Appropriate patient selection and consent for a total hip replacement or hip resurfacing is a serious undertaking and one that should not be taken lightly.From the patients’ first presentation, we cover the common pitfalls that can be encountered in the patients’ history and examination as well as specific indications and contraindications to hip resurfacing and hip replacement.Possible alternatives to arthroplasty are discussed ranging from simple analgesia to the more controversial treatments such as hyaluronic acid injections.The different options available for a total hip replacement are considered including the choice of a cemented or uncemented implant, the bearing surface and the reasons for making those choices.Unfortunately hip arthroplasty is not without risk and these potential complications are discussed. The incidence of a lower extremity thrombosis has been quoted as high as 70% but this can be mitigated with thromboembolic prophylaxis. The risk of infection varies from approximately 0.4 to 1.5%.The risk of dislocation between 0 and 2% and fracture less than 1%. Nerve injury can be as high as 3% but is commonly quoted nearer to 1%, and is higher in revision operations at up to 4 %.As well as possible complications, patients should also be made aware of the normal post-operative course from what to expect when they wake up to the type of tests they will have in their immediate post-operative recovery.With the pressures of clinic and operating lists it can be all to easy to rush through these important issues, however, time invested at this stage of the proceedings is well spent.