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Patients ask me about the disadvantages of hip replacement almost every week, usually after reading something online that scared them. I think that is a fair question, and a healthy one. After more than twenty years and thousands of hip and knee replacements, I would rather you understand the real risks up front than be surprised by them later.
Here is what I tell my patients. Hip replacement is one of the most reliable operations in all of medicine, but it is still surgery, and surgery carries risk. My job is to make those risks as small as possible and to be honest with you about every one of them.
If you want the full picture of the operation itself, my total hip replacement overview covers how it works and what recovery looks like. This article stays focused on the harder question most patients are quietly asking: what could go wrong, and is it worth it?
What are the disadvantages of hip replacement?
The disadvantages of hip replacement fall into a short list: infection, blood clots, dislocation, a small difference in leg length, loosening or wear of the implant over time, and, less often, nerve injury or a bone fracture during surgery. Most of these are uncommon, and most are treatable when we catch them early.
- Infection in or around the new joint
- Blood clots in the leg (deep vein thrombosis)
- Dislocation, when the ball slips out of the socket
- Leg length difference after surgery
- Loosening or wear of the implant over many years
- Nerve injury or fracture, which are rare
An artificial hip is excellent, but it is not a young, healthy natural hip. It has limits. Deep positions like a full squat are not ideal, and the parts do wear, slowly, over decades.
What are the real risks and complications of hip replacement?
Let me walk through each one the way I would across the desk from you, with plain numbers and what we do about it.
Infection
Infection is the complication I work hardest to prevent. It happens in roughly 1 percent of hip replacements. A surface infection at the incision often clears with antibiotics. A deep infection around the implant is more serious and can mean another operation to clean or replace the parts. We lower this risk with careful sterile technique, antibiotics around the time of surgery, and careful screening to minimize risk factors like smoking before your surgery.
Blood clots
A blood clot in the leg vein (deep vein thrombosis) is the most common medical complication after hip surgery. The concern is a clot breaking loose and traveling to the lungs. We reduce this risk a great deal with blood-thinning medicine, compression stockings, and getting you up and walking the same day. Most of my patients are surprised by how soon they are on their feet.
Hip dislocation
Dislocation is when the new ball comes out of the socket. It is uncommon, reported in fewer than 2 to 5 percent of patients, and it is most likely in the first few months before the soft tissues fully heal. The surgical approach matters here. I use the anterior approach for most hips, which spares muscle and tends to lower the dislocation risk compared with older techniques. It also means most patients avoid the strict hip precautions that older operations required.
A change in leg length
Many patients with hip arthritis already have one leg slightly shorter, usually on the arthritic side. During surgery I balance two goals: a stable hip that will not dislocate, and legs that are as even as possible. Stability comes first. The difference that remains is usually small enough that you will not notice it, and when needed a thin heel lift solves it.
Loosening and wear over time
A modern hip replacement is built to last, but not forever. Today the parts are designed to last at least 15 years, and current evidence shows 80 to 85 percent are still working well at that mark. Many last far longer. Over the long run an implant can loosen, or the smooth bearing surface can slowly wear. If that happens, a revision (a second surgery to replace the worn parts) can restore comfort. This matters most for younger, very active patients, who may simply outlive a first implant and need a revision down the road. It is a real trade-off, and one reason I sometimes counsel a younger patient to wait if their pain can still be managed.
Nerve injury and fracture
Nerve injury is rare, around 1 percent, and most cases involve temporary numbness or weakness that recovers on its own. A small fracture in the bone can happen as the implant is press-fit into place. When it does, I address it during the same surgery with a wire or cable, and recovery usually proceeds normally.
Why hip replacement is still worth it for most patients
Here is the part the scary headlines leave out. For the right patient, hip replacement is one of the most successful procedures medicine offers. The reason patients accept the small risks is that the payoff is large and dependable.
- Pain relief. More than 90 percent of patients get major or near-complete relief from arthritic hip pain. This is the single biggest reason people choose surgery.
- Better movement. Walking, stairs, getting out of a chair, and putting on socks and shoes get easier once the pain is gone.
- Long-lasting results. A successful hip replacement keeps working for many years, often for the rest of a patient’s life.
I tell patients to weigh the disadvantages against the daily reality of severe arthritis: pain that wakes you at night, a cane that is not enough anymore, and a life that keeps shrinking around the joint. For most, that comparison is not close.
When the disadvantages of hip replacement outweigh the benefits
Surgery is not the first step, and it is not right for everyone. We almost always try non-surgical care first: weight management, activity changes, physical therapy, anti-inflammatory medicine, and sometimes injections. You can read more about those options on my non-surgical joint pain treatment page.
I may recommend waiting, or a different plan, when an active infection is present, when other health conditions raise the risk too high until they are managed, or when a patient is young enough that delaying makes long-term sense. The decision is always shared, and it is always yours.
How I lower the risks of hip replacement in my practice
Experience and volume change outcomes in joint replacement, and that is not marketing. It is one of the most consistent findings in the research.
I am a board-certified, fellowship-trained orthopedic surgeon, and I perform more than 700 hip and knee replacements a year. For most hips I use the anterior approach, a muscle-sparing technique that works between the muscles instead of cutting through them. It tends to mean fewer movement restrictions and a lower dislocation risk. I also use the Mako® robotic-assisted system, which builds a 3D model of your hip and helps me place each component with sub-millimeter precision.
None of this removes risk. It lowers it. That is the honest promise I can make: a careful plan, a proven technique, and a team that has done this many thousands of times.
Is hip replacement worth it?
For a patient with severe hip arthritis who has tried other options without lasting relief, hip replacement is usually worth it. The disadvantages are real but uncommon, and the benefit (a life with much less pain) is reliable. The right answer for you depends on your hip, your health, and your goals, which is exactly what a consultation is for. You can also read more answers to common questions on my hip and knee FAQ page.
If you are weighing this decision, I would be glad to talk it through with you. You can schedule a consultation with Dr. Calendine online, or call the Bone and Joint Institute of Tennessee at (615) 791-2630. We are located at 3000 Edward Curd Lane, Franklin, TN 37067, serving patients across Franklin, Nashville, Columbia, and Middle Tennessee.
Medical disclaimer: This article is for general education only and is not a substitute for professional medical advice. Every patient is different. Please speak with a qualified orthopedic surgeon about your own hip, your health history, and whether joint replacement is right for you.
Disclosure: Dr. Calendine serves as a paid consultant to Stryker for hip and knee implant design and the ongoing development of the Mako robotic platform.
Watch: the only true cure for hip arthritis
In this short video, I explain what actually cures hip arthritis and when hip replacement becomes the right choice for lasting relief.
