Part of Total hip replacement rehab
Signs you need a hip replacement, and who decides
Warning signs, and when to get help
What are the signs you need a hip replacement?
Most people arrive at this question with a numbered list in front of them, because that is what the internet offers: eight signs, ten signs, five signs. The lists are not wrong about the symptoms. They are wrong about the arithmetic, because hitting six out of ten does not make an operation necessary and hitting two out of ten does not rule it out.
What the sources actually describe is a pattern with two parts. The NHS puts the threshold at hip pain and stiffness that is having a big effect on your day to day life, in someone for whom other treatments have not worked. OrthoInfo describes pain that limits everyday activities such as walking or bending, pain that carries on at rest by day or at night, and stiffness that makes it hard to move or lift the leg, in a person whose symptoms have not been helped enough by anti-inflammatory medicines, physical therapy or walking supports. Read either one twice and the same two parts show up: what the hip is doing to your life, and what you have already tried.
NICE says the same thing from the other end, for osteoarthritis specifically, and says it as an instruction to clinicians rather than as advice to patients: use clinical assessment when deciding to refer someone for joint replacement, instead of systems that numerically score how severe the disease is (NICE NG226, recommendation 1.6.2). So the arithmetic on those lists is not merely unreliable. It is not what the guideline asks anyone to decide on.
So the signs point you to an appointment, never to an operation. Nothing on this page can tell you that your hip needs replacing, and nothing on it should be read as advice for or against surgery. That decision belongs to a surgeon who has put their hands on your hip, with you in the room, and it comes before anything written here. If you have already had a hip replaced, your own surgical team's instructions govern everything, and hip replacement rehab is the page written for that stage.
Where the pain is, and what it stops you doing
Hip joint pain is usually felt in the groin and the front of the thigh, often with a deep ache in the buttock, and it can be referred down to the knee, which is why some people are convinced the problem is their knee. Pain only on the bony point at the side of the hip behaves differently and is often a tendon or bursa, not the joint. Where hip arthritis pain is felt covers that map properly. Read it before you decide what your own pain means.
What the sign lists underplay is the second part: what the hip stops you doing. The things that tell you a hip has taken over someone's life are small and specific, and they are rarely what the person leads with when they sit down.
Socks, shoes and toenails. Getting into and out of a low car. The stairs at work rather than the stairs at home. How far down the street you get before you plan where to stop. Whether you have started holding a rail you never used to need, picked up a walking stick or cane, or quietly stopped going somewhere.
Then there is the night. Hip pain at night is its own subject. Broken sleep changes how someone copes with everything else in the day, and both the NHS and OrthoInfo list pain at rest separately from pain on the move for that reason. Hip pain when walking and groin pain cover the other two patterns people describe.
Write these down before any appointment, in your own words and with real examples. A surgeon cannot weigh what you did not mention, and most people leave out exactly the things that matter, because the trips they stopped making and the help they now need at home feel like complaining rather than symptoms. They are symptoms.
What does a surgeon actually weigh?
Four things, roughly, and only one of them is a picture.
Your account and the examination come first: what hurts, when, what you have stopped doing, how far the hip moves and how the leg behaves when you walk.
Second, what has already been tried, and whether it was genuinely tried. The NHS names weight loss where someone is overweight, low-impact exercise such as swimming, walking or cycling with strengthening work for the hip, walking aids, footwear or insoles, pain relief medicines, gels or creams, and steroid injections as the things a doctor discusses before raising surgery. Treating hip arthritis without surgery covers that ground, including what the guidelines say about referral and the things that should not shut you out of an assessment, and the hip osteoarthritis program is what a fair trial of exercise looks like. One warning there: a few weeks of light movements that stopped when the pain eased is not the same as months of progressive strengthening, and the difference changes the conversation.
One thing that framing can obscure, though, and it goes the other way: NICE's referral recommendation for osteoarthritis asks that non-surgical management has been ineffective or is unsuitable, not that every option on the list has been worked through first (NICE NG226, recommendation 1.6.1). A treatment that is not appropriate for you does not have to be attempted in order to count as tried.
