Hip Replacement Surgery: Overview

Table of Contents
View All
Table of Contents

Hip replacement surgery (hip arthroplasty) involves the removal of a damaged or diseased hip joint and replacing it with an artificial implant.

This surgery is most often done to decrease pain and improve mobility in patients with hip osteoarthritis symptoms that have not resolved with conservative treatment.

The most common type of this surgery is a total hip replacement, in which both acetabulum (hip socket) and the head of the femur (the "ball" of the hip joint) are replaced.

What Is Hip Replacement Surgery?

Hip replacement surgery is considered a highly successful one with reliable outcomes. The new hip functions similar to a normal hip and significantly improve one's quality of life.

With a total hip replacement, a portion of the pelvis and the head of the thighbone are completely removed. They are replaced with lookalike implants—a cup to serve as the socket, and a ball to serve as the femoral head. A metal rod is inserted into the femur to allow the new head to be secured.

When only the femoral head is replaced with a prosthesis, the surgery is called a partial hip replacement (hemiarthroplasty).

Hip replacement is done by an orthopedic surgeon. While traditionally an inpatient procedure done in a hospital, some patients may qualify to have the surgery on an outpatient basis.

What Is Same-Day Hip Replacement?

Same-day hip replacement allows a patient to have a hip prosthesis placed in an ambulatory setting without having to stay overnight. It is also called rapid-recovery hip replacement, as it allows for quicker healing.

Various Surgery Techniques

There are a few variations in terms of how a surgeon may perform a hip replacement:

  • Posterior approach: This is the most common one used. You are operated on why lying on your side; an incision is made on the outside of the hip, close to your butt. Muscles are cut to access the hip joint.
  • A lateral approach: This is essentially the same as the posterior approach, except that the incision is made on the outside of the hip, closer to the front of the body (instead of the buttocks).
  • Direct anterior approach: You are positioned on your back and the incision is made on the front of the thigh. This is sometimes called muscle-sparing hip replacement, as the surgeon works around (rather than cuts) muscles to access the hip joint.

Some may be more appropriate for you than others, and discussion about which approach your surgeon wants to use—and why—is worthwhile.

Implant Options

Hip implant options fall into two categories:

  • Single-piece implants, in which the socket and head are combined
  • Modular implants, in which each of these components is available (and can be chosen) separately

These pieces may be plastic, metal, ceramic, or a combination. A spacer is placed between the two components to allow them to move easily.

Some implants may be secured with acrylic cement or screws, others press-fit (essentially pushed into place so that new tissue that can hold it can grow).

There are pros and cons to all of these options, and varying levels of durability.

Contraindications

Certain medical circumstances can make this surgery outright contraindicated. An active infection and severe osteoporosis are two examples.

Despite what some think, age is not a definite contraindication for hip replacement.

However, since these implants do wear out over time, having the surgery at a young age means it is likely that you will need to have it redone at some point. Older age can sometimes be an exclusion factor for a hip replacement in cases where the risks of surgery are too great.

Your doctor will make a judgement about the safety and need of a hip replacement in your specific case after considering your medical history, imaging of your hip, lifestyle, commitment to recovery, and more.

Potential Risks

Potential Risks of Hip Replacement Surgery
Verywell / Jessica Olah

Hip replacement may pose certain risks, or increased levels of risks, depending on your health status.

Generally speaking, possible risks of hip replacement include:

There is also the possibility of hip implant loosening, persistent symptoms, or that revision surgery may be needed.

Fortunately, only 4% of adults who undergo hip replacement surgery experience complications.

Purpose of Hip Replacement Surgery

If you have tried other treatments to address your symptoms without success, and they are significantly impacting your day-to-day, your doctor may suggest hip replacement.

Such measures include pain medication, activity modifications, physical therapy, and the use of walking aids (such as a walker).

Hip replacement may be recommended in cases where the hip joint has been compromised due to:

The damaged/diseased parts of the hip joint are replaced to:

  • Reduce persistent hip pain
  • Improve joint mobility
  • Restore confidence and ease of movement for a better quality of life

About 85% of hip replacement patients have good results after 20 years. The American Academy of Orthopedic Surgeons calls the surgery "one of the most successful operations in all of medicine."

How to Prepare

Preparation for hip replacement begins weeks before your procedure and involves both getting your body ready for the surgery and recovery from it, as well as tending to practical matters.

Among some of the suggestions your doctor may give you:

  • Try to lose weight and quit smoking, if applicable, to reduce your risk of complications.
  • Stay active and perform any exercises suggested by your doctor to build strength.
  • Set up help for household chores, like grocery runs, meal making, and cleaning.
  • Make sure your house will be as safe and accessible as possible for you as you heal. For example, move commonly-used items to easy-to-reach areas, clear clutter, consider getting a raised toilet seat, and so on.
  • Secure recommended mobility aids, like a cane or crutches.

