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Your Guide to Total Hip Replacement Surgery

Medically reviewed by Daniel Wiznia, MD — By Daniel Yetman on October 19, 2022A hip replacement is a procedure where a surgeon replaces damaged and worn-out surfaces in your hip with new artificial surfaces. Surgeons most often perform it to treat pain and loss of hip function caused by advanced osteoarthritis. Total hip replacement is the most extensive version of this surgery. In a total hip replacement, your surgeon will replace the head of your femur and the socket of your hip joint. Experts expect that the number of people in the United States with total hip replacements will nearly triple by 2040. If only part of your hip is damaged, a doctor or healthcare professional may recommend less extensive procedures such as partial replacement or resurfacing. Partial hip replacement involves replacing the head of your femur. Hip resurfacing involves covering the head of your femur with an artificial covering. Keep reading to learn everything you need to know about total hip replacements.

Who needs a total hip replacement

The most common reason people receive total hip replacements is to treat advanced osteoarthritis. Other conditions hip replacements treat include:hip osteonecrosiship dysplasiaother types of arthritis According to the American Academy of Orthopaedic Surgeons, people who benefit from hip replacement surgery include people with:hip pain that limits everyday activities such as walkinghip pain that persists while restinghip stiffness that limits leg mobilityinsufficient pain relief from physical therapy, walking aids, and anti-inflammatory drugs

Parts of a hip replacement

A total hip replacement replaces your entire hip joint. The replacement is made up of four parts:Cup or socket: A cup-shaped artificial piece replaces the socket of your hip (acetabulum).Cup lining: A liner reduces the friction between the ball and socket of your hip.Femoral head: A ball replaces the round head at the top of your femur.Femoral stem: A stem connects the ball to your thighbone. Share on Pinterest

What are the options for total hip replacement

Hip replacement implants are available in different materials. Factors such as your age, the cost, and your activity level determine which option is best for you. Opinions on the best material vary between surgeons. The following types are or were Food and Drug Administration (FDA)-approved in the United States.

Metal-on-polyethylene

The ball of the implant is made of metal, and the socket is made of or lined with a type of plastic called polyethylene. These implants were most common up to the middle of the 1990s. They’re still quite common and work for all types of people. But some research suggests that other types may be better suited to younger, more active people.

Ceramic-on-polyethylene

The ball of the implant is ceramic, and the socket is made of plastic or lined with polyethylene. It remains the most popular choice due to its high resistance to wear and lower risk of corrosion.

Ceramic-on-ceramic

The ball of the implant is ceramic, and the socket is lined with ceramic. A 2021 study found a lower wear rate in ceramic-on-ceramic implants at a 10-year follow-up than in ceramic-on-polyethylene. Although this type lasts longer than other types, there’s a risk of squeaking. One of the main concerns is persistent squeaking, which various studies report occur in 0% to 33% of people.

Ceramic-on-metal

The ball of the implant is ceramic, and the socket is lined with metal. In a 2015 study, researchers concluded that they wouldn’t recommend ceramic-on-metal due to higher-than-expected levels of metal ions in the blood. This type is uncommon in the United States.

Metal-on-metal

Metal-on-metal implants were common until 2016 in the United States. They stopped being FDA-approved in 2016 due to unsatisfactory results and the production of small metal particles. In the early to mid-2000s, they made up about one-third of hip implants in the United States.

What is the procedure for a total hip replacement

A total hip replacement usually takes about 1 to 2 hours. You’ll receive a general anesthetic through an intravenous (IV) line and will be asleep during your procedure. Surgeons use various surgical techniques to insert the implant. Each approach has its benefits and risks. Research hasn’t shown one approach to be better than the others.

Posterior approach

The posterior approach was traditionally the most common technique. During this procedure, the surgeon makes an incision on the back of your leg close to your buttocks and cuts through your gluteus maximus muscle. In a 2021 review of studies, researchers found very strong evidence that the posterior approach is associated with shorter operative time. But the anterior approach may decrease the length of your hospital stay and provide greater short-term restoration of function.

