There has been a significant increase in the number of total hip replacements performed throughout the world during the past 20 years. Hip replacements were originally designed for elderly people, generally over the age of 70, who had a sedentary lifestyle, and who were not expected to outlive the lifetime of the prosthesis. The ability of these artificial joints to maintain everyday activity and to relieve pain has been a revolution in the treatment of arthritic conditions, and we would expect a new hip joint in these elderly patients to be good for 15 to 20 years. As demand for total hip replacement increases, patients are going through surgical procedures at younger ages and often choose to maintain an athletic level of activity after the operation. Although the technology behind joint replacement surgery continues to improve, people are pushing the implants to the limit and causing them to fail earlier, leading to the necessity of setting guidelines according to the different types of sport activities practiced after the operation. While there are numerous published guidelines on what types of activity people should do after total hip replacement, none of them are based on proper randomised control trials. There is no doubt that patients who participate in sport after hip replacements are at higher risk of traumatic complications, including dislocation, fracture around the prosthesis and failure of the implant. Expert recommendations are available from the American Association of Hip and Knee Surgeons and the Hip Society, among others. These suggestions can be used in conjunction with a meticulous pre-operative evaluation to provide guidance for patient rehabilitation and activity post-operatively. Surgeons should also take into consideration the anatomic and biomechanical factors involved with surgical technique when providing patients with advice to make sure the stakes are well understood.