Posterior Hip Replacement in Sydney
The posterior approach is the most widely used technique for hip replacement, giving the surgeon excellent access to the joint. We explain how it works, what recovery looks like and how it compares with the anterior approach.
What is a posterior hip replacement?
A posterior hip replacement is a total hip replacement performed through an approach from the back of the hip. It is one of the most established and widely used approaches worldwide because it gives the surgeon excellent access to the hip joint.
The hip joint is made up of the ball, called the femoral head, and the socket, called the acetabulum. These surfaces are normally covered in smooth cartilage, which cushions the joint and helps it move freely. In hip osteoarthritis, this cartilage wears away, which can leave bone rubbing on bone and cause pain, stiffness and loss of function.
Hip replacement surgery involves placing a new cup into the existing arthritic socket and replacing the worn ball with a prosthetic ball attached to a stem that sits inside the thigh bone. In the posterior approach, the surgeon reaches the joint from behind the hip, repairs the soft tissues at the end of the procedure and then guides you through a structured recovery plan.
Do you need a hip replacement?
Hip replacement is usually considered when hip arthritis is causing pain, stiffness and loss of function despite good non-surgical treatment. It is rarely urgent, which means there is usually time to prepare properly and improve your strength, medical safety and confidence before surgery.
You may be ready to discuss hip replacement if pain is limiting walking, sleep, stairs, work, exercise or independence, and if treatments such as physiotherapy, exercise modification, medications or injections are no longer giving enough relief.
Not every painful hip needs surgery. Many people with hip osteoarthritis can improve with strength work, mobility training, activity changes and careful symptom management. Our Osteoarthritis Clinic, physiotherapy team and exercise specialists can help you explore non-surgical options first.
At your consultation, your surgeon will assess your symptoms, examine your hip, review imaging and discuss whether hip replacement is appropriate. The decision is not based on the X-ray alone. It depends on how much the arthritis is affecting your life, what you have already tried, and whether surgery is likely to help you achieve your goals.
Benefits and risks
What you can expect it to achieve
- Relief from pain caused by advanced hip arthritis
- Improved walking, standing and daily function
- Better hip movement and less stiffness for many patients
- Improved sleep when night pain is caused by the arthritic hip
- A return to many low-impact activities after rehabilitation
- A reliable, well-established approach with excellent access to the joint
- A suitable option for many straightforward and more complex hip replacements
Risks to understand
- Common and temporary: bruising, swelling, stiffness, fatigue and discomfort in the early recovery period
- Uncommon: infection, blood clots, wound problems, nerve or blood vessel injury, fracture and ongoing pain
- Specific to hip replacement: dislocation, leg length difference, implant loosening, wear or the need for revision surgery in future
- Posterior approach considerations: early hip precautions may be recommended while the repaired capsule and muscles heal
- Anaesthetic and medical risks: allergic reaction, heart or lung complications, stroke and other rare serious complications
All surgery carries risk and outcomes vary between individuals. The aim of your consultation is to decide whether hip replacement is the right operation for your problem, and whether the posterior approach is the safest and most suitable way to perform it.
Posterior vs anterior hip replacement
The main difference between posterior and anterior hip replacement is how the surgeon reaches the hip joint. The posterior approach comes from the back of the hip and gives broad access to the joint. The anterior approach comes from the front and uses an interval between muscles where suitable.
The anterior approach may allow faster early recovery for some patients, but it is not automatically better for everyone. The posterior approach remains a reliable and widely used option, especially when anatomy, bone quality, muscle mass or surgical complexity makes it the safer choice.
| Posterior hip replacement | Anterior hip replacement |
|---|---|
| Approaches the hip from the back | Approaches the hip from the front |
| Gives excellent access to the hip joint | Uses an interval between muscles where suitable |
| May involve repairing the capsule and short external rotator muscles | Usually avoids detaching major muscles |
| May involve early movement precautions while soft tissues heal | May allow faster early walking in selected patients |
| Often useful for complex anatomy, revision surgery or technical challenges | Not suitable for every anatomy or complex case |
The best approach is the safest approach for your hip. A well-performed hip replacement through the right approach for your anatomy is more important than choosing an approach based only on early recovery claims.
Preparing for posterior hip replacement
Hip replacement is rarely an emergency, and results are generally better when you have time to prepare. At MTP Health, preparation is taken seriously because your strength, medical safety, home setup and expectations all affect your recovery.
We generally aim to prepare you over a minimum period of four to six weeks where possible. This gives time to improve your strength and range of motion, check that you are medically safe for surgery, and help you understand what recovery will involve.
