Hip Replacement

A hip replacement is usually performed when the hip is damaged from wear and tear (osteoarthritis), inflammation or trauma. It involves an operation to remove the damaged joint and replace it with an artificial one. An incision (surgical cut) is made in the skin. The hip is surrounded by muscle, which either needs to be cut or moved aside.

How I Perform Your Hip Replacement

Before proceeding with surgery, I ensure we have thoroughly explored all non-operative alternatives. Once we are both completely satisfied that surgery is the right path forward, we will discuss and choose the best implant type for your specific needs. While this is often a straightforward choice, we will take all the time necessary to make the right decision for you.

I perform NHS procedures at the Sussex Orthopaedic Treatment Centre in Haywards Heath, and both NHS and private surgeries at The Montefiore Hospital in Hove.

Planning and Your Surgery Day

To ensure the highest level of precision, I use a digital templating system to meticulously plan your surgery beforehand.

On the day of your procedure, you will typically be admitted to the hospital an hour or two before the operation.

Anaesthetic: The anaesthetist generally uses a spinal anaesthetic.
Your Comfort: Sedation can be provided based on your preference. While a few patients choose to remain fully awake, the vast majority prefer to sleep through the procedure so they are completely unaware of it.

My Surgical Approach

Wherever appropriate, I use a minimally invasive, muscle-sparing approach. While this technique is not suitable for every single patient, my primary goal is always to deliver a safe, stable hip while minimising the risk of complications.

My preferred technique is a muscle-sparing posterior approach:

Preserving Tissue: Using specialised retractors, the hip joint can usually be accessed by releasing only a single tendon, which is carefully repaired at the end of the procedure.
Faster Recovery: Because fewer muscles are disrupted, patients experience a quicker recovery and a significantly reduced risk of hip dislocation.
Added Stability: I also perform a full capsular repair whenever possible to provide maximum joint stability.

What Does "Minimally Invasive" Really Mean?

Many surgeons offer a smaller skin incision and label it "minimally invasive". While a shorter scar has cosmetic appeal, the standard amount of muscle tissue is often still cut internally beneath the surface.

True minimally invasive surgery should be muscle-sparing.

With a genuine muscle-sparing approach, fewer muscles are cut, and more of your natural hip anatomy is left intact. This translates directly to a hip that feels:

More stable
Stronger
Quicker to get going

The benefits of this technique are evident within the first few days of recovery. Patients can often return to their daily routines much faster—and if you are comfortable and it is safe to do so, driving can sometimes be resumed from two weeks post-operatively.

Mr Stott's minimally invasive / muscle sparing technique

Piriformis

Obturator Internus in red

Quadratus Femoris

Obturator internus has been carefully cut off the femur, and folded backwards, revealing the hip capsule, and oburator externus just above quadratus

Under the gluteus maximus muscle, there are 4 muscles at the back of the hip - the Short External rotators;

- Piriformis

- Obturator Internus (with its 2 Gemelli)

- Obturator Externus

- Quadratus Femoris

On the image, the Obturator Internus is highlighted in red, and obturator externus is hiding behind the quadratus femoris.

Most surgeons doing the posterior approach will cut all 4 muscles, and then most of them will repair them. Mr Stott prefers to use the SPAIRE technique. This technique does not involve cutting the Obturator Internus Muscle. This results in a lower dislocation rate, higher patient satisfaction and probably a lower infection rate.

Sometimes, the SPAIRE is not possible to do. Mr Stott has also developed a technique, where only the Obturator internus is cut. This is then repaired at the end of the procedure.

With either approach that less damage occurs during the surgery, allowing quicker recovery and a more stable hip replacement

Choosing the Right Hip Implant for You

There are over 100 different hips on the market in the UK. How do I know which one is right for me?

The short answer is that every patient is different. Just as no two faces are the same, people come in all shapes and sizes—with entirely different lifestyles, needs, and expectations.

Active or Younger Patients: Often require a robust joint capable of supporting impact sports and demanding fitness regimes. I often treat active older people too.
Flexibility & Range of Motion: Some patients need an implant tailored for specific activities that require deep flexion, such as yoga, swimming, or cycling.
Mobility & Independence: Many people simply want to reclaim their daily independence, walk without discomfort, and improve their quality of life with as little pain and risk as possible.

Ultimately, while the exact choice of implant varies, most patients share the exact same goal: to be free from debilitating hip pain and return to living their lives as quickly and safely as possible.

During your consultation, we will look at your age, bone quality, and activity goals to select the specific implant that gives you the best, most long-lasting result.

The Myth of the "One-Size-Fits-All" Hip

Many surgeons rely on just one specific type of implant or surgical technique for all of their cases, arguing that the implant is available in a variety of sizes. However, standard sizing is only part of the equation.

In reality, different implants are better suited to different shapes of bone, not just different sizes.

The Reality of Choice: While some implants offer exceptional strength or durability, they may also come with their own specific nuances or potential drawbacks depending on the patient's anatomy.
No Single Perfect Implant: If a single, flawless hip replacement existed, every orthopaedic surgeon in the world would use it for every single patient.

Because there is no perfect universal implant, my approach is entirely bespoke. By carefully matching the right implant design and material to your unique anatomy and lifestyle, we can achieve a far more stable, natural-feeling, and long-lasting result.

'I do not believe in a ‘One size fits all approach'. There are no cookbooks of hip surgery, where just because you have a problem means that there is only one treatment’.

Do You Use the Latest, Most Modern Hip Replacements?