Direct anterior

During the direct anterior method, a surgeon makes an incision at the front of your hip. The surgeon pushes aside the muscle and tendons to access your joint.

Direct lateral

According to a 2015 study, about 60% of Canadian surgeons use the direct lateral technique. During this approach, the surgeon makes an incision on the side of your hip. They’ll detach the tendons of the gluteus medius muscle to access your joint capsule.

Before your total hip replacement surgery

The following steps can help you prepare for your procedure:Find a driver for after your procedure.Quit smoking if you do.Maintain a moderate weight.If you have diabetes, ensure that it’s under control.Tell the surgeon about any medications and supplements you’re taking.Follow the surgeon’s advice about when you need to stop eating and drinking.Add grab bars or railings to your bathroom and make other changes to your home to make getting around easier while you’re recovering.

What are the risks of total hip replacement surgery

Like with every surgical procedure, a total hip replacement comes with some risk. Serious complications such as infection occur in less than 2% of people. Other potential risks include:blood clotsuneven legship dislocationnerve and blood vessel injury

What is recovery like after total hip replacement

Following the surgeon’s recovery instructions can give you the best chance of a smooth recovery. Most people can resume light activity about 3 to 6 weeks after surgery. The surgeon may recommend:pain relievers such as opioids, nonsteroidal anti-inflammatory drugs, or acetaminophen (Tylenol)having your stitches removed after about 2 weekseating a balanced diet with an iron supplement to promote healingdrinking plenty of fluids Learn more about recovering from a hip replacement here.

What exercises can I do to help with rehab after total hip replacement

Regular exercise after your procedure is crucial for increasing strength and mobility. Your surgeon and physical therapist may recommend 20 to 30 minutes of exercise daily during the early recovery. They may recommend exercises such as:

Ankle pumps

Share on PinterestGif by Active Body. Creative Mind. While sitting on a chair or lying on a bed, move your ankle up (toes toward you) and down (toes pointing away from you) slowly. You can do this with one or both ankles.

Bed-supported knee bends

Share on PinterestGif by James Farrell While lying down on your back, slide your foot toward your buttocks while keeping your heel on your bed. Just make sure to hold the bent knee for 5 seconds before straightening.

Straight leg raises

Share on PinterestGif by Active Body. Creative Mind. While lying down on your back, use your thigh muscles to lift your leg off your bed with your knee fully straight. Just make sure to hold your leg in the air for a couple of seconds before lowering it.

Standing knee raises

Share on PinterestGif by Active Body. Creative Mind. Raise your leg until your thigh is parallel to the ground while holding a chair for balance. Just make sure to hold your raised knee for 2 to 3 counts before lowering. Do not lift your knee higher than your waist.

Standing hip extensions

Share on PinterestGif by Active Body. Creative Mind. Extend your leg back as far as you can while holding a chair for balance. Just make sure to hold your extended leg for 2 to 3 counts before lowering it again.

What precautions should I take after a total hip replacement

The American Academy of Orthopaedic Surgeons recommends asking a doctor if you should avoid the following while you’re still recovering:crossing your legs at the knee for 6 to 8 weeksbringing your knee higher than your hipleaning forward while sittingpicking something off the floor from a seated positionturning your feet inward or outward when bending downreaching down to pull up blankets in bedbending at the waist beyond 90 degrees

Talk with your dentist

It’s important to tell a dentist about your hip replacement before undergoing any dental procedures. Some dental procedures can cause bacteria to travel through your blood and settle in your artificial joint, which may increase your risk of infection. The dentist may recommend taking antibiotics before your procedure to lower this risk.

Are there alternatives to total hip replacement

Hemiarthroplasty, or a partial hip replacement, is a simpler surgery with a shorter surgery time. In a 2018 study, researchers found partial replacement was associated with a significantly lower need for readjustment surgery. Resurfacing is an even less invasive procedure. It involves replacing only the surface of your femur. But resurfacing comes with its own risks. Most resurfacing procedures involve metal-on-metal surfaces. Surgeons rarely pursue this option because of the risk of metal corrosion and debris.

