The four stages of a first consultation

Most people arrive at a first hip replacement consultation unsure what the appointment actually involves. In practice, it follows four clear stages — and knowing them in advance makes the whole experience far less daunting.

The surgeon begins with a symptom history: where the pain is, when it started, what makes it worse, and how it affects daily activities such as walking, driving, and dressing. Your medications, previous treatments, and broader health are covered here too.

Next comes a physical examination. The surgeon gently moves the hip through its range of motion to identify areas of stiffness, pain provocation, and functional restriction — checking whether the clinical picture matches what you've described.

X-rays are typically taken at the same visit. They show the extent of joint space loss, bone structure, and cartilage wear, giving the surgeon an objective measure of how the joint looks alongside how it feels.

Finally, there is a structured discussion of what the imaging and examination show, covering all options — conservative and surgical — so you can weigh them clearly.

No decision is required on the day. The consultation's purpose is understanding, not commitment.

What your surgeon asks about first

Before the physical examination begins, your surgeon will spend time taking a careful history — and the questions are more purposeful than they may initially seem.

Pain location is the starting point. Groin pain on movement points strongly toward the hip joint itself, whereas pain radiating toward the buttock or down the thigh may suggest a different distribution. The surgeon will ask when symptoms began, whether onset was gradual or tied to a specific event, what aggravates them (walking distance, stairs, putting on shoes), and what — if anything — provides relief.

Functional limitations are mapped in some detail: how far you can walk before stopping, whether stairs are manageable, and how you manage daily tasks such as dressing or getting in and out of a car. How symptoms have changed over time — stable, slowly worsening, or declining more quickly — helps the surgeon judge the pace and severity of the underlying condition.

Questions about medications, body weight, and smoking are clinically relevant to recovery planning and to identifying conditions — cardiovascular disease or diabetes, for example — that may affect surgical risk. Previous treatments, whether physiotherapy, injections, or anti-inflammatory medication, help establish where you currently sit on the pathway from conservative management toward surgery.

Your personal goals are part of the assessment from the outset. Returning to walking a reasonable distance, managing stairs without difficulty, or getting back to an active hobby — whatever improvement means to you — is recorded here. Those expectations feed directly into the shared decision-making discussion once imaging has been reviewed.

The physical examination and what X-rays show

Lying on the examination couch, you may find the surgeon's assessment more revealing than you expected. The hip is tested through a series of controlled movements — internal and external rotation, flexion, and extension — to identify precisely which directions are restricted and which provoke pain. Rotation, particularly internal rotation in flexion, is often the earliest movement lost in hip osteoarthritis, so its absence carries real diagnostic weight. The surgeon will also observe your gait as you walk, check for any leg-length difference, and assess the strength of the muscles around the hip, particularly the abductors, which govern stability with each step.

The point of the hands-on examination is to build a functional picture: not merely whether the hip is stiff, but which movements matter for the things you want to do.

X-rays taken at the same appointment add the structural layer. On a plain film, joint space — the visible gap between the ball and socket — corresponds to the thickness of surviving cartilage. When that space narrows, it indicates cartilage has worn away; when it is absent and bone is contacting bone directly, symptoms such as grinding, catching, and deep ache become structurally explained rather than just reported. The X-ray also reveals changes to the bone itself: cysts, sclerosis, and osteophytes that together confirm osteoarthritis and help gauge its severity.

Routine MRI or CT is not usually needed at a first consultation. These may be requested afterwards if the plain film is ambiguous or if bone quality is relevant to implant planning — but for most patients, the X-ray and clinical examination together provide enough clarity to move the conversation forward.

How the decision on surgery is reached

Once the clinical examination and X-rays have been reviewed together, the consultation moves into its most consequential phase: working out what to do next.

The threshold for recommending surgery is not a single scan finding. A severely narrowed joint space on X-ray carries real weight, but it is assessed alongside how much functional limitation is actually present — whether walking distance has shortened materially, whether tasks such as putting on shoes or getting in and out of a car have become difficult, and whether the trajectory is worsening. Imaging changes alone, or pain alone, rarely decide the question. It is the combination of symptom severity, functional loss, and structural evidence that tips the balance.

Before any surgical discussion, conservative options are walked through — not as a formality, but because for some patients they remain the right next step. Physiotherapy to strengthen the muscles around the hip, weight management, anti-inflammatory medication, and in some cases guided injections can all reduce symptoms. If those measures have already been tried and have not provided adequate function, that history itself becomes part of the evidence that surgery is the most effective remaining option.

The conversation ends with clarity rather than commitment. A well-structured consultation produces a written summary: the diagnosis, the options discussed, and the agreed next step — whether that is further investigation, a trial of conservative management, or the beginning of surgical planning.

For patients consulting Professor Paul Lee privately — at Grantham, Sleaford, or by secure video — this structure is a deliberate part of every 30-minute appointment. His view, informed by NHS and private practice spanning more than two decades, is that patients should leave with a written plan and a clear understanding of their options rather than feeling pressed toward a decision that is ultimately theirs to make.

The pre-operative assessment: what comes next if surgery is agreed

Agreeing to proceed with surgery does not mean walking into an operating theatre the following week. Between the decision and the operation sits a distinct preparation phase that most patients do not fully anticipate — and understanding it helps enormously with planning.

A pre-operative assessment clinic, typically scheduled two to four weeks before the surgical date, is a separate appointment with a different purpose: confirming that you are medically fit for anaesthesia and the procedure itself. It includes blood tests, a urine sample to exclude infection, an ECG to check cardiac function, and sometimes MRSA screening. These checks exist to reduce avoidable complications, not to create obstacles.

The period between consultation and pre-op assessment is also when lifestyle optimisation matters most. NHS guidance is clear on this: strengthening the muscles around the hip, losing weight if appropriate, and stopping smoking all reduce complication risk and support a faster recovery. This preparation — sometimes called prehabilitation — is particularly relevant for patients planning to follow a rapid recovery pathway, where early mobilisation after surgery depends heavily on baseline fitness and muscle strength.

Think of prehabilitation as work you actively do for yourself, not something the clinical team manages on your behalf. The stronger and healthier you arrive for surgery, the better placed you are to benefit from it.

What a specialist private consultation looks like in practice

Professor Paul Lee's private consultation runs for 30 minutes and can be booked without a GP referral — in person at Grantham or Sleaford, or by secure video. The format is structured: hip history and activity goals first, then a focused clinical examination alongside review of any existing X-rays or MRI. As sections 2 and 4 have covered, a written plan and genuine options review are built into every appointment regardless of outcome — the logistics here simply confirm that this holds whether or not surgery ultimately proves appropriate.

What the preceding sections have not addressed is what patients can expect if the consultation does conclude that surgery is the right direction. Professor Lee uses the SPAIRE approach — Saves Piriformis And Internus with Repair of Externus — a posterolateral technique that keeps the short external rotator tendons intact rather than dividing them. Preserving these posterior soft tissues is associated with reduced dislocation risk in the early post-operative period and avoids the precautionary movement restrictions that standard posterior repair typically requires for up to 90 days.

This surgical approach underpins his biological rapid recovery programme, which integrates technique, implant selection, and early mobilisation planning as a single pathway rather than separate considerations. For selected patients whose anatomy and baseline fitness suit the programme, it is designed to support discharge on the day of surgery or the following morning — a materially different expectation from the 3–5 day inpatient stay associated with traditional posterior hip replacement. Understanding this at consultation stage means recovery planning can begin well before a surgical date is set.