Risks of Total Hip Replacement Surgery

Reviewed by Greg Jaroszynski MD, FRCSC | Last updated May 2026

Total hip replacement is a reliable operation for many patients, but every surgery has risk. Understanding those risks is part of deciding whether surgery is appropriate.

General Expectations

Most patients recover without a major complication.
Total hip replacement is one of the most successful operations in orthopaedic surgery, but it is still a major operation.
The purpose of reviewing risk is not to create fear, but to make sure the decision for surgery is thoughtful and well informed.
Personal risk varies depending on age, general health, heart and lung disease, diabetes control, kidney disease, smoking, weight, previous blood clots, immune suppression, bone quality, spine stiffness, previous hip surgery, and the complexity of the hip.

Surgical and Implant-Related Risks

These are risks directly related to the operated hip, the incision, or the hip replacement components.

Infection
Bleeding, bruising, or wound healing problems
Hip dislocation or recurrent instability
Leg length difference
Persistent pain, limp, stiffness, or weakness
Fracture of the femur or pelvis during or after surgery
Nerve or blood vessel injury
Heterotopic bone formation, meaning extra bone forming in the soft tissues around the hip
Bursitis, tendon irritation, or soft tissue pain around the hip
Loosening, wear, implant failure, or later need for revision surgery

Medical Risks

Total hip replacement can also lead to complications elsewhere in the body, especially in patients with significant medical conditions.

Blood clots in the leg veins or lungs
Heart rhythm problems or heart attack
Lung complications, such as pneumonia
Kidney or urinary problems
Stroke
Medication-related side effects
Confusion or delayed recovery, especially in medically fragile patients

Rare but Serious Complications

Deep infection requiring further surgery
Recurrent dislocation requiring revision surgery
Major fracture around the hip replacement
Permanent nerve damage, weakness, or numbness
Major blood clot travelling to the lungs
Need for revision surgery or, very rarely, removal of the prosthesis
Death

Infection

Infection is one of the most serious risks after hip replacement. A superficial wound infection may sometimes be treated with antibiotics, but a deep infection around the prosthesis can require one or more further operations, prolonged antibiotics, and sometimes removal or exchange of the implants.

Scientific studies identify factors such as obesity, diabetes, inflammatory disease, immune suppression, and other medical conditions as important contributors to infection risk. Optimizing general health before surgery helps reduce risk.

Blood Clots

Blood clots can form in the leg veins after surgery and can travel to the lungs. Modern prevention includes early walking, leg exercises, compression when appropriate, and blood-thinning medication when prescribed.

Venous thromboembolism has become less common than in the past, but it remains one of the important medical risks after hip and knee replacement.

Dislocation and Hip Stability

A hip replacement can dislocate if the ball comes out of the socket. This is uncommon, but it is an important hip-specific risk. The risk is influenced by the patient's anatomy, muscle control, spine stiffness, previous hip surgery, implant position, implant design, and the type of activities performed after surgery.

Large systematic review data suggest that the overall dislocation rate after primary total hip replacement is less than 3% on average, although individual risk varies widely. Some dislocations can be treated without further surgery, but recurrent instability may require revision surgery.

Leg Length, Limp, and Soft Tissue Symptoms

Every effort is made to restore hip mechanics and leg length, but some patients feel that the operated leg is longer or shorter after surgery. In some cases this improves as the pelvis, spine, muscles, and walking pattern adapt. Occasionally a shoe lift, physiotherapy, or further assessment is needed.

Persistent limp, hip weakness, bursitis, tendon irritation, stiffness, or aching can occur even when the x-rays show that the implants are well fixed and well positioned.

Persistent Pain or Dissatisfaction

Total hip replacement is very reliable for relieving arthritis pain, but it is not a guarantee of a perfectly normal hip. Some patients continue to have pain after surgery. Current systematic review evidence suggests that a meaningful minority of patients report long-term pain after hip replacement, although the evidence is more limited than for knee replacement.

Persistent or worsening pain should be assessed because infection, loosening, instability, fracture, tendon problems, spine disease, nerve pain, or other correctable causes may be present.

Putting Risk in Perspective

Complications are an inevitable reality of any surgical procedure. Fortunately, total hip replacement is a common and generally safe operation, and most patients recover without a major complication. The list of possible complications is long, but most of them are uncommon.

Large studies and systematic reviews show that age, medical comorbidity, frailty, and the reason for surgery influence the risk of complications and mortality. These numbers are averages across populations and do not predict an individual patient's exact risk.