Third, your general health, because this is major surgery and the risks are not the same for everyone. They are also not a list for a page like this one to hand out, since every figure carries a population with it. Ask the surgeon for yours, in your own circumstances, before the appointment ends. OrthoInfo is clear that there are no absolute age or weight restrictions for total hip replacements and that recommendations are based on a person's pain and disability rather than age, so if you have privately decided you are too old or too heavy to ask, that sentence is the one to take in with you.
NICE names the same ground for osteoarthritis and names more of it: people with osteoarthritis should not be excluded from referral for joint replacement because of age, sex or gender, smoking, other health conditions, or being overweight or obese, including on measurements such as body mass index (NICE NG226, recommendation 1.6.3). Read that on its own and it is easy to hear as a clean bill of health, which is why the guideline attaches a second instruction to it: when referral is being discussed, the person should have it explained to them that the risks of joint replacement can vary depending on those same factors (recommendation 1.6.4). Keep both. The first one gets you through the door. The second one is what the appointment is for, and it is the reason to answer honestly about smoking, weight and the rest of your health once you are in there.
Fourth, what you want back. This sounds soft and it is the part people prepare least. Two or three activities, named, are worth more than a general wish to be out of pain, because they are what the surgeon can tell you is or is not realistic.
Does an X-ray decide it?
No, and a worn-looking film is not permission while a mild-looking film is not a refusal. The operation is offered for what the joint is costing you, and a film cannot measure that.
The mismatch is not small. Kim and colleagues compared hip pain with hip X-rays in two large research cohorts of adults, people in a community study and in a long-term osteoarthritis study rather than people already being assessed for an operation, and found the two agreed poorly in both directions: plenty of painful hips looked normal on the film, and plenty of hips with arthritis on the film were not frequently painful (Kim and colleagues, 2015). Where hip arthritis pain is felt carries the figures, and the stages of hip arthritis and how fast it progresses covers what the grades on a report do and do not predict.
The other direction needs saying as well, because a clear film gets heard as an all clear. A normal X-ray does not mean nothing is wrong with the hip. It means the X-ray has not shown it. OrthoInfo notes that an orthopedic evaluation occasionally needs other tests, such as an MRI scan, to judge the condition of the bone and soft tissues of the hip, and for loss of blood supply to the top of the thighbone it says plainly that an MRI scan can pick up bone changes at an early stage, when the X-ray still looks normal. So if the hip is behaving the way this page describes and the film came back clear, that is a reason to keep asking rather than a reason to stop, and it is worth saying out loud at that appointment if you take steroid tablets long term or drink heavily.
None of that makes imaging pointless once an operation is genuinely being discussed. It is a damaged joint that gets replaced, so the film is part of the picture a surgeon is weighing, along with the examination and everything you have told them. What it is not is the trigger. People turn up in both of the states this creates: certain the operation is overdue because of a phrase read out from a report, or certain it is not allowed because the film is not bad enough while the hip has emptied their week. Both of them need an assessment rather than a grade.
Why would someone need one other than for arthritis?
Osteoarthritis is the usual route here. The others are uncommon enough that the people on them rarely find themselves in the standard advice, so they get named. Rheumatoid arthritis is the one both the NHS and OrthoInfo name first among them, and inflammatory arthritis of any kind works differently from wear: the damage comes from the disease process, the hip is one joint among several, and the medical treatment of the condition runs alongside any surgical conversation. Rheumatoid arthritis covers the exercise side of it.
Arthritis after an injury is the next. The NHS describes pain and stiffness from damage to the hip after a fall, injury or accident, and OrthoInfo calls it posttraumatic arthritis, following a serious hip injury or fracture. A hip that was broken or dislocated years ago can arrive at this point earlier in life than wear alone would bring it.
OrthoInfo also names osteonecrosis, where an injury such as a dislocation or fracture limits the blood supply to the ball of the hip joint, and childhood hip disease, where problems treated successfully in infancy or childhood can still lead to arthritis later. Loss of blood supply has other associations worth knowing about, which is why the warning signs on this page include new groin or hip pain in someone on long-term steroid tablets or drinking heavily. OrthoInfo also says that osteoarthritis itself can be caused or accelerated by subtle irregularities in how the hip developed in childhood, the kind that were never given a name or a treatment at the time. Part of why some people meet hip arthritis decades earlier than they expected to is sitting in that sentence.
