Hip replacement surgery is a common procedure that can improve mobility and decrease pain in a hip joint that’s no longer functioning properly. The American College of Rheumatology reports that about 544,000 hip replacement surgeries are performed in the United States each year, and that number continues to climb as the population ages.
If you’re planning to get a total hip replacement, read on to learn more about what to expect from this big undertaking.
What Is a Hip Replacement?
The hip is one of the largest joints in the body and is shaped as a ball and socket joint. The ball sits at the top of the femur (thigh bone), which rests in a socket in the pelvis (the hip) to allow the legs to move about in several planes of motion.
Over time, however, the cushion between the ball and the socket can wear away, leading to bone grinding against bone, which can become quite painful. This is when you might end up needing a hip replacement — a procedure in which the old bone is cut away and replaced with prosthetic components that may be made from metal, ceramic and/or very hard plastic.
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Signs You Need a Hip Replacement
When nonsurgical, conservative treatments — such as physical therapy, medications and weight loss — don’t improve hip pain, it may be time for a more invasive approach.
Signs you need a hip replacement often include:
— Groin, side or buttock pain.
— Decreased range of motion in the hip.
— An inability to walk significant distances.
— Pain that interferes with daily activities or sleep.
An X-ray may also confirm the loss of cartilage. This loss can happen when someone has arthritis, a condition in which the cushioning cartilage inside the joint wears away over time, leading to pain and stiffness. In advanced cases, X-rays show bone-on-bone with no cartilage left.
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Types of Hip Replacements
There are a few ways your surgeon can go about fixing a bad hip.
“The simplest hip replacement is a partial hip replacement,” says Dr. Matthew Miller, an orthopedic surgeon specializing in hip and knee replacements at El Camino Health in California.
In that procedure, the surgeon replaces the ball portion of the joint that sits at the top of the femur. The partial replacement does not replace the socket.
This approach is mostly to treat fractures, particularly in elderly patients who tend to put less strain on the joint than younger patients who may be more physically active.
A total hip replacement, however, replaces both the ball and the socket sides of the joint. Miller says there are three main ways your surgeon can approach this procedure:
— Anterior approach or direct anterior approach. The surgeon cuts into the joint from the front to avoid slicing into certain muscles and tendons. It’s considered a less invasive approach, and some surgeons favor it because it can lead to lower risk of dislocation and faster recovery. However, it can be a more technically demanding surgery because the doctor can’t see as much of the hip during surgery. Your surgeon must be highly skilled to perform it.
— Posterior approach. The surgeon cuts into the side and back of the thigh. This more modern approach also has a minimized risk of dislocation and allows for rapid recovery.
— Lateral approach. The surgeon cuts into the joint from the side. This more traditional approach leads to a slightly longer early recovery because of the specific muscles targeted during surgery.
Your specific anatomy, the nature of the hip problem and your surgeon’s preferences and experience will all inform the decision of which approach is best for you.
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Hip Replacement Surgeons: How to Find One
When you’re looking for a physician to conduct hip replacement surgery, keep in mind that some orthopedic doctors are generalists and some specialize in joint replacement. Surgical outcomes are also usually better in a high-volume setting.
“If you go to someone who’s doing it routinely, they have a system in place at the hospital, in the operating room,” says Dr. Brian G. Evans, chief of the adult reconstructive surgery service at MedStar Georgetown University Hospital in Washington, D.C. “It’s not like you’re doing a new operation every time.”
If you’re looking for a hip replacement surgeon, be sure to ask about the surgeon’s complication rates. Complication rates for physicians who routinely perform hip replacements should be well below 4%, Evans says. Infection rates should be below 1%.
How Long Does Hip Replacement Surgery Take?
Typically, hip replacement surgery takes about two hours, but times can vary by surgeon, says Dr. Nader A. Nassif, chief of joint replacement surgery at Hoag Orthopedic Institute in Southern California.
Will I Have to Stay in the Hospital?
Increasingly, patients who undergo hip replacement surgery can go home the same day.
Just a few years ago, many doctors would have their patients stay in the hospital for several days following hip replacement surgery, but advances in surgical techniques and technology have changed that.
“Our ability to perform the surgery in a less invasive manner affords us the opportunity to send patients home safely and comfortably soon after their procedure,” says Dr. Michael B. Gerhardt, a sports medicine specialist and orthopedic surgeon at Cedars-Sinai Kerlan-Jobe Institute in Los Angeles. “Smaller incisions, less blood loss and expedited physical therapy allows patients to get up and comfortably walk within hours after surgery.”
In some cases, you may need to stay overnight, but it’s uncommon for folks to need to stay more than one night.
Hip Replacement Recovery: What to Expect
Recovery from hip replacement surgery varies, depending on your age and overall health, but it can take as little as six weeks. Younger and healthier patients may recover in a shorter time.
Compared with other types of operations, hip replacements provide patients with a greater change in their perception of their improved health than other surgeries, such as a bowel resection or an organ transplant, Evans says.
For example, patients who were functionally disabled with arthritis can resume a wide range of physical activities — like playing tennis or walking vigorously — after a hip replacement. It won’t take long for some patients to forget they’d once been hobbled by a bad hip.
“When you have a good hip replacement, it just feels like a natural part of you,” Evans points out.
For some, the only visible reminder is a scar, about 3 to 4 inches long where the incision was made, Nassif adds.
How Long Does a Replacement Hip Last?
The durability of hip replacements has increased in the past several years, Miller says.
“We used to quote people that a hip replacement would last 10 to 15 years,” he explains. “But then we found that replacements were becoming more and more durable starting around the year 2000. New polyethylene plastic liners in the joint started performing better.”
These days, a new hip can potentially last 40 years or more.
“I counsel patients that the decision to have a hip replacement should be more about how severe your symptoms are and how much pain and dysfunction you’re living with rather than how long it’s going to last,” Miller notes.
How Much Does Hip Replacement Surgery Cost?
Drug pricing transparency company GoodRx reports that the average cost of a hip replacement can be up to $74,000, depending on a range of factors, including where the surgery is performed.
“Most people would not be able to have the surgery performed if they didn’t have appropriate insurance,” Miller says.
The good news is that virtually all health insurance plans will cover this procedure when it’s deemed medically necessary.
However, each insurance policy has its own mix of benefits, copays and deductibles. It’s best to check with your insurer before you schedule a surgery to ensure that the hospital, surgeon, anesthesiologist and everyone else you’ll encounter during surgery is in network. Otherwise, you could get hit with an unexpected bill after the procedure.
“For the average patient, the copay or their responsibility is a manageable cost compared to the cash price of the surgery,” Miller says.
The Bottom Line
Hip replacement surgery can make a big difference in your ability to live comfortably and engage in the activities you enjoy most.
However, it’s “a major orthopedic surgery, and you should exhaust the conservative measures before you move forward with surgical intervention like hip replacement,” Miller notes.
Recovery from a major surgery can also be difficult, but many patients say they’re surprised by how quickly they were able to move around after hip replacement surgery.
“The truth is, most people have less pain immediately after surgery than they did the day before the surgery,” Miller says.
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Your Guide to Hip Replacement Surgery originally appeared on usnews.com
Update 04/22/24: This article was previously published and has been updated with new information.