Your preparation may include
- Planning imaging, which may include a CT scan and functional X-rays
- Routine blood tests
- MRSA swabs
- Medication review, especially blood thinners, diabetes and blood pressure medications
- Anaesthetic review
- Cardiology or physician review if needed
- Pre-operative physiotherapy and exercise physiology
- Planning around work, stairs, transport, family events and home support
Our physiotherapists and exercise specialists will assess your current level of function and build a personal program to help you start recovering as soon as you wake from the anaesthetic. This may include hip strength, walking tolerance, balance, stair practice and education about your hospital stay.
What happens before hip replacement surgery?
Before surgery, we need to know about all medications you take, including prescription medicines, over-the-counter medicines, supplements and blood thinners. Some medications may need to be stopped or adjusted before surgery, but this should only be done with medical guidance.
If you smoke, stopping for as long as possible before surgery is strongly recommended. Smoking can increase wound, anaesthetic and healing risks. It is also important to keep the skin around the hip free from cuts, scratches or sores in the weeks before surgery, as these can increase infection risk and may delay the operation.
The hospital will contact you before surgery to confirm your admission time and fasting instructions. If you are on a morning list, you may be asked to stop food from midnight and stop clear fluids in the early morning or two hours before the list starts, whichever comes first. Afternoon lists may have a later clear-fluid cut-off. Always follow the exact instructions from your hospital and anaesthetic team.
Acceptable clear fluids usually include water, clear apple juice without pulp, and clear sports drinks. Milk and cloudy juices are usually not considered clear fluids.
The procedure: what happens
You will usually arrive at hospital one to two hours before your operation. A nurse will prepare the hip area, and you will meet the anaesthetic team. Before the anaesthetic, your surgeon will confirm your identity, the correct joint and the correct side, then mark the hip. This safety check is an important part of preventing wrong-side surgery.
The most common anaesthetic for hip replacement is a spinal block with a light general anaesthetic, meaning you are asleep and comfortable during the procedure. The team also performs a formal time-out check to confirm your name, imaging, consent form and marked side all match.
For a posterior hip replacement, you are positioned on your side. The surgeon makes an incision behind the hip, carefully moves through the soft tissues and enters the hip joint from the back. The damaged femoral head is removed, the socket is prepared, and a new cup is placed into the pelvis. A prosthetic stem and ball are then placed into the femur and positioned within the new cup.
The hip is checked for stability, movement and leg length. The posterior capsule and short external rotator muscles are repaired at the end of the procedure where appropriate. The incision is then closed with dissolvable sutures, skin glue and a waterproof dressing.
The operation usually takes around 90 minutes to two hours, with extra time before and after for anaesthesia, preparation and recovery. For relatives or partners waiting, it can be three to five hours from leaving the admissions area to returning to the ward.
What should I expect immediately after surgery?
After the operation, you will wake in the recovery room, where nurses monitor your pain, blood pressure, circulation and general comfort. Once you are stable, you will return to the ward and begin your post-surgical recovery.
The hip replacement is usually strong enough to walk on straight away. The team will aim to have you standing and walking within hours of waking up. If you feel light-headed or nauseated, you may start by standing or marching on the spot before progressing further.
Walking
You will normally be encouraged to put full weight through the operated leg as tolerated, unless your surgeon gives you different instructions. A physiotherapist will help you use a frame or crutches safely and progress this as your balance and strength improve.
Dressings and wound care
You will have a waterproof dressing that should usually remain in place until your wound check at 10 to 14 days. A small amount of dried ooze in the first 24 to 48 hours can be normal. You can shower with the dressing, but avoid baths, pools, ocean swimming and hydrotherapy until the wound is healed and watertight.
Length of stay
Some suitable patients can go home on the day of surgery. More commonly, patients stay overnight and sometimes a second night. Your discharge depends on pain control, walking safety, stairs, medical stability, wound status and home support.
Surgeon follow-up
Your first post-operative visit is usually at around two weeks. This appointment is important for checking wound healing, assessing your new hip and answering questions. Further follow-up may include appointments at six weeks with X-ray, 12 weeks, six months, one year and then ongoing review as recommended.
When to seek help. Contact us or seek urgent care if you develop fever, increasing wound redness, discharge, worsening calf pain or swelling, shortness of breath, chest pain, sudden severe pain, new weakness or pain that is not controlled by medication. Concerned about your recovery? Call (02) 9437 9794.
Posterior hip replacement recovery and rehabilitation
Your recovery starts as soon as you wake from the anaesthetic. Early exercises usually include calf pumps to encourage blood flow and thigh muscle contractions to begin waking the leg muscles up again.
