Which Is Worse: Hip or Knee Replacement?

Knee replacement is generally considered the harder recovery, with more acute pain, a longer rehabilitation timeline, and higher rates of minor complications in the months after surgery. Hip replacement patients, on the other hand, tend to report feeling “normal” sooner and express slightly higher satisfaction at one year. But the picture is more nuanced than a simple ranking, because the two surgeries carry different risk profiles rather than one being universally worse. The answer depends a great deal on what you mean by “worse” and which part of the journey you’re asking about.

Pain in the First Days and Weeks

The clearest area where knee replacement comes out worse is early postoperative pain. Across multiple studies, patients undergoing total knee replacement consistently report higher pain levels than hip replacement patients in the first days after surgery. A study of over 7,300 patients in a fast-track surgical setting found that mean pain scores during movement were higher after knee replacement than hip replacement, and that knee patients consumed roughly 75 percent more opioid medication during their hospital stay.¹ That pattern held even though both groups were managed with the same enhanced-recovery protocols.

A separate study looking specifically at the first postoperative day found that about 58 percent of knee replacement patients reported moderate-to-severe pain at rest, compared with 47 percent of hip replacement patients.² The difference is partly anatomical. The knee joint sits right beneath the skin with relatively little soft-tissue cushioning, so the surgical trauma affects an area packed with nerve endings. The hip joint is buried deeper under layers of muscle and connective tissue, and patients aren’t constantly bending it against gravity to walk in the same way a knee must flex.

Research comparing pain predictors across both surgeries confirmed significantly higher acute postsurgical pain in knee replacement patients, with a moderate effect size.³ This doesn’t mean hip replacement is painless, but the intensity of early knee pain is one reason the surgery gets its reputation as the tougher procedure.

Rehabilitation and the Road to Feeling Normal

Recovery from knee replacement takes longer and demands more physiotherapy. When patients who had undergone both a hip and knee replacement were surveyed, about 71 percent said the knee required more rehabilitation effort.⁴ The reason is straightforward: a replaced knee needs to regain a functional range of motion that involves bending well past 90 degrees for everyday activities like climbing stairs, sitting in a chair, or getting in a car. That flexion has to be actively worked on, often with exercises that push into painful territory during the first few months.

A large study tracking over 2,600 patients found that 67 percent of knee replacement patients used postoperative physiotherapy for 12 weeks or more, compared with 56 percent of hip replacement patients.⁵ Hip replacement patients often find that walking and basic movement feel dramatically better within just a few weeks, which is part of why satisfaction scores trend higher for hip surgery. Many hip patients describe the joint feeling “normal” in a way knee patients less commonly do, even after full recovery.⁴

Stiffness is a particular concern after knee replacement. Some patients develop significant scar tissue that limits bending, a complication serious enough to sometimes warrant a second procedure. When arthroscopic surgery was used to treat stiff knees after replacement, the average range of motion improved from a very restricted arc to a more functional one, though it didn’t fully return to the range achieved on the operating table.⁶ Stiffness after hip replacement is far less common, partly because the hip’s ball-and-socket design naturally allows a wider range of motion with less soft-tissue resistance.

Complication Profiles Are Different, Not Simply Better or Worse

When you compare complication rates head-to-head, knee replacement patients report higher rates of both major and minor complications in the first six months. An Australian registry study found that 14.4 percent of knee replacement patients experienced a major complication, compared with 9.5 percent of hip replacement patients. Minor complications followed the same pattern: about 47 percent for knees versus 34 percent for hips.⁷ Knee patients were more likely to experience reoperation, readmission, infection, nerve injury, persistent stiffness, and unexpected pain or swelling.