Some operations share these words without being this one. A hip replaced as part of treating a broken hip, a partial replacement, and a second operation on a hip that has already been replaced each follow their own surgical plan and their own rehabilitation. Those plans can look quite different from what is described across this cluster.
Is there such a thing as too early or too late?
For a hip worn by arthritis there is no deadline to catch, and nobody can name the right month either. What there is instead is a trade-off, and the belief in a closing window does real damage in both directions, hurrying some people into a decision and freezing others in place for years.
That holds for arthritis, which is what most people reading this have. It does not hold for all of the routes above, and the qualification matters most to the people least likely to be looking for it. On some of those routes an operation to keep your own hip may be the one on the table rather than a replacement, and those operations generally depend on the joint not being badly damaged yet, so the clock behaves differently. Loss of blood supply to the top of the thighbone is the clearest case. OrthoInfo says it is important to diagnose osteonecrosis early, because it reports that early treatment is associated with better outcomes, and that where the diagnosis comes early, core decompression sometimes stops the ball at the top of the thighbone (femoral head) from collapsing and keeps arthritis from developing. A hip that did not form normally follows the same shape of reasoning: good long-term results from reorienting the socket are expected where it is done at a young age in a hip whose cartilage is still preserved (Buchler and Beck, 2014). So if a surgeon has raised either of these with you, holding out as long as possible is the wrong question. Ask what the window is in your own hip, what closes it, and what has to be watched while you decide.
Each side of that pull has evidence behind it, and both are set out with their sources on treating hip arthritis without surgery: what is known about going into surgery in worse shape, and what is known about how long replacements last, which is the reason people give for waiting. Reading them together is more use than reading either alone, and the figures should be weighed with a surgeon against your own situation rather than against an average.
What does change while you wait is the leg, and that part is in your hands. Whatever strength the leg has on the day is the strength rehabilitation starts from, which is why exercises before hip replacement surgery is worth a look as soon as surgery is a live question, whether you have a date or an open-ended wait. Waiting for physio covers what to do with a long wait for an appointment.
One thing that genuinely is out of your hands: how the surgeon reaches the hip, from the back, the front or the side. That choice is theirs, it shapes what you are asked to avoid afterward and not whether you are offered the operation, and hip precautions and how long they last explains why two people can come home with different rules.
What to ask at the appointment
Bring the written list of what the hip has stopped you doing, and the two or three things you most want back. Everything else in the appointment gets easier once those are on the table.
Four questions earn their place. What is this likely to change for me, and what will it probably not change. What are the risks in my situation, with my health and my age. What happens if I wait a year. And what would you want me to do between now and then.
Then ask about the rehabilitation, because people ask about the operation and forget the months that follow it. NICE expects a physiotherapist or physical therapist, or an occupational therapist, to start rehabilitation on the day of surgery where that is possible, and within 24 hours of it otherwise (NICE NG157, recommendation 1.10.1). If the plan is that you will largely do it yourself at home, the same guideline says you should be given clear goals and a point of contact for advice and support (recommendation 1.10.4), so it is fair to ask who that contact is and how to reach them. And if daily activities are hard, if there is ongoing loss of function with particular needs, or if the home program is not getting you to your goals, NICE says supervised rehabilitation, in a group or one to one, should be offered (recommendation 1.10.5). Knowing those three things exist is the difference between accepting whatever you are given and asking for what you need.
Ask what the first months will ask of you at home and at work, in your own terms rather than in weeks. The hip replacement recovery timeline sets out what the sources say about the shape of it.
When to get the hip looked at sooner
Some hip changes should not sit in a diary waiting for a routine appointment, and none of them has anything to do with the surgical decision.
A fall or injury followed by severe hip pain, or a leg you cannot stand on, needs an emergency department straight away, and so does tingling or numbness in the hip or leg after one. If you have fallen and cannot get up, or you think you may have hurt your head, neck, back or hip, stay where you are, keep warm and call emergency services, or get someone to call for you. A hip that is hot and swollen, or hip pain with a temperature or with feeling shivery, needs medical help the same day. So does a small fall in someone older or with thinning bones, even if they are still walking, and so does a leg or foot that is getting weaker or a foot that drags or slaps.
