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Total Hip Arthroplasty Procedure Recovery and More

Medically reviewed by Daniel Wiznia, MD — By Jennifer M. Edwards on September 27, 2022Different conditions can affect your hips over time, from arthritis to a sudden fall. Doctors usually recommend medication, physical therapy, or lifestyle adaptations as first-line therapies. However, total hip arthroplasty may be warranted if:the function of the joint and the cartilage lining have deterioratedyou’re experiencing significant pain and having trouble getting restful sleepyou’re unable to accomplish everyday tasks, like climbing stairsyou’re unable to particulate in activities you used to enjoy, like hiking or biking Total hip arthroplasty is surgery that involves replacing one or both hip joints. It’s widely considered to be one of the safest and most effective surgeries. If you’re considering the procedure, read on to learn more about whether it’s right for you and what to expect if you make the decision to have a total hip arthroplasty. Share on Pinterest
Total hip arthroplasty. Illustration by Jason Hoffman

What is total hip arthroplasty

Your hip is where the top of your thighbone — called the femur — meets the pelvis and forms a ball-and-socket joint. The hip joint has two parts:Femoral head: the ball-shaped top of your femurAcetabulum: the socket in your pelvis where the top of your femur slots in The hip joint is surrounded by cartilage and ligaments that cushion, limit, and control the movement of the joint. Over the course of a lifetime, different conditions and excessive wear and tear can affect this joint, causing increasing pain and difficulty walking. The result can be a joint that’s so damaged you may need total hip arthroplasty. Some conditions that could cause hip damage requiring surgery include:osteonecrosis, which happens when blood supply is cut off or greatly reduced to the joint, causing damageosteoarthritisrheumatoid arthritispost-traumatic arthritis, which happens after a traumatic hip injury or fracturechildhood hip diseasehip dysplasia

Total hip arthroplasty stats

Total hip arthroplasty is fairly common. The number of people seeking it is growing each year. Older statistics showed about 450,000 people a year were getting the surgery in the United States. A 2019 analysis projected that the number would grow to 652,000 by 2025. About 40% of people getting the surgery are ages 60 and under.

Primary approaches to a total hip arthroplasty

Total hip arthroplasty involves a surgeon removing one or both hip joints and replacing them with prostheses (manufactured replacement parts). There are many ways your surgical team can perform a total hip arthroplasty. The three most common approaches are: posterior (back incision)direct lateral (side incision)direct anterior (front incision), also called “muscle sparing” because the surgeon doesn’t cut through muscles with this approach

Types of joint replacement

If you undergo total hip arthroplasty, a surgeon will replace the socket of your hip with a sturdy cup made of plastic and metal. They will replace the top, or ball, of your femur — called the femoral head — with a ball made of metal or ceramic. The ball is then fitted onto a metal stem that’s placed into your femur, or thighbone. Some stems are porous, allowing your bone to grow into it and secure it. Others are cemented in. The new femoral head is then pressed into the prosthetic socket. Your doctor will make recommendations for your prostheses based on:your ageactivity levelthe quality of your bone

What are the benefits of a total hip arthroplasty

The benefits of the procedure include:increased quality of lifeincreased joint functionincreased mobilityreduced painlower risk of fallsless risk of becoming homeboundbetter mental healthlonger life spanreduced long-term healthcare expenses

Who should have a total hip arthroplasty

In general, the surgery is recommended for people with hip conditions that are getting worse, not improving with other methods, or causing excessive pain or difficulty walking or moving. The most common reason for total hip arthroplasty is end-stage degenerative hip osteoarthritis (OA). It affects about 88 out of 100,000 people per year in the United States. Other top reasons doctors recommend total hip arthroplasty include:Congenital hip disorders: hip conditions present at birth, such as hip dysplasia, when the femur doesn’t fit into the hip socket properlyInflammatory arthritis: a type of arthritis that causes joint pain, swelling, warmth, and tenderness in the jointsHip osteonecrosis (ON): happens when the blood supply to the femur is cut off or severely disrupted, causing the joint to degrade or collapse. ON is less common than OA. It typically shows up in younger people, generally between ages 35 and 50. About 10% of total hip arthroplasty surgeries are due to ON.

Nonsurgical treatment options

When your discomfort or trouble moving increases, your doctor will likely diagnose the underlying issue and make other suggestions before recommending surgery. Those suggestions might include:medicationphysical therapylifestyle changesweight lossassistive devices, like canes or walkers When nonsurgical treatments no longer provide enough relief, your doctor may recommend total hip arthroplasty.

What s a total hip arthroplasty procedure like

Your surgical team will usually perform the procedure in a hospital or medical facility. It takes about 1.5 hours. You will be under general anesthesia. Some people may be able to have outpatient surgery, in which they get the surgery and are able to come home the same day. However, most people undergoing total hip arthroplasty require a hospital stay of a night or two after surgery.

What s the recovery like for a total hip arthroplasty

Recovery is usually fairly speedy. Most people are up and using a walker or cane to get around after about a day. Full healing can take up to 6 weeks or more depending on your physical condition before the surgery. Here are some things you can do to prepare for your recovery:get into an exercise routine lose weight if neededprepare your recovery environment

Helpful items for after surgery

assistive devices, such as a walker or canenon-slip socksslide-on shoes or shoes with Velcrotoilet seat support railsgrab bars in the showera grabber tool that can help you reach items

What are the potential risks of a total hip arthroplasty

Although total hip arthroplasty is considered one of the safest and most successful orthopedic surgeries you can get, there is some risk of complications.

