Hip Replacement Surgery: What to Expect on the Day of Surgery

The hip joint is a ball-and-socket joint, with the "ball" being the top of the thighbone (called the femoral head), and the "socket" being part of the pelvic bone (called the acetabulum). The ball rotates within the socket to allow for hip movement.

Covering the ball and socket is a layer of smooth cartilage, which allows the hip joint to move freely. When the cartilage lining of the joint wears out or becomes damaged, hip movements become stiff and painful. If severe enough, a hip replacement may be recommended.

When a hip replacement is performed, the damaged bone and cartilage of the joint are removed and replaced with prosthetic parts, made of some combination of metal, ceramic, or plastic. These prosthetic parts recreate a healthy ball-and-socket hip joint that is painless and allows for normal hip function.

Before the Surgery

On the day of your hip replacement surgery, you will first go to a pre-operative room where you will change into a hospital gown. A nurse will then check your vital signs and place an IV in your arm. This IV is used to give you fluids, an antibiotic, and anesthesia medications prior to or during the surgery.

Next, your surgeon and anesthesiologist will come to say hello and briefly review the surgery with you. You may need to sign additional consent forms at this time.

Finally, you will be taken into the operating room where you will be given medication to put you to sleep (if undergoing general anesthesia). While you are asleep, the anesthesiologist will connect you to monitoring devices and insert a breathing tube.

During the Surgery

Hip replacement surgeries are traditionally performed by the surgeon making a large incision over the hip joint. This approach is sometimes replaced by a minimally invasive approach, which requires one or two smaller incisions. Research suggests no major benefit to using one approach versus the other.

A traditional hip replacement surgery takes around one to two hours and generally proceeds in the following fashion:

• Your surgeon will make an incision either behind (posterior), to the side of (lateral), or in front of (anterior) your hip in order to expose the joint. The approach used is associated with varying types and rates of complications.
• The surgeon will then cut and remove the damaged "ball" of the joint (the femoral head).
• The damaged cartilage and bone of the socket are then scraped away, leaving a smooth, perfectly rounded surface. A metal "cup" is then inserted into the socket. Screws or bone cement may be used to keep it in place.
• A liner made of plastic, metal, or ceramic is then pressed into the "cup" to create a smooth surface, so the hip can move freely.
• Next, the surgeon focuses on the thighbone (femur). After hollowing out the end of the femur, a long metal stem will be placed into the hollow space. This stem can either be fixed into the femur with cement or be "press-fit" into the bone. "Press-fit" means that the implant is wedged tightly into the bone. Over time, bone grows into the implant.
• A metal or ceramic ball is then tightly fit on top of the metal stem. The ball is then placed into the "cup," or the new socket.
• Once the prosthetic parts are placed, the incision site is closed with stitches or surgical staples. A bandage is then placed over the surgical wound.
• Anesthesia medication will then be stopped, your breathing tube will be removed, and you will be taken to a recovery room.

After the Surgery

In the recovery room, you will wake up from anesthesia. A nurse will monitor your vital signs and manage common post-operative symptoms like pain and nausea.

Once you are alert, and your symptoms are under control, you will be taken to a hospital room to recover for approximately one to three days. If your hip replacement is performed in an outpatient surgical center, you will be discharged home to recover.

In your hospital room, you can expect the following:

• You will be given a blood thinner (an anticoagulant) to prevent blood clots.
• You will meet with a physical therapist, who will start you on an exercise regimen to continue at home.
• You will begin eating meals, as tolerated, while sitting up in bed.

As you recover at home, you will have various post-operative instructions to follow, such as:

• Taking your medications as prescribed, which will include pain medication and an anticoagulant.
• Keeping your wound site clean and dry.
• Following up with your surgeon as instructed for stitches or staple removal (usually around two weeks after the surgery).
• Engaging in home exercises and using a cane or walker, as advised, by your physical therapist.

A Word From Verywell

Most patients are very satisfied with the outcome of their hip replacement surgery, relishing in their ability to participate pain free in both routine and enjoyable activities of living again. That said, everyone's post-operative experience is a bit different, based on factors like age and their overall health status. To ensure you are not disappointed in your surgical outcome, it's important to discuss realistic expectations before the procedure with your surgical team.