Hip Replacement Surgery: Procedure, Recovery & What to Expect

What Is Hip Replacement Surgery?

Hip replacement surgery, also called total hip arthroplasty (THA), is a surgical procedure where the damaged parts of the hip joint are removed and replaced with artificial components made of metal, plastic, and sometimes ceramic. The procedure replaces both the ball (femoral head) and socket (acetabulum) of the hip joint with prosthetic implants designed to restore pain-free movement.

The hip joint is one of the largest joints in the body and functions as a ball-and-socket joint. The ball is the femoral head, which is the upper end of the thighbone (femur), and the socket is a curved part of the pelvis called the acetabulum. In a healthy hip, both surfaces are covered with smooth cartilage that allows the joint to glide easily during movement. When this cartilage wears away due to arthritis, injury, or disease, the bones rub against each other, causing pain, stiffness, and reduced mobility.

Hip replacement surgery has been performed since the 1960s and has become one of the most successful and reliable operations in medicine. Advances in surgical techniques, implant materials, and rehabilitation protocols have made the procedure safer and more effective than ever. Today, the surgery is commonly performed on people of all ages, from young adults with hip damage from injury or disease to older adults with arthritis.

The decision to have hip replacement surgery is typically made when conservative treatments such as physical therapy, medications, lifestyle modifications, and walking aids no longer provide adequate relief. The primary goals of surgery are to eliminate pain, restore mobility, and improve quality of life. Most patients find they can return to activities they had given up due to hip pain, such as walking, gardening, golf, and swimming.

Types of Hip Replacement

There are several types of hip replacement procedures, each suited to different patient needs and conditions:

• Total hip replacement (THR): Both the ball and socket are replaced with prosthetic components. This is the most common type of hip replacement.
• Partial hip replacement (hemiarthroplasty): Only the femoral head is replaced, while the natural socket is preserved. This is often used for certain types of hip fractures.
• Hip resurfacing: The femoral head is capped with a metal covering rather than removed. This preserves more bone but is less commonly performed today.
• Revision hip replacement: A previous hip replacement is removed and replaced with a new prosthesis, typically performed when the original implant wears out or fails.

Why Is Hip Replacement Surgery Needed?

Hip replacement surgery is primarily performed to treat severe hip pain and disability caused by osteoarthritis, rheumatoid arthritis, hip fractures, avascular necrosis (bone death due to insufficient blood supply), or other conditions that damage the hip joint. Surgery is recommended when conservative treatments no longer provide adequate relief and the pain significantly impacts daily life.

The decision to undergo hip replacement surgery is a significant one that should be made collaboratively between you and your healthcare team. Surgery is typically considered when you experience persistent hip pain that interferes with daily activities such as walking, climbing stairs, or getting in and out of chairs. The pain may also disturb your sleep or persist even at rest. When physical therapy, anti-inflammatory medications, pain relievers, and other conservative treatments have been tried but no longer provide sufficient relief, hip replacement becomes a viable option.

Osteoarthritis

Osteoarthritis is the most common reason for hip replacement surgery. This degenerative condition occurs when the protective cartilage that cushions the ends of bones wears down over time. As the cartilage deteriorates, bones begin to rub against each other, causing pain, swelling, and stiffness. While osteoarthritis is often associated with aging, it can also result from previous injuries, genetic factors, or abnormal hip development. The condition typically progresses slowly, and many people manage symptoms for years before surgery becomes necessary.

Hip Fractures

Hip fractures, particularly those involving the femoral neck, are another common indication for hip replacement. These fractures often occur in older adults due to falls and can be devastating injuries that significantly impact independence. Depending on the type and severity of the fracture, as well as the patient's age and activity level, a partial or total hip replacement may be recommended. For certain fracture patterns, surgical repair with screws or plates may be attempted first, with hip replacement reserved for cases where healing fails.

Other Conditions

Several other conditions may lead to the need for hip replacement:

• Rheumatoid arthritis: An autoimmune disease that causes chronic inflammation, leading to cartilage damage and bone erosion in the hip joint.
• Avascular necrosis (osteonecrosis): A condition where the blood supply to the femoral head is disrupted, causing the bone to die and collapse. This can result from hip injuries, long-term corticosteroid use, excessive alcohol consumption, or certain blood disorders.
• Hip dysplasia: An abnormality in the development of the hip joint that can lead to premature wear and arthritis.
• Post-traumatic arthritis: Arthritis that develops after a serious hip injury, even if the injury was treated successfully.
• Bone tumors: Rarely, tumors affecting the hip may require joint replacement as part of treatment.

How Should You Prepare for Hip Replacement Surgery?

Preparing for hip replacement surgery involves medical evaluations, physical conditioning, home preparation, and lifestyle modifications. Stopping smoking, optimizing nutrition, exercising to strengthen muscles, and preparing your home for recovery are all essential steps that can significantly improve surgical outcomes and speed recovery.

