Hip Replacement Risks and Complications
Hip replacement can substantially improve pain and function in appropriately selected patients, but it remains major surgery. Risk is not zero and is not identical for every patient. A useful consent discussion explains which complications are possible, which personal factors alter risk, what can be optimised before surgery and which warning signs require urgent action.
For the principal treatment page, read Total Hip Replacement in Mumbai.
Quick Answer
Important risks include infection, blood clots, bleeding, medical complications, dislocation, fracture, nerve or vessel injury, leg-length difference, persistent pain, implant wear and loosening.
Primary replacement, revision surgery, fracture surgery and complex deformity do not carry the same risk profile.
Diabetes, nicotine use, anaemia, malnutrition, infection, previous blood clots and uncontrolled medical disease may increase risk.
Robotic assistance may support planning and component positioning but cannot eliminate complications.
Chest pain, sudden breathlessness, collapse, a suddenly deformed painful hip or inability to bear weight requires emergency assessment.
How to Think About Risk
A published percentage is an average from a particular population, hospital, implant and follow-up period and may not describe one patient. Risk should be discussed as baseline procedural risk, modifiable factors and non-modifiable factors that affect planning. The consequence of a complication also matters; an uncommon infection may be more important than a common temporary symptom.
Infection and Wound Problems
Infection may involve the wound or develop deep around the implant and can occur early or years later. Deep periprosthetic joint infection is serious because bacteria can attach to the implant surface and may require surgery as well as targeted antibiotics.
Increasing wound drainage or a wound that opens.
Spreading redness, warmth or swelling.
Increasing pain at rest after initial improvement.
New stiffness, chills, fever or feeling systemically unwell.
Fever may be absent, so a draining wound or unexplained worsening pain should not be ignored. Risk assessment includes diabetes, nicotine use, skin or dental infection, nutrition, anaemia, immune suppression, previous infection and recent injections. Read Infection After Hip Replacement.
Blood Clots and Pulmonary Embolism
Hip replacement temporarily increases the risk of deep-vein thrombosis and pulmonary embolism. Prevention may include early mobilisation, calf exercises, mechanical compression and prescribed anticoagulant medicine. NICE recommends VTE prophylaxis when thrombosis risk outweighs bleeding risk. Patients should follow the exact prescribed plan and should not stop or double anticoagulants without instructions.
Possible DVT: new calf pain, one-sided swelling, warmth or redness.
Possible pulmonary embolism: sudden breathlessness, chest pain, coughing blood, fainting or collapse.
Read Blood Clots After Hip Replacement.
Bleeding, Anaemia and Medical Complications
Blood loss can cause anaemia, dizziness, weakness or delayed mobilisation. Tranexamic acid, careful haemostasis and appropriate anticoagulant management help reduce bleeding. Preoperative anaemia should be investigated when feasible. Possible medical complications include medication reactions, heart attack, stroke, kidney injury, breathing problems, urinary retention, nausea, constipation and delirium. Risk varies with age, frailty and medical health.
Dislocation and Instability
Dislocation occurs when the femoral head leaves the socket. Risk depends on component position, surgical approach, soft-tissue function, previous surgery, spinal stiffness or fusion, neurological conditions and falls. A sudden painful deformity, shortened or rotated leg and inability to stand requires emergency assessment.
Read Hip Replacement Dislocation.
Fracture Around the Implant
Fracture can occur during implantation or later after a fall. Fragile bone, osteoporosis, previous surgery, deformity and some press-fit stems can increase risk. Treatment may require fixation, revision components or both. New severe pain, deformity or inability to bear weight after a fall requires urgent imaging.
Read Periprosthetic Fracture After Hip Replacement.
Nerve and Blood-Vessel Injury
Nerve injury is uncommon but may cause weakness, foot drop, numbness, burning pain or altered sensation. Risk may be higher in revision surgery, major deformity, previous nerve disease or when substantial length restoration is required. Major blood-vessel injury is rare; a cold, pale foot, severe swelling or loss of pulse requires immediate assessment.
Leg-Length Difference and Offset
The surgeon balances leg length, hip stability and offset. A hip may feel long or short early because of pelvic tilt, muscle tightness, spinal alignment or previous deformity even when structural lengths are similar. Small differences may settle or be managed without surgery; a large or persistent difference should be assessed clinically and radiographically.
