Posterior Hip Replacement FAQs: Common Questions Patients Ask Before Surgery

Key Takeaways

• Posterior hip replacement is a well-established surgical approach, and suitability depends on your symptoms, imaging, overall health and response to non-surgical treatment—not on a single factor.
• Understanding the procedure, recovery process, precautions and potential risks can help you prepare for surgery and set realistic expectations.
• Recovery is individual, with guidance on mobility, returning to daily activities and exercise tailored to your surgeon’s recommendations and your progress.
• Asking informed questions and discussing your specific circumstances with your orthopaedic surgeon can help you make confident decisions throughout your treatment journey.

If you’ve been told you’ll be having a posterior hip replacement, there’s a decent chance you’ve also come across plenty of anterior-approach content online — glossy pages describing muscle-sparing techniques and fast recoveries, sometimes implying that posterior surgery is the older, less desirable option. It’s an understandable thing to worry about right before a major operation.

This FAQ brings together the questions patients most commonly ask before posterior hip replacement, organised the way they tend to come up through the actual patient journey — from deciding whether surgery is appropriate, through understanding the posterior approach itself, preparation, the operation, recovery, precautions, risks, and the practical Australian pathway. Where advice genuinely varies between surgeons, that’s noted directly, since it usually reflects real clinical differences rather than any source being wrong. Your own surgeon’s guidance should always take priority over anything general written here.

Deciding whether hip replacement is right for you

How do I know whether I need a hip replacement?

This is generally based on a combination of your symptoms — pain, reduced walking tolerance, night pain, difficulty with daily tasks — alongside your imaging findings and how well you’ve responded to non-surgical treatment. No single test makes this decision alone.

Do I need bone-on-bone arthritis on my X-ray?

Not necessarily. While advanced imaging changes are common in patients considered for surgery, the decision is usually based on your symptoms, functional limitation, and imaging together, rather than one specific X-ray appearance in isolation.

What non-surgical treatments can I try first?

Some younger or highly active patients comparing different surgical options may also want to understand hip resurfacing. Unlike a total hip replacement, this procedure preserves more of the natural femoral bone, but suitability depends on factors such as age, bone quality, anatomy, activity goals and the underlying hip condition, making an individual assessment with an orthopaedic surgeon important.

Commonly tried options include physiotherapy, anti-inflammatory or pain medication, activity modification, weight management where relevant, a walking aid for symptom control, and in some cases a corticosteroid injection. Most surgeons like to see that reasonable non-surgical measures have had a fair trial before proceeding, unless the situation is severe or urgent.

What happens if I delay surgery?

Hip replacement is generally an elective decision based on how much your symptoms affect your life, not an emergency procedure. Many patients continue non-surgical management for years without disadvantage. Timing is usually a personal decision made together with your surgeon, based on your symptoms, function and goals, rather than something with one universal answer.

Understanding the posterior approach

What is a posterior hip replacement?

It’s a total hip replacement performed by accessing the joint from the back of the hip. The damaged femoral head and worn socket are removed and replaced with prosthetic components. “Posterior” describes the surgical pathway used to reach the joint, not a different type of operation.

Is the implant different from an anterior hip replacement?

No. The implant components themselves — the acetabular cup, liner, femoral stem and head — are generally the same regardless of which approach is used to insert them. Approach and implant choice are separate decisions.

What happens to the muscles and capsule?

The surgeon works through the fibres of the gluteus maximus muscle, generally separating rather than cutting across them. To access the joint itself, the posterior hip capsule and the short external rotator muscles are typically released, and modern technique generally involves repairing these structures before the operation is completed.

Is posterior hip replacement outdated?

No. It remains one of the most widely used and well-established approaches to total hip replacement worldwide, with a long track record of reliable long-term outcomes. It isn’t a fallback technique — it’s a mainstay of hip replacement surgery in its own right.

Why might my surgeon recommend it?

Common reasons include reliable, familiar access to both the femur and the acetabulum, suitability for routine primary arthritis as well as more complex reconstruction, and your surgeon’s own experience and consistency with the technique. It may also be favoured for patients with significant muscularity, previous hip surgery, complex anatomy, or those requiring revision surgery.

Suitability and approach selection

Who is a good candidate?

A genuinely broad range of patients — from straightforward osteoarthritis through to complex anatomical or revision cases. Being recommended posterior surgery doesn’t imply your case is unusually difficult.

Is there an age limit?

No strict upper or lower limit exists. General health, bone quality, frailty and function tend to matter more than age alone.

Does weight or muscularity matter?

Body composition is one consideration among several. Posterior access can offer more predictable exposure in some patients where higher body weight or significant muscle bulk make anterior access more technically demanding, though medical and wound-healing risks are still assessed individually regardless of approach.