Proper preparation before hip replacement surgery is crucial for achieving the best possible outcomes. The preparation process typically begins several weeks or even months before your scheduled surgery date. Your healthcare team will guide you through each step, but being proactive in your preparation can make a significant difference in your recovery.

Medical Evaluation

Before surgery, you will undergo a comprehensive medical evaluation to ensure you are healthy enough for the procedure and to identify any factors that could increase your risk of complications. This typically includes:

• Physical examination: Your orthopedic surgeon will examine your hip, assess your range of motion, muscle strength, and alignment.
• Blood tests: To check blood counts, kidney function, blood sugar levels, and other important markers.
• Urine tests: To rule out urinary tract infections, which could increase infection risk during surgery.
• Imaging studies: X-rays of your hip, and sometimes CT scans or MRIs, to help plan the surgery.
• Cardiac evaluation: An electrocardiogram (ECG) and possibly additional heart tests, especially if you have heart disease risk factors.
• Anesthesia consultation: A meeting with an anesthesiologist to discuss anesthesia options and any concerns.

Quit Smoking and Limit Alcohol

If you smoke, quitting before surgery is one of the most important things you can do to improve your outcome. Smoking significantly increases the risk of surgical complications including wound healing problems, infections, blood clots, and implant failure. Studies show that quitting smoking at least 4-6 weeks before surgery can substantially reduce these risks. Similarly, reducing or eliminating alcohol consumption is important, as excessive alcohol can interfere with anesthesia, increase bleeding risk, and impair healing.

Exercise and Physical Conditioning

Being in the best possible physical condition before surgery can dramatically improve your recovery. Your surgeon or physical therapist may recommend a "prehabilitation" program that includes:

• Strengthening exercises: Focusing on the muscles around your hip, thigh, and core to support the joint after surgery.
• Cardiovascular conditioning: To improve overall fitness and help your body handle the stress of surgery.
• Flexibility exercises: To maintain or improve range of motion.
• Balance training: To reduce fall risk and prepare for walking with crutches or a walker.

Research has shown that patients who participate in prehabilitation programs often have shorter hospital stays, less pain after surgery, and faster return to normal activities.

Nutrition and Weight

Good nutrition supports healing and helps your body fight infection. Eating a balanced diet rich in protein, vitamins, and minerals in the weeks before surgery is important. If you are significantly overweight, your surgeon may recommend weight loss before surgery, as excess weight puts additional stress on the new joint and can increase the risk of complications. Even modest weight loss can improve surgical outcomes.

Prepare Your Home

You will have limited mobility immediately after surgery, so preparing your home in advance is essential. Consider the following:

• Remove tripping hazards: Clear loose rugs, electrical cords, and clutter from walkways.
• Arrange frequently used items: Place items you use daily at waist height to avoid bending or reaching.
• Install safety aids: Add grab bars in the bathroom, a raised toilet seat, and shower chair or bench.
• Prepare meals in advance: Cook and freeze meals you can easily reheat during recovery.
• Create a recovery space: Set up a comfortable area with everything you need within reach, preferably on one floor to minimize stair climbing.
• Arrange for help: Have someone available to assist you during the first few weeks after surgery.

Medications

Tell your doctor about all medications you take, including prescription drugs, over-the-counter medicines, vitamins, and supplements. Some medications may need to be stopped before surgery:

• Blood thinners: Medications like warfarin, aspirin, or newer anticoagulants may need to be stopped or adjusted before surgery.
• Anti-inflammatory drugs: NSAIDs like ibuprofen may increase bleeding risk and are often stopped before surgery.
• Certain supplements: Some herbal supplements and vitamins can affect bleeding or interact with anesthesia.

Never stop taking prescribed medications without discussing it with your healthcare team first.

Day Before Surgery

The day before surgery, you will typically need to:

• Fast: Stop eating solid food 6-8 hours before surgery (usually from midnight). You may be allowed clear liquids until 2 hours before.
• Shower with antibacterial soap: Use a special antiseptic wash to reduce skin bacteria and lower infection risk. You will typically do this the night before and morning of surgery.
• Remove jewelry and nail polish: Leave all jewelry, body piercings, and cosmetics at home.

How Is Hip Replacement Surgery Performed?

During hip replacement surgery, the surgeon removes the damaged femoral head and cartilage, reshapes the hip socket, and inserts prosthetic components. The surgery typically takes 1-2 hours and is performed under spinal anesthesia (most common) or general anesthesia. Modern techniques often allow for same-day discharge or just one night in the hospital.

Hip replacement surgery is a carefully planned procedure that has been refined over decades. Understanding what happens during surgery can help ease anxiety and prepare you for the experience. The procedure typically takes between 1 to 2 hours, though this can vary depending on the complexity of your case.

Anesthesia Options

Before surgery begins, you will receive anesthesia to ensure you are comfortable and pain-free throughout the procedure. There are two main options:

• Spinal anesthesia (regional anesthesia): This is the most common choice for hip replacement. An injection in your lower back numbs your body from the waist down while you remain awake. You may also receive sedation to help you relax or sleep lightly during the procedure. Spinal anesthesia typically has fewer side effects and allows for faster recovery.
• General anesthesia: You are completely asleep during the surgery. This may be preferred if spinal anesthesia is not suitable or if you strongly prefer to be completely unconscious.