But hip replacement carries its own set of risks that don’t really apply to knees. Dislocation, where the ball pops out of the socket, is the signature complication of hip replacement. A meta-analysis covering nearly five million hip replacements found a pooled dislocation rate of about 2 percent, though rates varied widely depending on surgical approach and patient factors.⁸ Patients with a BMI over 30 had roughly 38 percent higher risk, and the surgical approach mattered substantially: a posterior approach doubled the dislocation risk compared with an anterolateral approach. Dislocation can require emergency treatment and, in recurring cases, revision surgery. Hip replacement patients also face higher rates of periprosthetic fracture (a break around the implant) and leg-length discrepancy.⁷

Blood loss during surgery also tends to be higher with hip replacement. A prospective study found median estimated blood loss was about 984 mL for hip patients compared with 789 mL for knee patients, a statistically significant difference. Transfusion rates ran numerically higher for hip patients at 18 percent versus 11 percent, though that gap didn’t quite reach statistical significance.⁹

Blood Clot Risk Follows Different Timelines

Both surgeries raise the risk of blood clots, but the pattern differs in a way that matters for how long you need to stay vigilant. Knee replacement is associated with a high rate of small clots forming in the calf veins, most of which cause no symptoms and resolve on their own. Nearly all symptomatic clot events after knee surgery show up within the first three weeks. Hip replacement, by contrast, carries a higher rate of clots forming in the larger veins closer to the torso, which are more dangerous because they’re more likely to travel to the lungs. Those symptomatic events can appear as late as six to eight weeks after discharge.¹⁰ This is why blood-thinning medication is sometimes prescribed for a longer period after hip replacement.

Long-Term Outcomes and Satisfaction

Here’s the twist that challenges the “knee is worse” narrative: once you get past the difficult early months, the long-term functional outcomes of hip and knee replacement are remarkably similar. A study directly comparing patient-reported outcome scores found no significant differences between the two groups on measures of pain, stiffness, function, or quality of life once patients had recovered.¹¹ Both groups showed substantial improvement from their preoperative state.

That said, satisfaction rates still lean in favor of hip replacement. When patients who had received both a hip and a knee replacement were asked to compare, hip surgery was more likely to meet their expectations for functional improvement and quality of life, and the one-year Oxford score (a validated joint function questionnaire) was significantly better for the hip side.⁴ Pain relief expectations, interestingly, were met equally by both procedures. The satisfaction gap seems to be less about pain and more about how natural the joint feels afterward.

How Expectations Shape the Experience

One of the strongest predictors of whether you’ll be satisfied with either surgery isn’t which joint you had replaced; it’s whether the outcome matched what you expected. A systematic review found that in nearly all studies examined, fulfilled expectations were linked to satisfaction, regardless of whether the surgery was hip or knee.¹² Preoperative expectations themselves, however, were only linked to satisfaction about half the time, suggesting that what you expect matters less than whether you get what you expected.

The expectations pattern plays out differently between the two joints. For hip replacement, patients who placed the highest importance on their expectations tended to report less pain improvement at three months, possibly because their bar was set especially high. For knee replacement, higher expectations were actually associated with greater functional improvement at six months, perhaps because those patients engaged more aggressively with rehabilitation.¹³ The practical takeaway is that surgeons who counsel knee patients about the longer and harder recovery, and who set realistic benchmarks for the first three to six months, tend to produce more satisfied patients even though the surgery itself hasn’t changed.

How Long Do the Implants Last

Implant survival is one area where hip and knee replacements are on essentially equal footing. A large population-based cohort study found that hip implants had a 10-year survival rate of about 96 percent and a 20-year rate of 85 percent. Knee implants were nearly identical: 96 percent at 10 years and about 90 percent at 20 years.¹⁴ The biggest factor for implant longevity isn’t the joint but the patient’s age at surgery. People over 70 face roughly a 5 percent lifetime risk of needing a revision regardless of which joint was replaced. For men in their early 50s, however, that risk climbs to about 35 percent, mostly because younger patients simply live long enough to outlast the implant.

