Consent, benefits and risks

What consent actually means

Before your operation a surgeon will discuss it with you and ask you to sign a consent form. For that consent to be valid, three things must be true: you have been given the information you need, you are free from pressure, and you have the mental capacity to decide. It is your decision, not your family's and not your doctor's.

You are entitled to ask about, and have explained:

• What the operation involves and who will be doing it.
• What benefit you can realistically expect, and how long it should last.
• The risks, including the rare but serious ones.
• The alternatives — continuing with painkillers, physiotherapy, injections, or waiting.
• What is likely to happen if you decide not to have surgery.

You can ask for the conversation to be repeated, ask for it in writing, ask for an interpreter, or bring someone with you. And you can say no, or not yet, at any stage — right up to walking into theatre. Nobody will be angry with you.

The benefits — what to expect

Hip replacement is one of the most reliably successful operations in medicine, and the reason is simple: it treats a mechanical problem mechanically.

• Pain relief. This is the main benefit and it is usually dramatic. Studies using pain scoring scales show average reductions of more than 50%, and many people describe the grinding, sleep-stealing pain as simply gone.
• Movement and independence. Walking further, managing stairs, getting in and out of a car, dressing yourself, sleeping through the night.
• Durability. Around 90% of implants are still working well at 15 years.
• Satisfaction. UK figures put satisfaction after hip replacement at about 95%.

Being honest about limits matters too. The new hip is very good, but it is not the hip you had at 30. Deep squatting, high-impact running and extreme twisting are generally discouraged. And the improvement varies from person to person — other health conditions, the state of your other joints and your expectations all play a part.

The risks — in plain numbers

These figures are approximate averages for planned hip replacement in the UK. Your own risk depends on your health, and your surgeon will give you a more personal estimate.

General risks of any major operation

As well as the hip-specific risks above, any big operation carries a small risk of chest infection, urine infection, pressure sores, heart or breathing problems, and — very rarely — death. For planned hip replacement the risk of dying within 90 days is well under 1 in 200 and is concentrated among people who are already seriously unwell. Pressure sores and chest infections are largely prevented by the same thing: getting you up and moving early.

What if you decide not to have surgery?

This is a legitimate choice. Arthritis tends to progress slowly, so the likely path is continuing pain and gradually reducing mobility, managed with painkillers, physiotherapy, walking aids and occasional injections. Some people prefer that, particularly if they have other serious health problems. You can also choose to wait and reconsider later — although becoming much weaker and less mobile in the meantime does make recovery from eventual surgery harder.

How your team reduces the risks

Every risk above has a specific defence, and most of them happen without you noticing:

• Antibiotics given into a vein within the hour before the first cut.
• Skin cleaned with an antiseptic solution and covered with sterile drapes.
• Theatre air filtered and the number of people and door openings kept to a minimum.
• A safety checklist read aloud before you go to sleep and again before you wake.
• Tranexamic acid to reduce bleeding, and warming to keep your temperature normal.
• Calf compression during surgery, then blood-thinning medication afterwards.
• A physiotherapist getting you standing within hours.

Hospitals also audit themselves against national standards, and standardised pathways of this kind have been shown to cut complications by around a fifth. You are entitled to ask your hospital how its results compare.