Hip or groin pain that is worse at night or does not settle with rest, and keeps building, needs a doctor within a few days, and sooner if you have had cancer at any time or are losing weight without trying. New groin pain in someone who has taken steroid tablets long term or drinks heavily needs an appointment within a few days with those facts mentioned. Never stop or change a prescribed medicine on your own.
The warning signs below set out each of these with its own level of urgency. If you have already had a hip replaced, these are not the right list for you: the signs that matter after that operation, including a dislocation and a late infection, are on hip replacement rehab.
Related exercise programs
Warning signs
Get emergency help now
- Emergency: you have just fallen and cannot get up, or you think you may have hurt your head, neck, back or hip. Stay where you are, keep warm and call emergency services, or get someone to call for you. If you got up and walked without trouble and only notice pain later, use the same-day lines in this list instead.
- Emergency: you have had a fall or an injury and now have severe hip pain, or you cannot walk or put weight on the leg. Call emergency services or go to an emergency department. This can be a sign of a broken hip (hip fracture).
- Emergency: tingling or loss of feeling in the hip or leg after a fall or injury. Call emergency services or go to an emergency department.
Get help today
- Same day: the hip is hot and swollen, or the skin over it has changed color, or you have hip pain with a high temperature or feel hot, cold or shivery. Get medical help the same day, and go to an emergency department if you feel very unwell. A joint infection needs treatment quickly. If you have a very high or very low temperature, shivering you cannot control, you are breathing very fast or finding it hard to breathe, you are confused or your speech is slurred, your skin, lips or tongue look blue, gray, pale or blotchy (on brown or black skin this can be easier to see on the palms of the hands or soles of the feet), or you have a rash that does not fade when you press it, call emergency services, as this can be sepsis.
- Same day: severe hip pain that came on suddenly without a fall, or pain that is getting worse quickly over a few days. Get medical advice the same day.
- Same day: new hip or groin pain after a fall, even a small one, if you are older, have low bone density (osteoporosis) or have taken steroid tablets for a long time, even if you can still walk. Get medical advice the same day. A broken hip is not always obvious at first.
- Same day: a leg or foot that is getting weaker, for example your foot drags, catches on the ground or slaps down when you walk (foot drop). Get medical advice the same day. If the weakness is getting worse by the hour, go to an emergency department.
- Same day: hip or groin pain that is worse at night or does not ease with rest, and keeps getting worse. If you are being treated for cancer now, contact your cancer team the same day.
Book an appointment
- Within a day or two: hip or groin pain that is worse at night or does not ease with rest, and keeps getting worse. If you have had cancer, now or in the past, or are losing weight without trying, see your doctor sooner, within a day or two, and mention it. This applies even if the pain is not getting worse.
- Within a few days: you have had a fall, even if you were not hurt, or you keep tripping, stumbling or feeling that your legs might give way. Book an appointment with your doctor within a few days and ask about a falls assessment. Tell them about every fall, even the ones where you were not hurt.
- Within a few days: hip or groin pain that is worse at night or does not ease with rest, and keeps getting worse. See your doctor within a few days.
- Within a few days: new groin or hip pain and you take steroid tablets long term, or have in the past, or you regularly drink a lot of alcohol. This can be a sign of a problem with the blood supply to the top of the thighbone (avascular necrosis). Book an appointment with your doctor within a few days and mention the steroids or alcohol.
Common questions
What are the signs you need a hip replacement?
The ones that carry weight are about function and about rest. OrthoInfo describes hip pain that limits everyday activities such as walking or bending, pain that continues while you are resting by day or at night, and stiffness that makes the leg hard to move or lift, in someone whose symptoms have not been helped enough by anti-inflammatory medicines, physical therapy or walking supports. The NHS frames the same thing as hip pain and stiffness having a big effect on your life when other treatments have not worked. Notice that both descriptions have two parts: the symptoms, and what has already been tried. A checklist that covers only the first is telling you half of what the decision is made of.