Can it be used for hip dysplasia?

Often yes, and the broader exposure posterior access provides can be genuinely useful when dysplasia requires more extensive acetabular reconstruction.

Can it be used after previous surgery or fracture?

Yes, and in many cases posterior access is preferred specifically because it offers a safer, more predictable route around existing scar tissue, retained metalwork, or altered anatomy from earlier surgery.

Is it commonly used for revision surgery?

Yes. Posterior access is frequently favoured for revision hip replacement because it allows the surgeon to remove previous implant components, manage bone loss, and use specialised revision implants where needed.

Why might two surgeons recommend different approaches?

This usually reflects genuine differences in each surgeon’s training, experience and interpretation of your individual anatomy — not that one surgeon is wrong. Seeking a second opinion is a reasonable step if you’d like more clarity.

Assessment and preparation

Do I need a GP referral?

Generally yes. A referral from your GP is usually required to claim a Medicare rebate for your specialist consultation with an orthopaedic surgeon.

What happens at the first consultation?

Typically a review of your symptom history, a physical examination including gait and hip range of motion, a review of your imaging, and a discussion of both surgical and non-surgical treatment options.

What scans will I need?

Weight-bearing pelvic and hip X-rays are the standard starting point. A CT scan may be used in selected cases involving complex anatomy or revision planning, and MRI is generally reserved for situations where the diagnosis is uncertain.

What tests are required before surgery?

Typically, blood tests, an ECG in some cases, and a medical or anaesthetic review, often organised through a pre-admission clinic closer to your surgery date.

Will I need to stop medications?

Possibly, particularly blood-thinning medication, but this should always be guided by your surgeon’s and anaesthetist’s specific instructions rather than general advice.

Should I stop smoking or lose weight?

Stopping smoking can genuinely improve wound healing and reduce surgical risk, and is worth discussing with your surgeon regardless of timing. Weight management may also be discussed as part of your overall pre-operative optimisation, depending on your individual circumstances.

How should I prepare my home?

Useful preparations include removing trip hazards, arranging a firm chair with armrests, considering a raised toilet seat and shower chair, organising help with meals in the first week, and thinking through transport and support for the early weeks of recovery.

How much help will I need?

This varies depending on your living situation, general strength, and how your recovery progresses. Patients living alone may need more equipment or short-term support arranged in advance, while those with a partner or family nearby may need less formal assistance.

The operation

How long does surgery take?

This varies with individual complexity, but many primary posterior hip replacements take somewhere in the order of one to two hours, not counting anaesthesia and recovery time.

What anaesthetic is used?

Spinal anaesthesia, general anaesthesia, or a combination with sedation may all be used, depending on your health, preferences, and your anaesthetist’s assessment. Neither option is universally superior — the choice is individualised.

Will I be awake?

With spinal anaesthesia alone, you may remain awake, though sedation is often available if you’d prefer to be drowsy or asleep during the procedure. This is worth discussing directly with your anaesthetist.

What implant will be used?

Modern implants typically combine metal alloys, ceramic, and high-performance polyethylene for the bearing surfaces, selected based on your individual case and your surgeon’s assessment and experience.

Is the implant cemented or uncemented?

Both options exist, and the choice depends on factors including your bone quality and your surgeon’s preference and experience.

Will I have a catheter or a drain?

This depends on your surgeon’s usual practice and your specific operation. Not every patient requires one.

How does the surgeon check stability and leg length?

During surgery, your surgeon typically tests the hip’s range of motion and stability directly and compares leg length using anatomical landmarks and, in some cases, intraoperative measurement or imaging.

Hospital stay and early mobility

When will I stand and walk?

Many patients are assisted to stand and take a few steps with a physiotherapist on the day of surgery itself, using a frame or crutches, depending on your individual case.

How long will I stay in the hospital?

This ranges from same-day discharge to a couple of nights, depending on your recovery, home support, and your surgeon’s protocol. Discharge is generally based on safe mobility and adequate pain control rather than a fixed date.

What must I be able to do before discharge?

Generally, safely getting in and out of bed, managing your pain, using the bathroom, walking with your assistive device, managing a small number of stairs if needed for your home, and understanding your specific precautions.

Will I need inpatient rehabilitation?

Most patients recover at home with outpatient or home-based physiotherapy. A dedicated rehabilitation facility is sometimes considered for patients with more complex needs or limited support at home.

Will I need a frame, crutches, or a cane?

Most patients use some form of walking aid initially, progressing as gait, balance and confidence improve. There’s no fixed timeline — reducing your aid should be guided by how safely you’re walking rather than a specific day.

Pain, wound care, and normal symptoms

How painful is recovery?

Pain is generally well controlled with medication and tends to ease gradually over the first few weeks. Some discomfort, particularly with activity, is a normal part of healing.

