Total Hip Replacement: Common Questions
Common questions about total hip replacement — the MBS item code, anaesthetic, dislocation risk, flying, dental work, airport scanners, sport, and having the second hip done. Answered by Perth orthopaedic surgeon Dr Rhys Clark.
These are the ones that come up most often about the operation itself — how it is billed, what the anaesthetic involves, and the practical business of living with a replaced hip. That last group tends to get raised at the end of a consultation rather than the beginning, usually on the way to the door.
If what you are after is the timeline — hospital, the fortnight at home, when driving becomes reasonable, and what warrants a phone call — that is all on Hip Replacement Recovery. For the operation itself, see total hip replacement, and for the approach Dr Clark generally prefers, anterior hip replacement.
A note on implant longevity
The numbers here are genuinely good ones, though they repay a bit of unpacking.
Around 90% of hip replacements are still in place and working well 18 years after surgery, and modern implants are generally expected to last 15 to 20 years or longer. Australia keeps one of the world’s better datasets on this: the Australian Orthopaedic Association National Joint Replacement Registry records essentially every joint replacement performed in the country, so longevity figures here reflect national practice rather than a single surgeon’s series.
All of which describes a population rather than your hip specifically. Two things move an individual’s odds more than the rest. Body weight matters because the joint sees several times your weight with every step, so the multiplier works against you. How you load it matters because a bearing surface wears at the rate you wear it, and repetitive impact is simply harder on it than steady, low-impact use.
None of that argues for taking it easy. Staying active is good for the hip, for the joints either side of it and for everything else, and inactivity has its own long list of costs. It argues for being deliberate about which activities you keep. Where that line falls is a conversation about your circumstances, not a rule that applies to everyone.
If a replacement does eventually need attention, hip revision surgery is a routine part of this practice: Dr Clark completed a UK fellowship in revision arthroplasty and has performed 60 revision procedures since January 2024.
On cost and item numbers
MBS item 49318 is the code commonly used for total hip replacement in Australia. Item numbers and scheduled fees are revised periodically, so confirm the current figures with the rooms.
What a hip replacement costs sets out the public, private and self-funded pathways in full, including the costs that sit outside most quotes.
Still deciding?
If you have not yet settled whether surgery is the right step, Do I Need a Hip Replacement? works through what actually indicates it is time, and Understanding Hip Arthritis explains the condition in plain English.
To ask something not covered here, book a consultation or phone the rooms on (08) 6332 6365. Dr Clark consults at Murdoch and Mandurah.
What is the MBS item number for a hip replacement?+
MBS item 49318 covers total arthroplasty of the hip, including minor bone grafting where performed. Item numbers and scheduled fees are revised periodically, so confirm the current code with the rooms when you are quoted and use it to check your level of cover with your health fund.
What anaesthetic is used for a hip replacement?+
Typically a spinal anaesthetic with sedation, so you are asleep but not under a general anaesthetic. A cannula is placed in your arm for medication. Spinal anaesthesia is associated with less nausea and a clearer head afterwards for most patients. Your anaesthetist will discuss what suits you, taking your other health conditions into account.
How much bone is removed in a hip replacement?+
The femoral head — the ball at the top of the thigh bone — is removed and replaced, and the socket is prepared to take a cup. The stem sits inside the shaft of the femur, which is hollowed to receive it rather than cut away. It is a bigger reconstruction than a knee replacement in that sense, and it is also why the operation is so effective at removing arthritic pain: the arthritic surfaces are gone entirely.
How likely is a hip replacement to dislocate?+
Uncommon, and the risk depends partly on the approach. The direct anterior approach leaves the structures at the back of the hip that resist dislocation undisturbed, which is why no movement restrictions are needed afterwards. A posterior approach carries a higher early risk, which is what the post-operative precautions are for — follow them for as long as you were told. Risk is highest in the first weeks and falls as the soft tissues heal.
When can I fly after a hip replacement?+
Discuss it with the rooms before booking. Short domestic flights are usually manageable within a few weeks, but long-haul travel in the first six weeks is commonly advised against because sitting still for long periods raises the risk of a blood clot. If you must travel, ask about compression stockings, aisle seats, keeping hydrated and moving regularly.
Will I set off airport security scanners?+
Possibly. Modern implants can trigger walk-through metal detectors, and body scanners will show the implant. Implant cards are no longer routinely issued or accepted as proof, so the practical approach is simply to tell the screening officer before you walk through and expect a secondary check. It causes no problem beyond a short delay.
Do I need antibiotics before dental work after a hip replacement?+
Do not decide this one on your own in either direction — it is a question for your dentist and your surgeon together, and the answer depends on the work being done and on you. The reasoning behind the caution is that bacteria released into the bloodstream from anywhere in the body can, rarely, find their way to an artificial joint. On the same principle, a fever or an unexplained ache in the hip is worth reporting promptly no matter how many years have passed since the operation.
What sport can I do after a hip replacement?+
Low-impact activity is encouraged and is good for you: walking, swimming, cycling, golf, doubles tennis, bowls. Running and repetitive high-impact loading wear a bearing surface faster, so they are generally discouraged in someone who was not already doing them. If a specific activity matters to you, raise it before surgery so it can be discussed on its own terms rather than as a general rule.
When can I have sex after a hip replacement?+
Usually once you are comfortable, which for most people is a few weeks. After an anterior approach there are no positional restrictions. After a posterior approach the same precautions apply here as elsewhere — avoiding deep hip flexion, crossing the legs and turning the leg inwards — for the period you were given. It is a reasonable thing to ask about at your two-week review, and it gets asked more often than people assume.
Can I kneel, squat or sit cross-legged after a hip replacement?+
After an anterior approach, generally yes, as comfort allows. After a posterior approach, deep squatting and sitting cross-legged fall under the precautions you were given and should wait until those are lifted. Kneeling is usually far more comfortable after a hip replacement than after a knee replacement, because the kneecap is not involved.
What happens if I need my other hip done?+
It is common, and the second hip is usually staged rather than done at the same time — typically some months apart, once the first has recovered enough to support the rehabilitation of the second. Many people find the second recovery easier, partly because they know what to expect and partly because they are already stronger.
Does a hip replacement need to be checked over the years?+
Yes. Periodic review with an X-ray is worthwhile even when the hip feels entirely normal, because wear or loosening can begin silently and is far easier to address when found early. Any new pain, a change in the way the hip feels or sounds, or a limp that appears years later should be reviewed rather than watched.