis, but it does not independently prove that you need a replacement.

It may become more relevant when it is:

• frequent rather than occasional;

• progressively worsening;

• disrupting sleep despite reasonable positioning and pain management;

• occurring alongside substantial daytime limitation;

• not returning to baseline after a flare.

New, severe or unusual night pain should be medically assessed, particularly if it is accompanied by fever, unexplained weight loss, recent trauma or feeling generally unwell.

Are you too young or too old for hip replacement?

Age alone should not determine whether someone is referred to discuss joint replacement.

A younger person may reasonably consider surgery when symptoms are severe and function is substantially restricted, although implant longevity and possible future revision surgery deserve discussion.

An older person should not automatically be denied referral because of age alone. General health, surgical risk, rehabilitation capacity and personal priorities matter.

Guidelines also advise against excluding people from referral solely because of body weight, smoking or other health conditions. These factors may alter surgical risk and may need optimisation, but they should be discussed individually rather than used as crude gates.

The orthopaedic surgeon and medical team are responsible for assessing your specific surgical risk.

What if you have already been told you need a hip replacement?

Once an orthopaedic surgeon has recommended hip replacement for moderate-to-severe osteoarthritis after appropriate non-surgical care, repeating more treatment simply to delay surgery may not provide additional benefit.

That does not mean physiotherapy has no role.

Before surgery, physiotherapy may help you:

• maintain strength and general fitness;

• practise using walking aids;

• understand the early rehabilitation process;

• prepare your home and activity expectations;

• identify exercises that remain tolerable;

• plan your return to work and meaningful activity.

But preoperative physiotherapy should not be sold as a mandatory final attempt to “save” a hip that you and your surgeon have already reasonably decided to replace.

When is it probably too early to decide?

It may be too early to make a surgical decision when:

• the diagnosis remains unclear;

• symptoms have only recently developed;

• you are in a temporary flare;

• you have not trialled an appropriate non-surgical plan;

• another source of pain may be contributing;

• you have not discussed medication or relevant medical care;

• your symptoms are manageable and activities remain acceptable;

• you do not yet understand the operation, risks or rehabilitation;

• you feel pressured into either having or avoiding surgery.

You can seek an orthopaedic opinion without agreeing to surgery. Equally, receiving an X-ray report that says “severe osteoarthritis” does not oblige you to proceed if your symptoms remain manageable.

How can physiotherapy help with the decision?

A physiotherapist does not decide whether you should have a hip replacement.

An assessment can help clarify:

• whether your symptoms are reasonably consistent with hip osteoarthritis;

• how much movement and strength have changed;

• which daily and recreational activities are limited;

• whether your current rehabilitation plan has been adequate;

• whether another source of pain should be considered;

• whether imaging or GP review may be useful;

• what can realistically still be addressed non-surgically;

• what information to take into a surgical consultation.

This can be particularly useful when you feel stuck between two unhelpful messages:

• “You are too young for surgery.”

• “Your X-ray is bad, so surgery is inevitable.”

The reality requires slightly more thought than either slogan.

If you have hip arthritis but remain unsure whether your current plan has been adequately tested, you can book an in-person hip assessment in Camberwell.

Questions to ask an orthopaedic surgeon

If you are referred for a surgical opinion, consider asking:

• Is hip osteoarthritis the main explanation for my symptoms?

• What are the likely benefits in my specific situation?

• What symptoms may not improve after surgery?

• What are my individual complication risks?

• What happens if I wait?

• Are there medical issues I should address beforehand?

• What implant and surgical approach do you recommend, and why?

• What will the first six weeks involve?

• When might I return to work, driving and exercise?

• What rehabilitation support will I need?

• What activities may remain limited afterwards?

Bring a list. Medical appointments have a peculiar ability to remove every question from the human brain as soon as the door closes.

What this means for you

It may be time to discuss hip replacement when:

• pain and stiffness substantially affect your quality of life;

• walking and daily function are progressively declining;

• appropriate non-surgical care has not provided enough relief;

• the diagnosis and imaging support hip-joint osteoarthritis;

• you understand that surgery has benefits, risks and a rehabilitation period;

• you feel ready to consider the option.

You do not need to wait until you are completely disabled before asking for an opinion.

You also do not need surgery simply because an X-ray looks advanced.

The decision should be shared, individual and based on how the hip affects your life.

If your diagnosis or non-surgical plan remains unclear, learn more about hip physiotherapy in Camberwell or book an in-person hip assessment.

If you are already preparing for surgery, read Hip Replacement Recovery Timeline: What to Expect at Each Stage.

Emma

References

Hannon, C. P., Goodman, S. M., Austin, M. S., Yates, A. J., Guyatt, G., Aggarwal, V. K., Baker, J. F., Bass, P., Bekele, D. I., Dass, D., et al. (2023). 2023 American College of Rheumatology and American Association of Hip and Knee Surgeons clinical practice guideline for the optimal timing of elective hip or knee arthroplasty for patients with symptomatic moderate-to-severe osteoarthritis or advanced symptomatic osteonecrosis with secondary arthritis for whom nonoperative therapy is ineffective.

Arthritis & Rheumatology, 75(11), 1877–1888. doi:10.1002/art.42630

National Institute for Health and Care Excellence. (2022). Osteoarthritis in over 16s: Diagnosis and management (NICE Guideline NG226).

Healthdirect Australia. (2026). Hip replacement.

Medical disclaimer

This article provides general educational information and is not a substitute for individual medical or surgical advice. Whether hip replacement is appropriate depends on your diagnosis, symptoms, health, imaging, personal preferences and assessment by your treating medical team. Seek prompt medical care for severe or rapidly worsening pain, recent trauma, inability to bear weight, fever, unexplained weight loss, neurological symptoms or other symptoms that concern you.