The physiotherapist will help you get out of bed, sit in a chair, stand and walk. You may start with a frame and progress quickly to crutches or sticks. Your goal is to become safe walking, managing stairs if needed, and completing the basic exercises required for discharge.
The total recovery from hip replacement takes at least 12 months. Many patients walk without sticks by four to six weeks, but strength, balance, endurance and confidence continue improving for many months.
Recovery timeline
| Phase | Timeframe | What to expect |
|---|---|---|
| Wake up & mobilise | Day 0–1 | Standing, walking with assistance, calf pumps, early exercises and pain control |
| Early home recovery | Weeks 0–2 | Wound care, walking practice, swelling control, basic strengthening and safe daily routines |
| Early independence | Weeks 2–6 | Reducing walking aids, improving confidence, building strength and returning to light daily activities |
| Strength & control | Weeks 6–12 | Progressive strengthening, balance work, longer walks, cycling and return to many normal routines |
| Return to activity | Months 3–6 | Gradual return to low-impact sport and more demanding activity, guided by your recovery |
| Final recovery | Months 6–12+ | Ongoing improvement in strength, comfort, endurance and confidence |
Timeframes are a guide. Your surgeon and rehabilitation team will progress you based on your hip, your health, your goals and your recovery.
Hip precautions after posterior hip replacement
Because the posterior approach involves repairing soft tissues at the back of the hip, your surgeon may recommend movement precautions while these tissues heal. These may include avoiding deep bending past 90 degrees, avoiding crossing your legs, and avoiding combined hip flexion and internal rotation in the early recovery period.
These precautions are designed to reduce the risk of dislocation while your hip is healing. Your surgeon and physiotherapist will explain which precautions apply to you, how long they are needed and how to move safely at home.
Rehabilitation at MTP Health
This is where MTP Health is different. Your rehabilitation is delivered by our own physiotherapists and exercise specialists, working in the same clinic as your surgeon. Your plan can begin before surgery and continue seamlessly afterwards, with everyone working from the same goals and shared clinical record.
Your rehabilitation may include pre-operative rehabilitation, post-operative rehabilitation, physiotherapy and exercise physiology, depending on your needs.
Inpatient rehabilitation
Most patients do not need inpatient rehabilitation after hip replacement. It can be useful for people who live alone, have many stairs, need extra medical supervision or do not have enough support at home. We will discuss your home setup and recovery options during your preparation sessions.
Returning to driving, work and sport
Return to driving, work and sport depends on your comfort, strength, medication use, confidence, transport needs and the demands of your activity. You should always follow your surgeon’s advice and check with your insurer before driving.
Returning to driving
You should not drive until you can safely perform an emergency stop and are no longer taking strong painkillers. As a general guide, many patients wait at least four weeks after a left hip replacement and around six weeks after a right hip replacement, but this varies between people.
Returning to work
Desk-based work can often be restarted once you are comfortable, mobile enough and no longer taking strong pain medication. Sitting for long periods may still be uncomfortable early on, so a staged return and regular movement breaks are often helpful.
More physical jobs usually take longer. Climbing ladders, carrying heavy loads and high-risk manual work are generally avoided for around 12 weeks, unless your surgeon and rehabilitation team advise otherwise.
Returning to sport
Return to sport is gradual and should be guided by your pain, strength, balance and physiotherapy progress. Swimming can usually restart once the wound is fully healed and watertight, often from around three weeks, but this should be confirmed at your wound review.
Activities such as golf, bushwalking, cycling and gym-based strengthening are introduced progressively. Running and high-impact sport are generally not recommended after hip replacement unless specifically discussed with your surgeon.
Rehab is half the result. Posterior hip replacement is a proven operation, but your long-term outcome still depends on preparation, safe surgery, early movement, progressive strength work and sensible return-to-activity planning.
Posterior hip replacement cost in Sydney
The cost of posterior hip replacement depends on your private health cover, hospital insurance, surgeon fees, anaesthetist fees, assistant fees, hospital charges, implant costs and any excess on your policy.
If you are having surgery using private health cover, your out-of-pocket costs depend on your insurer, level of cover and whether reduced-gap arrangements apply. The anaesthetist is an independent practitioner and may charge a separate gap, so we provide their details and recommend checking their quote before surgery.
The surgeons at MTP Health participate in various reduced-gap schemes run by different health insurance providers. Availability can vary, and reduced-gap surgical time slots may involve a longer wait. Your insurer may also charge an excess depending on your policy. For a broader overview of related expenses, see our knee and hip replacement cost guide.
