An Overview of Hip Replacement Surgery

Hip replacement surgery (hip arthroplasty) involves removing a damaged or diseased hip joint and replacing it with an artificial implant. This may be made from plastic, metal, and ceramic parts.

This surgery is most often done to decrease pain and improve mobility in individuals 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.

This article discusses what hip replacement surgery is, how to prepare, and what to expect.

What Is Hip Replacement Surgery?

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

Types of hip replacement surgery:

• 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 individuals may qualify to have the surgery on an outpatient basis.

Various Surgery Techniques

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

• Posterior approach: This is the most common one used. You are operated on while lying on your side; an incision is made on the outside of the hip, close to your buttocks. 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 techniques 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 contraindicated. An active infection and severe osteoporosis are two examples.

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 healthcare provider 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

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

Generally speaking, possible risks of hip replacement include:

• Infection of a joint replacement
• Blood clots
• Bleeding
• Nerve injury
• Hip dislocation
• Leg length difference
• Joint stiffness

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.

What Are the First Signs of Needing a 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 healthcare provider 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:

• Osteoarthritis of the hip, which is the most common indication
• Rheumatoid arthritis
• Injury/fracture
• Hip osteonecrosis, or when blood flow to bone is reduced and bone tissue dies as a result

How to Prepare

Preparation for hip replacement surgery begins weeks before your procedure.

Among some of the suggestions your healthcare provider 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 healthcare provider to build strength.
• Set up support 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 surgery typically takes about one to two hours.

Despite the different surgical approaches that can be used, the steps of a hip replacement surgery 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 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 may stay at the hospital for one night (unless you are undergoing an ambulatory procedure, in which case you will be discharged that day).

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

Hip Replacement Surgery Recovery Timeline

The recovery from hip replacement surgery typically lasts two to four weeks, but it may be longer for some individuals.

In terms of recovery:

• Many individuals may be able to begin walking the day of the surgery and may not need to spend the night in the hospital.
• Beginning right after surgery, 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.
• It can take weeks to a month before you are able to drive again.
• You may be able to return to work after about two weeks.
• You may be able to engage in low impact sports and sexual activity when you feel ready.

Recovery Tips

A hip replacement's success is largely owed to the rehabilitation period that follows the surgery.

Be sure to follow your healthcare provider's specific instructions, which may include:

• 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. Keep in mind, that even with proper care, you will likely have a scar from this surgery.
• Calf and ankle swelling is not uncommon and should improve day-by-day.

Contact your healthcare provider right away if you notice any possible signs of infection. This may include fever, redness at the incision site, as well as blood clots, which may look like new or increased swelling of the leg that doesn't improve with elevation.

Long-Term Care

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:

• Avoid high-impact activities, like football and running.
• Engage in healthcare provider-approved exercise that can keep your muscle strength and overall fitness up.
• Wear supportive shoes with no-slip bottoms.
• Rid your home of tripping hazards.
• Make sure all areas of your home are well-lit and have hand rails and grab bars, where appropriate.

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 healthcare provider 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 it is easier to revise, if needed.