What to Expect on the Day of Surgery

A hip replacement typically takes about one to two hours.

Despite the different surgical approaches that can be used, the steps of a hip replacement are basically the same.

Regional or general anesthesia is used for this operation.

The surgeon makes their incision using the pre-determined surgical approach and then uses precise instruments to remove the bone and cartilage from the ball-and-socket hip joint. They create surfaces that can accommodate the implant(s) perfectly.

In a total hip replacement, the cup that will serve as the new hip socket is placed first. (This is skipped in a partial hip replacement.)

Next, the surgeon hollows the end of the femur to place a metal rod that the artificial femoral head is then attached to. The ball is finally placed in the cup.

After any incisions are closed and surgery is complete, you are moved to recovery. Measures will be taken to control pain, minimize swelling, and get you moving safely.

You will stay at the hospital for at least one night (unless you are undergoing an ambulatory procedure, in which case you will be discharged that day).

Some patients may be discharged to a nursing or rehabilitation facility if the surgeon believes they need extra time and help recovering.

Recovery

A hip replacement's success is largely owed to the rehabilitation period that follows the surgery. Most of your progress will be in the first couple of months post-op, but recovery will need to continue beyond that.

You will work with a physical therapist to restore normal gait, maintain motion of the hip replacement, improve strength in the lower extremities, and more.

Don't engage in activities until you are cleared to do so. Walking with a cane, walker, or crutches can help you feel more secure on your feet.

You will be given instructions on proper wound care and showering, which you should follow closely.

Calf and ankle swelling is not uncommon and should improve day-by-day.

Contact your doctor right away if you notice any possible signs of infection (e.g., fever or redness at the incision site) or blood clots (e.g., new or increasing swelling of the leg that doesn't improve with elevation).

Long-Term Care

You may feel like your new hip gives you a new lease on life.

As you enjoy days with less pain and more ease of movement, remember to take steps to protect the integrity of your replacement and reduce the risk of injury.

The National Institute of Arthritis and Musculoskeletal and Skin Diseases offers many suggestions to help you with this, including:

  • Avoiding high-impact activities, like jogging and basketball
  • Engaging in doctor-approved exercise that can keep your muscle strength and overall fitness up
  • Wearing supportive shoes with no-slip bottoms
  • Ridding your home of tripping hazards
  • Making sure all areas of your home are well-lit and have hand rails and grab bars, where appropriate

How Long Do Hip Replacements Last?

Estimates vary depending on the studies, but hip replacements can last anywhere between 15 to 25 years. After that time, it's possible that your doctor may recommend that your implant be replaced.

A Word From Verywell

Hip replacement is a major surgery, and deciding to have one is a big decision.

As you weigh the possible risks, also consider the possible consequences of delaying this surgery. Ask your doctor whatever questions you need to feel comfortable about your choice to proceed (or not).

If you are under age 60, hip resurfacing—in which less bone is removed—may be an alternative option worth asking about, as is easier to revise, if needed.

Was this page helpful?
Article Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Hospital for Special Surgery. Hip Replacement.

  2. Hospital for Special Surgery. Outpatient Hip Replacement Surgery: Frequently Asked Questions.

  3. Johns Hopkins Health. Total Hip Replacement: Anterior Approach.

  4. Bayliss LE, Culliford D, Monk AP, et al. The effect of patient age at intervention on risk of implant revision after total replacement of the hip or knee: a population-based cohort study. Lancet. 2017;389(10077):1424-1430. doi:10.1016/S0140-6736(17)30059-4

  5. Boniello AJ, Simon MS, Emenari CC, Courtney PM. Complications and mortality following total hip arthroplasty in the octogenarians: An analysis of a national database. J Arthroplasty. 2018;33(7S):S167-S171. doi:10.1016/j.arth.2017.08.030

  6. Foran, J. Total Hip Replacement. American Academy of Orthopaedic Surgeons. OrthoInfo. Reviewed June 2020.

  7. Agency for Healthcare Research and Quality. Chartbook on Patient Safety. National Healthcare Quality and Disparities Report. Updated October 2018.

  8. National Institute of Arthritis and Musculoskeletal and Skin Diseases. Hip Replacement Surgery. Reviewed April 2020.

  9. University of California San Francisco. Recovering from Hip Replacement Surgery.

  10. Zhang X, Shi G, Sun X, Zheng W, Lin X, Chen G. Factors influencing the outcomes of artificial hip replacements. Cells Tissues Organs (Print). 2018;206(4-5):254-262. doi:10.1159/000500518

  11. Evans JT, Evans JP, Walker RW, Blom AW, Whitehouse MR, Sayers A. How long does a hip replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-upLancet. 2019;393(10172):647-654. doi:10.1016/S0140-6736(18)31665-9