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Hip replacement surgery, or hip arthroplasty, 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.
Advancements in medical technology, technique and pain management have made it possible for most patients to have a total hip replacement as an outpatient procedure, called a rapid-recovery hip replacement, which means you may chose to have the surgery done at a hospital or at an ambulatory surgery center. If you’re planning to get a hip replacement, read on to learn more about what to expect and recovery post-surgery.
[SEE: 11 Pre-Surgery Tips to Boost Recovery]
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. Arthritis, an injury or bone disease can all can all be factors affecting your hip. Osteoarthritis is the most common reason people have hip replacements. Inflammatory arthritis, like rheumatoid arthritis, can also wreak havoc on the joints. So can osteonecrosis — death of the bone cells — from decreased blood flow. Developmental dysplasia (instability) of the hip in childhood may lead to surgery as an adult. And a broken hip from trauma could require a partial or complete replacement.
For a hip replacement, an orthopedic surgeon removes the diseased parts of the hip joint and replaces them with prosthetic parts that mimic the function of the normal hip joint. The prosthetic components may be made from metal (usually titanium), ceramic and/or very hard plastic.
The various hip joint replacement options include:
— Metal ball with a plastic socket lining
— Ceramic ball with a plastic socket lining
— Ceramic ball with a ceramic socket or lining
The goals of hip replacement surgery include:
— Relieve pain
— Improve the function of the hip
— Increase mobility
[SEE: Procedures Commonly Performed at Ambulatory Surgery Centers]
Signs You Need a Hip Replacement
When nonsurgical, conservative treatments — such as physical therapy, medications, assistive devices 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. In advanced cases, X-rays show bone-on-bone with no cartilage left.
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.
[See: Questions to Ask an Orthopedic Surgeon.]
Hip Replacement Surgery: Where to Go
Both hospitals and ambulatory surgery centers offer hip replacement surgery. When you’re looking for a physician to conduct hip replacement surgery, keep in mind that some orthopedic surgeons 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%.
Hip Replacement Surgery: What to Expect
Depending on your health and current medications, your past experiences with anesthesia, and the type of hip replacement you are having, you may have either regional anesthesia or general anesthesia, which puts your whole body to sleep.
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.
The two-part prostheses is either attached to the bone with epoxy cement, or with mesh that bone can grow into. The surgeon uses a power saw, drill, reamer and rasps (filing tools) to cut through the original femoral head, ream out cartilage from the original hip socket and reshape the socket before inserting the new metal piece.
Since a hip replacement requires anesthesia, patients spend an hour or more in recovery.
Risks
Infection, nerve damage, blood clots, anesthesia side effects, bone fracture and blood vessel injury are all possible complications of hip replacement surgery. But in general, these complications occur in only 1% of cases. Blood clots are the most common complication of hip replacement surgery, so physicians routinely prescribe blood thinners to patients.
What If Both Hips Are Bad?
If both hips are bad, is it worth getting them replaced at the same time?
Experts generally advises against a bilateral procedure because the medical risks of doing it are higher, with a much higher risk of blood clots. Other medical complications — cardiovascular, pulmonary — are also higher. Experts recommend you get one done, get stronger, then get the other side done.
Will I Have to Stay in the Hospital?
Increasingly, patients who undergo hip replacement surgery go home the same day.
To prevent complications like blood clots, postoperative care includes getting patients up and moving as soon as possible and giving anti-clotting medications. Infection is possible soon after the procedure or months later, and some post-replacement patients take preventive antibiotics before dental work or certain surgical procedures.
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 to need to stay more than one night.
[Read: Should I Try Acupuncture for Arthritis?]
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.
Immediate recovery may pose some challenges. Pain may be an issue; you’ll probably need pain medicine to get through the first couple nights. And you’ll likely need an assistive device like a walker for the first two weeks and a special toilet seat to keep from bending your hips past 90 degrees. Driving a car or even being a passenger may be temporarily off limits to avoid bumping.
Patients typically need physical therapy for at least two months following surgery.
Most patients feel pretty good by about six to eight weeks after surgery. Eventually hip replacements can come to feel so natural that people may forget they even have them.
Lower-impact exercises such as swimming, water aerobics and cycling are all great ways to stay in shape, to be active, to exercise, without putting the kind of impact loads on a joint that may lead to wear and tear over time — and ultimately to the need for a new joint replacement.
Preparing your house before surgery
The American Academy of Orthopaedic Surgeons recommends making changes to your home beforehand to ensure it’s safe after surgery. That includes buying a raised seat, a reacher, a walker and a handheld shower head. You should also ensure you rugs are tacked down to avoid falls and that items you need are on the upper cabinets — to avoid bending.
Skilled nursing facilities
In some cases, a person may be discharged to a rehabilitation center or a skilled nursing facility after hip replacement surgery. People who had complex surgeries or lack support at home may benefit from starting their recovery in places like this to focus on physical and occupational therapy to regain mobility and strength while receiving help for managing pain and medications.
[READ: What Qualifies a Patient for Skilled Nursing Care]
How Long Does a Replacement Hip Last?
The durability of hip replacements has increased in the past several years, Miller says. 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.
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 03/13/25: This article was previously published and has been updated with new information.