Read Leg-Length Difference After Hip Replacement.
Persistent Pain, Weakness and Limp
Not every patient becomes completely pain-free. Ongoing symptoms may arise from infection, loosening, fracture, instability, tendon irritation, abductor weakness, trochanteric pain, heterotopic bone, nerve injury or pain referred from the spine or knee. Persistent pain should be diagnosed before revision is discussed.
Implant Wear, Loosening and Material Reactions
Bearings can wear and components can loosen over time. Wear particles may contribute to bone loss. Modern bearings have reduced wear, but no implant can be guaranteed for life. Material reactions are particularly relevant to some metal-on-metal implants and modular junctions. Pain should not be attributed to allergy until infection, loosening, instability and other common causes are evaluated.
Read How Long Does a Hip Replacement Last? and Ceramic vs Metal Hip Replacement Implants.
Factors That May Increase Risk
Uncontrolled diabetes or severe medical disease.
Nicotine use, anaemia, malnutrition or active infection.
Previous blood clot, clotting disorder, osteoporosis or high fall risk.
Previous hip operations, infection, revision surgery, deformity or bone loss.
These factors do not automatically prohibit surgery. They may change preparation, consent, timing, implant planning or postoperative monitoring.
How Risk Is Reduced
Confirming that the hip joint is the correct pain source.
Optimising medical conditions, skin, nutrition and haemoglobin.
Appropriate antibiotics, sterile technique and implant-compatibility checks.
Individual clot and bleeding prevention, early mobilisation and fall prevention.
Clear wound, medicine and emergency instructions with prompt reassessment of abnormal recovery.
Robotic Assistance and Risk
Robotic assistance may support planning, component positioning, leg-length and offset measurements. It does not eliminate infection, clots, bleeding, fracture, nerve injury, anaesthetic complications or persistent pain. Technology should support a safe surgical plan rather than be presented as zero-risk surgery.
When to Contact the Team the Same Day
Persistent wound drainage, increasing redness, warmth or swelling.
Worsening pain after initial improvement.
New weakness, numbness, calf pain or marked one-sided swelling.
Medication reaction, repeated vomiting or inability to take prescribed medicines.
When to Seek Emergency Care
Sudden breathlessness, chest pain, collapse or coughing blood.
Sudden painful hip deformity or inability to bear weight.
Major bleeding, a cold pale foot, severe confusion or rapidly worsening illness.
Questions Patients Commonly Ask
Is hip replacement a high-risk operation?
It is a major operation with recognised risks, but individual risk varies widely. Assessment and optimisation identify risks that can be reduced.
Can robotic surgery prevent complications?
No. It may support planning and component positioning but cannot eliminate surgical or medical complications.
Does persistent pain mean the implant has failed?
Not necessarily. The hip, spine, tendons, muscles, nerves and implant must be evaluated before the cause is assigned.
Should I compare surgeons using one complication percentage?
Not in isolation. Case complexity, follow-up, definitions and reporting differ. A better discussion covers individual risk, prevention and the management pathway if a complication occurs.
Clinical References
NICE NG157: Joint replacement—primary hip, knee and shoulder
NICE NG89: Venous thromboembolism prevention
AAOS OrthoInfo: Total Hip Replacement
AAOS OrthoInfo: Infection After Joint Replacement
About Dr. Mayur Rabhadiya
Dr. Mayur Rabhadiya is an Orthopedic and Joint Replacement Surgeon in Mumbai. His hip practice includes diagnosis-led assessment, hip arthritis and AVN treatment, primary and revision hip replacement planning and robotic-assisted planning in selected cases. Risk counselling is individualised according to diagnosis, medical health, anatomy, operation complexity and realistic recovery goals. Qualifications: MBBS, D’Ortho, DNB (Orthopedics), MNAMS (Orthopedics), FIJR (Robotic & Navigation). Read his professional profile.
Written and medically reviewed by Dr. Mayur Rabhadiya. Last medically reviewed: 17 July 2026.
Book a Hip Consultation
Consultations are available in Ghatkopar East and Ghatkopar West, Mumbai. Call or WhatsApp +91 84249 03913 or +91 96113 30063, or use the orthopedic appointment page.
Medical Disclaimer
This guide provides general patient education and does not replace individual risk assessment, consent, examination or emergency care. Follow the specific instructions of the treating surgical and anaesthesia teams.