Where is the pain when you need a hip replacement?
Usually in the groin or the front of the thigh, often with a deep ache in the buttock, and often showing up at the hip joint's jobs rather than in one spot: putting socks on, getting out of a low car seat, turning in bed. Pain felt only on the bony point at the side of the hip is more often a tendon or bursa problem than the joint itself. None of that is diagnostic on its own, and the location of your pain does not tell you whether an operation is needed. Our page on where hip arthritis pain is felt goes through the map, and the signs that need a doctor sooner are listed on this page.
Is there a right age for a hip replacement?
No age makes it necessary and no age rules it out. OrthoInfo states that there are no absolute age or weight restrictions for total hip replacements, and that recommendations rest on a person's pain and disability rather than on age. NICE is firmer still for osteoarthritis: it advises that people should not be excluded from referral for joint replacement because of age, sex or gender, smoking, other health conditions, or being overweight or obese (NICE NG226, recommendation 1.6.3), while also advising that the risks of the operation can vary depending on those same factors (recommendation 1.6.4). Age still comes into the conversation, because a joint fitted earlier in life has longer to serve, and how that applies to you is a question for the surgeon who sees you rather than something to settle from a page.
Can anything other than arthritis mean you need a new hip?
Yes. Osteoarthritis is the common route, and the NHS also names rheumatoid arthritis and damage to the hip after a fall, injury or accident. OrthoInfo adds posttraumatic arthritis following a serious hip injury or fracture, osteonecrosis, where an injury such as a dislocation or fracture limits the blood supply to the ball of the hip joint, and hip problems from childhood that can lead to arthritis later even when they were treated well at the time. People on these routes often cannot find themselves in the usual advice, which is why they are named here.
Who decides, me or the surgeon?
A referral is an assessment and a discussion, not a slot on an operating list. The surgeon decides whether this is an operation they would offer you, from the examination, the imaging and your general health. You decide whether you want it, and you can be referred, listen to the whole picture and say no or not yet. If it feels as though the answer is being handed to you in either direction, ask what would have to change for the answer to be different.
References
- NHS. Why a hip replacement is done. Page last reviewed 6 March 2024. https://www.nhs.uk/tests-and-treatments/hip-replacement/why-a-hip-replacement-is-done/
- NHS. Alternatives to a hip replacement. Page last reviewed 6 March 2024. https://www.nhs.uk/tests-and-treatments/hip-replacement/alternatives-to-a-hip-replacement/
- NHS. Falls. Page last reviewed 6 March 2025. https://www.nhs.uk/conditions/falls/
- American Academy of Orthopaedic Surgeons. Total hip replacement. OrthoInfo. https://www.orthoinfo.org/en/treatment/total-hip-replacement/
- American Academy of Orthopaedic Surgeons. Osteonecrosis of the hip. OrthoInfo. https://www.orthoinfo.org/en/diseases--conditions/osteonecrosis-of-the-hip/
- National Institute for Health and Care Excellence. Osteoarthritis in over 16s: diagnosis and management. NICE guideline NG226, recommendations 1.6.1, 1.6.2, 1.6.3 and 1.6.4. 2022. https://www.nice.org.uk/guidance/ng226
- Buchler L, Beck M. Periacetabular osteotomy: a review of Swiss experience. Current Reviews in Musculoskeletal Medicine. 2014;7(4):330-336. https://doi.org/10.1007/s12178-014-9232-0
- National Institute for Health and Care Excellence. Joint replacement (primary): hip, knee and shoulder. NICE guideline NG157, recommendations 1.10.1, 1.10.4 and 1.10.5. 2020. https://www.nice.org.uk/guidance/ng157
- Kim C, Nevitt MC, Niu J, et al. Association of hip pain with radiographic evidence of hip osteoarthritis: diagnostic test study. BMJ. 2015;351:h5983. https://doi.org/10.1136/bmj.h5983
Written and checked by the PocketPhysio editorial team. Last updated 2026-10-17.
This page is general education, not a diagnosis or a personal treatment plan. See a physiotherapist or doctor for advice about your own situation.