If surgery is performed through the public system, there is no out-of-pocket surgical cost, but waiting times can be long and depend on hospital access, urgency category and local availability.
Why have your posterior hip replacement at MTP Health
MTP Health brings together fellowship-trained hip surgery specialists, careful surgical planning, physiotherapy and exercise physiology in one clinic. That matters because hip replacement is not just about the implant or the approach — it is about choosing the right operation, preparing properly and rehabilitating well afterwards.
Honest advice comes first. If your hip is better suited to non-surgical care, we will tell you. If the posterior approach is the safer option for your anatomy, we will explain why. If another approach is more appropriate, we will discuss that too. The goal is not to sell a technique. The goal is to choose the safest operation for your hip and your recovery.
Your surgeon
Dr Donald Cawthorne
Dr Donald Cawthorne is an Australian fellowship-trained orthopaedic surgeon with a focus on hip and knee surgery. His clinical interests include robotic and computer-assisted hip and knee replacement, arthroscopic surgery and the management of hip and knee conditions. Dr Cawthorne works alongside MTP Health's physiotherapy and exercise physiology team so your surgical treatment and rehabilitation can be managed as one coordinated plan.
View full profile →Frequently asked questions
What is total hip replacement surgery?
The hip joint is made up of a ball, called the femoral head, and a socket, called the acetabulum. These surfaces are normally covered in joint cartilage, which cushions the joint and helps it glide smoothly.
Hip osteoarthritis means this cartilage has worn away. When bone rubs on bone, it can cause significant pain, stiffness and loss of movement, which can limit walking, sleep, exercise and daily activity.
Total hip replacement surgery involves placing a new cup into the existing arthritic socket and replacing the worn ball with a prosthetic ball attached to a stem that sits inside the thigh bone. When the surgeon reaches the hip through the back of the joint, this is called the posterior approach.
The total recovery takes at least 12 months, but we aim to have you walking on the day of surgery. Many patients can walk without sticks by around four to six weeks, depending on their recovery.
Should I have anterior or posterior approach for my hip replacement?
It is important to discuss this with your surgeon so you can weigh up the pros and cons for your hip, rather than choosing based only on general claims about one approach.
The approach used depends on many factors, including your age, bone strength, hip anatomy, muscle mass, body habitus, previous surgery, deformity and whether the replacement is straightforward or complex.
Anterior hip replacement has been well publicised for quicker early recovery in some patients, but this does not apply to everyone. Some complications that can slow recovery may be more common with the anterior approach. The posterior approach is widely used, reliable and can be the safer option for many patients, particularly when anatomy or surgical complexity makes access important.
How do I best prepare for hip replacement surgery?
Total hip replacement is rarely urgent, and results are generally better with proper preparation.
It is important to work with your physiotherapist to improve hip strength, walking capacity and range of motion before surgery. At MTP Health, our Hip Programs can help you prepare for rehabilitation and recovery.
You should also think carefully about timing. Recovery can affect family events, holidays, work trips, busy work periods, driving and home responsibilities.
At MTP Health, we aim to prepare you over a minimum period of four to six weeks where possible. Preparation may include planning imaging such as CT scan and functional X-rays, routine blood tests, MRSA swabs and medical optimisation if you have heart, lung, diabetes or other health concerns.
Our physiotherapists and exercise specialists will assess your function and provide a personal program so you are ready to start recovering as soon as you wake from the anaesthetic.
What happens before hip replacement surgery?
We need to know about all your medications, especially those for diabetes, blood pressure or blood thinning, because some may need to be stopped or adjusted before surgery.
If you smoke, it is strongly recommended that you stop for as long as possible before surgery to support healing and reduce risk. You should also keep the hip area free from scratches, cuts or sores in the weeks before surgery. Last-minute gardening, shaving injuries or skin breaks can increase infection risk and may cause surgery to be delayed.
The hospital will contact you in the week of surgery to confirm your arrival time and fasting instructions. Clear fluids usually include water and clear drinks without milk or pulp, but you should follow the exact instructions given by your hospital and anaesthetic team.
What happens during hip replacement surgery?
You will arrive at hospital around one to two hours before surgery. A nurse will prepare the hip area, and you will meet the anaesthetic team, who will make sure you are comfortable and safe during the procedure.
Before your anaesthetic, your surgeon will confirm which joint and which side is being operated on. They will check this against your consent form and mark the correct hip. The surgical team will also complete a formal time-out procedure before surgery begins.
The most common anaesthetic for joint replacement is a spinal block with a light general anaesthetic, meaning you will be asleep. A catheter may be used in some cases and is often removed early after surgery.