How will pain be managed?

Typically, through a combination of medications, often reducing in strength and frequency as you heal, alongside ice, elevation, and gradually increasing activity.

When can I shower?

This depends on your wound closure and dressing type — your surgical team will give you specific instructions.

Is bruising and swelling normal?

Yes, and it can be more noticeable than many patients expect, sometimes travelling down into the thigh or lower leg. It generally settles gradually over several weeks, though mild swelling can persist for months.

Why does the buttock or thigh feel sore?

This is where the surgical repair took place, so soreness and some weakness here is a normal part of early posterior recovery, generally improving with strengthening and time.

Why am I tired or constipated?

Fatigue is common after major surgery and anaesthesia, and can persist longer than many patients expect. Constipation is generally related to reduced activity and pain medication, and often improves with hydration, diet, and gentle movement.

Posterior hip precautions

Why are precautions used?

They’re generally intended to protect the repaired posterior capsule and short external rotator muscles while they heal, reducing stress on these structures during the early recovery period.

Can I bend past 90 degrees?

Some surgeons still use this traditional guideline, while others allow comfortable bending and focus instead on avoiding a combined position of deep bending, leg crossing, and inward rotation together. Follow your own surgeon’s specific instructions.

Can I cross my legs?

This may be temporarily restricted, particularly in combination with bending or rotating the leg inward. Advice varies between surgeons.

Can I sleep on my side?

This depends on wound comfort, which side was operated on, and your surgeon’s specific guidance.

Do I need raised seating?

It can genuinely help in the early weeks, particularly if your usual furniture is low or soft, though it isn’t necessarily required for every patient.

How long do precautions last?

There’s no single universal duration. Six weeks is commonly cited as a traditional guideline, but this varies according to your surgeon’s protocol, the stability found during your surgery, and whether your procedure was straightforward or more complex.

What if I accidentally break a precaution?

A brief, accidental movement — crossing your legs momentarily, bending slightly further than intended — doesn’t automatically mean the hip has dislocated. Watch for sudden severe pain, an inability to bear weight, or a visible change in your leg’s shape, and contact your surgeon if you’re concerned.

Dislocation and other risks

Is posterior replacement more likely to dislocate?

Some historical data have suggested a somewhat higher risk with posterior surgery compared with certain other approaches, but modern soft-tissue repair, implant selection, and surgeon experience meaningfully influence this comparison, and overall risk after a straightforward primary replacement remains low.

How can risk be reduced?

By following your specific precautions, using your walking aid as needed, taking fall prevention seriously, progressing activity gradually, and attending your follow-up appointments.

What does a dislocation feel like?

Typically, sudden, severe pain, an inability to bear weight, and sometimes a visible change in leg length or position — a sudden functional change rather than gradual discomfort.

What other complications are possible?

These include infection, blood clots, fracture, nerve-related symptoms, leg-length differences, and implant loosening over time. Your surgeon can discuss which are most relevant to your individual case.

Which warning signs require urgent review?

Fever, increasing wound redness, wound drainage, sudden severe pain, an inability to bear weight, calf pain or swelling, chest pain, shortness of breath, and a significant fall all warrant prompt medical attention.

Returning to everyday life

When can I drive?

Once you’re off medication that could impair your reaction time and can safely control the vehicle, including performing an emergency stop. The operated side and your ability to transfer in and out of the car safely also matter.

When can I return to desk work?

Often within a couple of weeks for many patients, depending on comfort sitting and fatigue levels.

When can I return to standing or manual work?

Standing-based work generally needs a bit more time. Manual work, involving lifting, kneeling or climbing, usually requires the longest recovery, often extending to three months or more.

When can I fly?

This depends on your individual blood clot risk, mobility, and flight duration. Worth discussing timing directly with your surgeon rather than assuming a fixed point applies universally.

When can I resume sexual activity?

This varies by individual comfort and healing, and is a reasonable topic to raise directly with your surgeon, who can advise on positions and timing relevant to your specific precautions.

Exercise and sport

When can I swim?

Generally, once your wound is fully healed and your surgeon has confirmed it’s appropriate.

When can I cycle?

A stationary bike is often introduced earlier, within the first several weeks, with outdoor cycling generally following once balance and confidence have improved.

When can I play golf?

Golf typically progresses in stages, from putting through chipping and full swings, before returning to full rounds.

Can I hike?

Yes, generally progressing from flat, familiar paths to more varied terrain as strength and balance improve.

Can I return to running or high-impact sport?

This requires more individual discussion, since these activities involve repetitive impact loading. It’s worth a direct conversation with your surgeon about what’s appropriate for your specific case.

Will activity wear out the implant?