Frequently asked questions

Here are some frequently asked questions people have about total hip replacements:

What is the success rate for total hip replacement surgery

Many studies have found that more than 90% of people experience pain relief for at least 10 years.

Can I have both hips replaced at the same time

You can have hip replacement surgery on both hips at the same time or one at a time. Both hips at the same time is called a bilateral procedure. If you have both hips replaced at the same time, the surgery will take about twice as long. There’s also a higher risk of heart attack, stroke, and blood clots.

How long do hip replacements last

In a 2019 review, researchers found that about 58% of hip replacements last 25 years. In a 2021 study, researchers found a lifetime risk of revision surgery of 27.6% in people ages 46 to 50 years, which decreased to 1.1% in people older than 90 years.

Takeaway

A total hip replacement is a procedure where a surgeon replaces the ball and socket of your hip with implants. It’s a common treatment for late stage osteoarthritis and other conditions that cause hip pain. A doctor can help you figure out if you’re a good candidate for a hip replacement. Some people can benefit from less invasive procedures such as a partial hip replacement or resurfacing. There are several different approaches to total hip replacement surgery. They each have their benefits and risks, and no one is better than the other. What’s most important is to find a surgeon you’re confident in. Last medically reviewed on October 19, 2022

How we vetted this article

SourcesHistoryHealthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. We avoid using tertiary references. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.Campbell P, et al. (2020). Local and systemic consequences of metal-on-metal hip resurfacing implants.
aoj.amegroups.com/article/view/5437/htmlElsiwy Y, et al. (2019). Risk factors associated with cardiac complication after total joint arthroplasty of the hip and knee: A systematic review.
josr-online.biomedcentral.com/articles/10.1186/s13018-018-1058-9Evan JT, et al. (2019). 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-up.
ncbi.nlm.nih.gov/pmc/articles/PMC6376618/Fogotti L, et al. (2021). Posterior versus anterior approach to total hip arthroplasty: A systematic review and meta-analysis of randomized controlled trials.
ncbi.nlm.nih.gov/pmc/articles/PMC8601379/Foran JRH, et al. (2020). Total hip replacement.
orthoinfo.aaos.org/en/treatment/total-hip-replacement/General information about hip implants. (2019).
fda.gov/medical-devices/metal-metal-hip-implants/general-information-about-hip-implantsHernigou P, et al. (2016). What every surgeon should know about ceramic-on-ceramic bearings in young patients.
ncbi.nlm.nih.gov/pmc/articles/PMC5367589/Hill JC, et al. (2015). Early surveillance of ceramic-on-metal total hip arthroplasty.
pubmed.ncbi.nlm.nih.gov/25737511/Hu D, et al. (2015). Comparison of ceramic-on-ceramic to metal-on-polyethylene bearing surfaces in total hip arthroplasty: A meta-analysis of randomized controlled trials.
ncbi.nlm.nih.gov/pmc/articles/PMC4324779/Kenney C, et al. (2019). A systematic review of the causes of failure of revision total hip arthroplasty.
ncbi.nlm.nih.gov/pmc/articles/PMC6512562/Merola M, et al. (2019). Material for hip prostheses: A review of ear and loading considerations.
ncbi.nlm.nih.gov/pmc/articles/PMC6384837/Metal-on-metal hip implants. (2019).
fda.gov/medical-devices/implants-and-prosthetics/metal-metal-hip-implantsNugent M, et al. (2021). The lifetime risk of revision following total hip arthroplasty.
pubmed.ncbi.nlm.nih.gov/33641431/Okafor L, et al. (2019). Patient satisfaction and total hip arthroplasty: A review.
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ncbi.nlm.nih.gov/pmc/articles/PMC5785289/Sheth NP, et al. (2022). Activities after total hip replacement.
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ncbi.nlm.nih.gov/pmc/articles/PMC5407395/Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available. Current Version Oct 19, 2022 By Daniel Yetman Edited By A. L. Heywood Medically Reviewed By Daniel Wiznia, MD Copy Edited By Kristin Hitchcock Share this articleMedically reviewed by Daniel Wiznia, MD — By Daniel Yetman on October 19, 2022

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