For the posterior approach, you are positioned on your side. The incision is made behind the hip. The surgeon accesses the joint from the back, replaces the damaged socket with a new cup, and replaces the worn ball with a prosthetic ball and stem. The repaired soft tissues are closed carefully, and the wound is sealed with dissolvable sutures, skin glue and a waterproof dressing.
The surgery usually takes around 90 minutes to two hours, with extra time for anaesthesia and recovery. For relatives or partners, it is often three to five hours from leaving admissions to returning to the ward.
What should I expect immediately after hip replacement surgery?
After the operation, you wake in the recovery room, where you are monitored closely. Once stable, you will be transferred to the ward to begin your recovery.
The hip replacement is usually strong enough for you to walk on straight away. The team will aim to have you walking within hours of waking up. If you feel light-headed or nauseated, they may help you stand and march on the spot first.
You will have a waterproof dressing that usually stays on until your wound check at 10 to 14 days. You can shower with the dressing, but should avoid baths, pools, ocean swimming and hydrotherapy until the wound is healed and watertight.
Some patients can go home on the same day, but most stay overnight and sometimes a second night. Your first post-operative visit is usually around two weeks after surgery to check your wound, assess your hip and answer your questions.
What is my rehabilitation following hip replacement surgery?
Your recovery starts the minute you are awake from the anaesthetic. You begin with simple exercises such as calf pumps and thigh muscle contractions to encourage circulation and start waking up the muscles around the hip.
The physiotherapist will help you get out of bed, sit in a chair and begin walking. You may start with a frame and then progress to crutches or sticks as your balance and confidence improve.
Your first goal is to be safe for discharge home. This usually means walking safely, managing stairs if needed, understanding your exercises and having pain controlled well enough to move.
In the first two weeks, the focus is pain control, wound care, walking, swelling management and completing your exercises. At around two weeks, we check your wound. At around six weeks, X-rays may be arranged to confirm the prosthesis remains secure and functioning well.
Most patients do not need inpatient rehabilitation, but it can be useful for people who live alone, have difficult stairs or need extra medical support.
When can I return to driving, work and sport after hip replacement surgery?
Return to driving, work and sport depends on your recovery speed, pain levels, strength, medication use, transport needs and the physical demands of the activity.
Driving
You should not return to driving until you can safely perform an emergency stop and are no longer taking strong painkillers. As a guide, this is often at least four weeks after a left hip replacement and around six weeks after a right hip replacement. Please check with your surgeon and car insurance company.
Work
Office work can often restart once you are comfortable and no longer taking strong painkillers. More physically demanding work takes longer. Climbing ladders and carrying heavy loads are generally avoided for around 12 weeks.
Sport
Return to sport is gradual and guided by your pain, confidence and physiotherapy progress. Swimming may restart once the wound is healed, often from around three weeks. Activities such as golf, bushwalking and cycling are introduced gradually. Running is generally not recommended after hip replacement unless discussed with your surgeon.
What are the risks of hip replacement surgery?
Hip replacement is a safe and effective procedure when well planned, but all surgery has risks.
General surgical risks include blood clots, infection, wound problems, bleeding, injury to blood vessels, injury to nerves and fracture. Anaesthetic risks can include allergic reaction, heart or lung complications, stroke and other rare serious complications.
Specific hip replacement risks include leg length difference, dislocation, implant loosening, wear, ongoing pain and the possibility of revision surgery in future.
Specific to the posterior approach, early movement precautions may be recommended while the repaired soft tissues heal. This is to reduce the risk of dislocation during the early recovery phase.
Nerve injury is uncommon, but sciatic nerve irritation or damage can cause numbness or weakness in the leg or foot. Your surgeon will discuss your individual risk profile before surgery.
Posterior hip replacement consultations across Sydney
North Shore Health Hub, Level 4, Suite 401, 7 Westbourne St, St Leonards NSW 2065
St Leonards consulting →173 Warringah Road, Beacon Hill NSW 2100 — serving the Northern Beaches
Beacon Hill consulting →Also consulting at Gosford, Wahroonga, Castle Towers and Tamworth.
Talk to a surgeon about your hip
Book a consultation to find out whether posterior hip replacement is right for you — and if it is not, to leave with a clear plan for the most suitable next step.
Book a ConsultationPrefer to talk? Call (02) 9437 9794 · GP & physio referrals: referrer information
- Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), Annual Report — hip arthroplasty outcomes and revision data.
- Current peer-reviewed literature and consensus guidance on total hip replacement, surgical approach selection, rehabilitation and return to activity.