Encouragingly, real-world revision rates appear to be running lower than statistical models predict. An analysis of U.S. data from 1996 to 2020 found that actual revision hip replacements were about 41 percent lower than expected, and revision knee replacements about 33 percent lower than expected. The share of revisions due to loosening and implant wear has dropped significantly over the past decade, suggesting that modern materials and surgical techniques are improving durability beyond what earlier data forecasted.¹⁵

Costs and Hospital Stay

The financial burden of hip and knee replacement is broadly similar, though the details shift depending on the healthcare system you’re in and whether you have an inpatient or outpatient procedure. In one U.S. analysis, median hospital costs were about $17,600 for hip replacement and $16,300 for knee replacement. In the 90 days after discharge, however, knee patients accrued slightly higher costs, likely reflecting their greater rehabilitation needs.¹⁶

Enhanced-recovery protocols, which use standardized pain management and early mobilization to shorten hospital stays, have compressed costs for both procedures. One study found that these protocols reduced average length of stay by about 2.8 days for hip replacement and 3.9 days for knee replacement, with corresponding cost savings.¹⁷ That larger reduction for knee replacement reflects its traditionally longer inpatient stay. The shift toward outpatient joint replacement, increasingly common at high-volume centers, has reduced costs by several thousand dollars per case for both joints, with similar savings for each.¹⁸

Anesthesia Choices Affect Both Surgeries Similarly

Whether you receive regional anesthesia (a spinal or epidural block) or general anesthesia matters for both hip and knee replacement, and the data favors regional for both. A large analysis from the UK National Joint Registry found that regional anesthesia reduced hospital stay by about half a day for both hip and knee patients and lowered the risk of readmission, any complication, urinary tract infection, and surgical site infection.¹⁹ The benefits were comparable across both joints, so anesthesia type is one of those decisions where the hip-versus-knee distinction doesn’t change the calculus much.

Robotic Surgery and Implant Fixation

Robotic-assisted surgery is increasingly available for both hip and knee replacement, and it’s natural to wonder whether it makes a meaningful difference. The evidence so far is mixed. Robotic systems consistently improve the precision of component positioning and alignment, which matters for long-term implant function. For partial knee replacement specifically, there’s growing evidence that robotic assistance improves clinical outcomes and implant survivorship. But for total hip and total knee replacement, convincing evidence that robotic surgery improves the outcomes patients care about, like pain, function, and revision rates, hasn’t materialized yet.²⁰

The choice between cemented and cementless implant fixation is another area where the two joints diverge somewhat. In hip replacement for patients over 65, cemented fixation of the femoral stem is associated with lower rates of periprosthetic fracture, while cementless fixation tends to produce fewer blood clots but more aseptic revisions in the first two years.²¹ In partial knee replacement, at least one controlled comparison found no survival difference between cemented and cementless tibial components.²² These are conversations worth having with your surgeon, but they don’t change the fundamental hip-versus-knee comparison so much as they highlight that each procedure has its own set of technical decisions.

Who Gets These Surgeries and Why It Matters

Knee osteoarthritis is substantially more common than hip osteoarthritis, which means the pool of knee replacement patients is larger and more diverse. A meta-analysis of European data estimated that about 10 percent of adults have knee osteoarthritis, compared with about 6 percent for hip osteoarthritis.²³ The prevalence of knee osteoarthritis varies dramatically by region and diagnostic method, reaching nearly 20 percent in Eastern Europe by some estimates. This higher prevalence means that knee replacement is performed more often, on a wider range of disease severity, and in patients with more variable fitness levels, all of which can influence how “average” outcomes look in studies.

It also means that many people facing a knee replacement may have already had, or will eventually need, a hip replacement too. When both joints are affected, surgeons generally recommend addressing whichever joint is more disabling first. For people in that situation, the comparison between the two recoveries is something they’ll experience firsthand. Pilot research on hyaluronic acid injections in patients with both hip and knee osteoarthritis found that injections provided meaningful pain relief for both joints, suggesting that nonsurgical options can help buy time before either surgery becomes necessary.²⁴ Delaying surgery until function is genuinely impaired, rather than rushing in at the first sign of arthritis, remains sound advice for both joints.