Venous thromboembolism events VTE

VTE is a rare but potentially serious side effect in which blood clots develop and stop the flow of blood to a portion of your body. A clot can also sometimes break off and travel to your lungs, which could potentially be fatal. However, the risk of VTE is small: Its likelihood is less than 1% for first surgeries and up to 2.5% for joint revision surgeries, according to 2018 research.

Dislocations

The majority of total hip arthroplasty dislocations occur in the first month. They happen in about 1% to 3% of surgeries. These happen when the socket comes apart after surgery and requires surgical correction. Risk factors are:a revision total hip replacementbeing older than 70components not being placed properlyneuromuscular conditions, such as Parkinson’s diseasedrug and alcohol misuse

Fracture

Total hip arthroplasty can sometimes lead to small fractures in the bone around the new components. It’s rare, affecting less than 1% of people who undergo the surgery.

Other possible side effects

Other side effects can include:prosthetic joint infectionwound complications, such as infectionsciatic nerve palsyleg length discrepancy (LLD)iliopsoas impingementheterotopic ossificationvascular injury

When to call a doctor br

Call 911 or local emergency services if you experience chest pain or shortness of breath after your surgery. Call your doctor right away if you have:a bad smell or fluid draining at the incision sitea fever above 100.4°F (38°C)chillsincreasing pain or redness at the surgical siteworsening hip painswelling in your legs not related to the surgery

What s the best way to choose a surgeon

There are many ways to choose the right surgeon. Some suggestions from the American Association of Hip and Knee Surgeons include:asking family and friendsgetting a referral from your physicianchoosing a board certified surgeon, such as from the: American Board of Orthopaedic SurgeryAmerican Osteopathic Board of Orthopaedic Surgery

How much does a total hip arthroplasty cost and is it covered

How much you will end up paying for a total hip arthroplasty can vary widely depending on whether you have Medicare, Medicaid, private insurance, or no insurance. Where you have the procedure and who covers it will ultimately determine the price tag. It’s best to check with your insurance so you can plan for the expense. Some factors that go into the bottom line include:who performs your surgical serviceswhere you have your procedure (the facility, location, and region)contractual agreements by your insurance provider (some provide “bundled payments,” in which the entire procedure carries one price tag)implant and rehabilitation costs

Frequently asked questions about total hip arthroplasty

Is total hip arthroplasty the same as total hip replacement

Yes. A total hip arthroplasty is the same as a total hip replacement.

Can you have both hips replaced at the same time

Yes. You can have both hips replaced at the same time. This is called a double hip replacement. It’s worth noting that with a double hip replacement, there’s a higher risk of: heart attackstrokeblood clotsneed for a blood transfusiondeath

Are there other approaches to restoring hip mobility and reducing pain to consider before a total hip arthroplasty

Your healthcare team will likely recommend you try lifestyle changes, medication, physical therapy, or pain management before recommending surgery.

Who should not have a total hip arthroplasty

According to 2022 research, you should not have a total hip arthroplasty if you have:a hip infection or sepsisan active or ongoing infectiona severe case of vascular dysfunction A doctor may also not recommend surgery if you: have an unmanaged health condition, such as diabeteshave obesitysmoke cigarettes

Takeaway

Total hip arthroplasty is a procedure in which a damaged hip socket is removed and replaced with prostheses. It’s considered one of the safest and most effective orthopedic surgeries. It’s done to reduce pain and disability, and increase mobility and quality of life. A total hip arthroplasty takes a couple of hours. It can be performed on an outpatient basis or require a couple of nights’ stay in a hospital. Most people are up and walking within a day or two and recover fully in a few weeks. Last medically reviewed on September 27, 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.Chalmers BP, et al. (2017). Iliopsoas impingement after primary total hip arthroplasty: Operative and nonoperative treatment outcomes.
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hipknee.aahks.org/choosing-the-right-surgeon-for-you/De Fine M, et al. (2019). Sciatic nerve palsy following total hip replacement: Are patients personal characteristics more important than limb lengthening? A systematic review.
ncbi.nlm.nih.gov/pmc/articles/PMC5705876/Edwards PK, et al. (2017). Preoperative education for hip and knee replacement: Never stop learning.
Preoperative Education for Hip and Knee Replacement: Never Stop Learning - PMC (nih.gov)Galakatos GR. (2018). Direct anterior total hip arthroplasty.
ncbi.nlm.nih.gov/pmc/articles/PMC6312152/Gustke KA, et al. (2018). Anterior-based muscle-sparing total hip arthroplasty approach.
online.boneandjoint.org.uk/doi/abs/10.1302/1358-992X.2019.8.112Lecoanet P, et al. (2018). Leg length discrepancy after total hip arthroplasty: Can leg length be satisfactorily controlled via anterior approach without a traction table?
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ncbi.nlm.nih.gov/books/NBK560533/Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available. Current Version Sep 27, 2022 By Jennifer M. Edwards Edited By Willow Banks Medically Reviewed By Daniel Wiznia, MD Copy Edited By Sara Giusti Share this articleMedically reviewed by Daniel Wiznia, MD — By Jennifer M. Edwards on September 27, 2022

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