Total load over time — intensity, frequency, technique, and body weight — all factor in. Golf, hiking, and moderate cycling are generally considered lower-impact activities, and normal recreational participation is quite different from years of repetitive high-impact loading.

Implant longevity and follow-up

How long does a hip replacement last?

Many hip replacements perform well for well over a decade, with current outcomes continuing to be tracked through the Australian Orthopaedic Association National Joint Replacement Registry. It’s worth discussing current, registry-based figures with your surgeon rather than relying on older statistics.

Will I need another operation?

Some patients eventually require revision surgery, though many do not. Younger, more active patients are generally counselled about this possibility given the longer timeframe their implant needs to last.

What is revision hip replacement?

It’s a further operation to replace or adjust a hip replacement that has failed, worn out, become infected, or is otherwise no longer functioning well.

Will I need routine X-rays?

Follow-up protocols vary between surgeons. Some recommend periodic X-rays even without symptoms; others reserve imaging for when a concern arises. This is worth clarifying directly with your surgeon.

Do I need antibiotics before dental treatment?

Recommendations have evolved and vary by individual risk factors. It’s best to check current guidance with both your surgeon and your dentist.

Australian treatment pathways and costs

Can surgery be performed publicly or privately?

Both pathways exist. Public treatment typically involves a public hospital waiting list, while private treatment allows more choice of surgeon and timing, generally with associated costs offset partly by Medicare and private health insurance.

What does Medicare cover?

Medicare provides a rebate toward eligible specialist and hospital-related costs, though this generally doesn’t cover the full fee for private treatment. Specific coverage depends on your individual circumstances.

What should I ask my health insurer?

Useful questions include whether your hospital has an agreement with your insurer, whether any waiting periods apply, what excess you may need to pay, whether the prosthesis is covered, and what rehabilitation or extras benefits are included in your policy.

What out-of-pocket fees may apply?

Depending on your circumstances, you may encounter fees from your surgeon, anaesthetist, any surgical assistant, and the hospital. It’s reasonable to ask for a written quote covering these components before proceeding.

Is physiotherapy covered?

This depends on your individual private health insurance policy and whether you’re eligible for Medicare-supported allied health services under a relevant care plan. Worth checking directly with your fund and GP.

Questions to ask your surgeon

• Why is the posterior approach appropriate for me specifically?
• How often do you perform this approach, and what repair do you use for the posterior structures?
• What is my individual risk profile, based on my anatomy and health?
• Which implant and fixation method do you recommend for my case?
• What precautions will apply to my particular operation, and for how long?
• What recovery milestones should I realistically expect?
• Who should I contact if I have concerns after hours?

Final takeaway

Posterior hip replacement is a well-established, thoroughly proven approach used across the full spectrum of hip replacement surgery — from routine arthritis to complex reconstruction and revision cases. It isn’t a fallback or an outdated technique, and recommending this approach doesn’t mean your case is unusually difficult or that you’re receiving a lesser operation. What matters most for your outcome is safe surgical access, accurate implant positioning, and a surgeon experienced in the technique they’re using — not which direction the incision runs. If something you’ve read online conflicts with what your surgeon has told you, that’s often a reflection of genuine clinical differences rather than either source being wrong, and it’s always worth asking your surgeon directly for clarity on your own case.

Frequently Asked Questions (FAQs)

1. Is posterior hip replacement only used for complex cases?

No. It’s commonly used for straightforward primary hip replacements as well as more complex and revision surgery.

2. Is posterior surgery less advanced than the anterior approach?

No. Both are well-established, modern techniques. Neither is universally superior, and long-term outcomes are often similar when either is performed well by an experienced surgeon.

3. Is recovery always slower after posterior hip replacement?

Some patients notice differences in the early weeks, largely related to precautions, but longer-term function is often comparable between approaches.

4. Does posterior surgery involve cutting muscles?

The gluteus maximus fibres are typically separated rather than cut across, while the short external rotator muscles and posterior capsule are released and then repaired to allow safe access to the joint.

5. How likely is dislocation after posterior hip replacement?

Dislocation is a recognised but generally uncommon complication after a straightforward primary replacement. Individual risk depends on factors like soft-tissue repair, implant position, and your own anatomy and health.

6. How long will the implant last?

Many hip replacements perform well for well over a decade. Currently, registry-based data is the most reliable source for up-to-date figures, and this is worth discussing directly with your surgeon.

7. Should I seek a second opinion if I’m unsure about my recommended approach?

Yes, if it would help you feel more confident. Different surgeons may reasonably recommend different approaches based on their training and interpretation of your case, and a second opinion can help clarify the reasoning behind your specific recommendation.

This article is general information only and does not replace individualised medical advice. If you have specific questions about your own suitability, surgery, or recovery, speak with your orthopaedic surgeon or GP for guidance tailored to your situation.