Scientific and technological progress continues to move orthopaedics forward. However, history shows that "new" does not always mean "better". Occasionally, innovative theories have been proven wrong in practice, causing unexpected patient harm.

Two notable examples from recent decades include the Capital 3M hip and the ASR resurfacing system. Both were backed by compelling scientific theory, but ultimately resulted in unacceptable failure rates. Fortunately, we now have robust tracking databases like the National Joint Registry (NJR) to monitor implant performance and keep patients safe.

The Gold Standard: Tried and Tested

To safeguard his patients, Mr Stott strongly recommends using femoral implants that have a proven track record of at least 10 years in real patients under real conditions.

The majority of hip implants Mr Stott uses have over 15 years of clinical data and rank among the top-performing joints on the National Joint Registry. These include:

The Exeter Stem (Stryker): Widely regarded as a global gold standard in cemented fixation.
The Furlong HAC and EVO stems (JRI): Highly successful, clinically proven cementless options.

These tried-and-tested replacements provide predictable, excellent results across thousands of patients.

Modern Innovation for Active Lifestyles

For younger, highly active patients who wish to return to high-impact sports, alternative modern designs can be highly beneficial.

Where the patient’s anatomy allows, Mr Stott utilizes a short-stemmed hip implant: the B Braun Metha.

Bone-Conserving: This design preserves more of the patient’s natural bone stock, both where the bone is cut and within the femur itself—leaving more options open for the future.
A Natural Feel: Patients frequently report that this shorter stem provides a more natural-feeling joint during movement.

A Balanced Approach to Technology: First introduced in Europe in 2005, the Metha hip has demonstrated very promising results for over 20 years. While it does not possess the decades-long historical track record of the Exeter or Furlong stems, it represents a carefully selected, modern advancement for patients who require a specific, active-lifestyle solution.

The X-ray of this patient shows a short stem Metha Hip replacement. This patient is a keen runner, and was able to get back to running long distances after their rehabilitation

What about custom made hip replacements? Surely they are made to fit me, and will have the best function?

'I do use custom hip replacements for complex cases where there is little other choice. Usually this is because the patient has had previous surgery, and there are anatomical deformities which would preclude the use of a tried and tested hip replacement. I am currently using the Symbios system from Switzerland. Whilst these hips are custom made to fit, each design is different, and therefore has not had the same exposure as the 25 year old plus designs that I commonly use.'

John was in his early 40s. He had suffered from a disease called Perthes when he was a child, and had a series of operations on his hip. He has been struggling on for many years with a short, stiff and painful leg.

The X-ray shows how abnormal his femur was, with the femoral head collapse, and where surgeons had operated on him to change the angle of his hip.

He needed his hip replacing. Traditionally, John would have had to undergo one operation to restore the shape of his femur. This would have involved putting some metalwork in to support the bone as it healed. He would then need a second one to remove this metalwork, and a third one to do the hip replacment.

With one operation, John's life was transformed. Using a Custom made hip replacement, Mr Stott was able to restore John's leg length and function. He was ready for discharge the following day post-operatively.

He reported that his mother cried when she saw him at two weeks, already walking better than he had since he was a child.

Post-op X-ray of John's new Custom made hip

Pre-op X-ray of John's hips

Custom Case Example - John's Story

I've heard that Robot Assisted Surgery is better, do you use it?

The Reality of Robotic Hip Surgery

Robotic technology is developing rapidly, and while robots are excellent at precisely placing implants, studies show this hasn't actually improved patient recovery or long-term satisfaction yet

To use a robot, a surgeon must map your anatomy. For a hip replacement, this means:

More Incisions: Extra markers must be attached to the bone, requiring separate cuts that add to your recovery time.
More Tissue Disruption: Extra muscles must be cut so the robot can "see" the pelvis and femur.
Higher Risks: More incisions and tissue trauma naturally mean a higher risk of infection and complications.

Ultimately, recent evidence shows that robotic-assisted hip replacements carry a higher rate of complications—such as fractures and cup failures—meaning they are not yet as reliable as the hands of a dedicated specialist hip surgeon.

'"I have evaluated robotic hip systems, but I have not been impressed by their actual accuracy. Furthermore, the additional trauma to the surrounding muscles and tissues required just to let the robot 'see' simply isn't worth the risk to my patients." Mr Philip Stott

How a Hip Replacement is Performed

1. Making the Incision. The surgeon makes a careful incision at the back of your hip to safely access the joint.

2. Removing the Damaged Joint The damaged parts of the hip joint are gently separated. The worn-out top end of the thigh bone (the femoral head) is removed.

3. Preparing and Fitting the New Socket The natural hip socket is cleared of damaged cartilage and shaped (reamed) to fit the new implant. A durable titanium shell is inserted into the socket, which is then lined with either a smooth ceramic or specialized medical plastic (polyethylene) liner.

4. Fitting the New Stem and Ball. A modern implant (the stem) is securely placed into the hollow centre of the thigh bone. This can be fixed in place with bone cement, or it can be a "cementless" implant that relies on your natural bone growing into it over time. A new ceramic or metal ball is then fitted to the top of this stem.

5. Joining the New Hip The new ball and socket are precisely aligned and put together, restoring your joint's natural, smooth movement.

6. Closing the Incision The surgeon closes the incision using stitches, and covers it with a sterile dressing.

7. Post-Operative Recovery You will be taken from the operating theatre to the recovery ward as your anaesthetic wears off. The nursing team will monitor you closely and provide appropriate pain relief medication to ensure you are comfortable.