Many patients who receive spinal anesthesia choose to listen to music through headphones during surgery. Some find the sounds of the operating room uncomfortable, while others prefer to be lightly sedated and sleep through the procedure.

The Surgical Procedure

Once anesthesia has taken effect, the surgery proceeds through several key steps:

1. Incision and access: The surgeon makes an incision on the side or back of your hip, typically about 20-30 cm long for a standard approach, though minimally invasive techniques may use smaller incisions. The muscles and soft tissues are carefully moved aside to expose the hip joint.

2. Removal of the damaged femoral head: Using a special saw, the surgeon cuts through the femoral neck and removes the damaged femoral head (the ball portion of the joint). This ball-shaped bone is the part that has been causing pain due to arthritis or damage.

3. Preparation of the socket: The surgeon reshapes the hip socket (acetabulum) using specialized tools, removing any remaining damaged cartilage and bone. This creates a smooth surface for the new socket component.

4. Implanting the socket component: A metal cup is placed into the prepared socket. This cup may be fixed with bone cement or, more commonly, press-fitted into place with the expectation that your bone will grow into the porous surface of the implant over time. A plastic or ceramic liner is placed inside the metal cup to provide a smooth bearing surface.

5. Preparing the femur: The hollow center of your thighbone is prepared using specially shaped instruments to accept the femoral component (stem).

6. Inserting the femoral component: A metal stem is inserted into the prepared femoral canal. Like the socket component, this may be cemented in place or designed to have bone grow into it for fixation. A ball (made of metal or ceramic) is attached to the top of the stem.

7. Joining the new joint: The new ball is placed into the new socket, and the surgeon tests the joint for proper fit, stability, and range of motion. Adjustments are made if necessary.

8. Closing the incision: The muscles and tissues are repositioned around the new joint, and the incision is closed with stitches or staples. A sterile dressing is applied.

Cemented vs. Cementless Techniques

There are two main methods for fixing the prosthetic components to the bone:

• Cemented fixation: Special bone cement is used to secure the prosthetic components to the bone. This provides immediate strong fixation and is often used in older patients or those with weaker bone quality.
• Cementless (press-fit) fixation: The components have a textured surface that allows bone to grow into them over time. This is often preferred in younger, more active patients who may need a revision surgery in the future (as it's easier to revise an uncemented prosthesis).
• Hybrid fixation: A combination where one component (usually the stem) is cemented and the other (usually the cup) is uncemented.

Your surgeon will recommend the best approach based on your age, bone quality, activity level, and other individual factors.

Bone Donation

During hip replacement surgery, the removed femoral head contains healthy bone that can be donated to help other patients. This bone graft can be used in various orthopedic procedures to help repair bone defects or assist in securing prostheses. You may be asked before surgery if you wish to donate this bone. The decision is entirely voluntary and does not affect your surgery or recovery.

What Happens During Recovery After Hip Replacement?

Recovery after hip replacement begins immediately after surgery with early mobilization - most patients walk with assistance the same day or next day. Full recovery typically takes 3-6 months, with most patients able to resume normal activities within 6-12 weeks. Following your physical therapy program and adhering to movement precautions are essential for optimal outcomes.

The recovery journey after hip replacement surgery is a gradual process that requires patience, commitment, and active participation in your rehabilitation. Modern surgical techniques and rehabilitation protocols have significantly shortened recovery times compared to the past, and most patients experience substantial improvement in pain and function within the first few months.

Immediately After Surgery

After surgery, you will be taken to a recovery area where medical staff will monitor your vital signs as the anesthesia wears off. You will receive pain medication to keep you comfortable - it is important to stay ahead of pain rather than waiting until it becomes severe. Some key points about the immediate post-operative period:

• Pain management: You will receive a combination of medications to control pain. This may include local anesthetics, anti-inflammatory drugs, and opioid painkillers if needed. Many hospitals now use multimodal pain management that combines several types of medications to minimize opioid use.
• Blood clot prevention: You will receive blood-thinning medication to prevent deep vein thrombosis (blood clots in the legs). This typically continues for 4-6 weeks after surgery. Compression stockings and/or intermittent pneumatic compression devices may also be used.
• Antibiotics: You will receive antibiotics before and during surgery to prevent infection.

Hospital Stay

The length of hospital stay after hip replacement has decreased dramatically in recent years. Many patients now go home the same day (outpatient or "day surgery") or after just one night in the hospital. Some patients, particularly those who are older, have other health conditions, or lack support at home, may stay 2-3 days or be transferred to a rehabilitation facility.

During your hospital stay, the focus is on:

• Early mobilization: A physical therapist will help you get out of bed and take your first steps, usually within hours of surgery or the next morning. This early movement is crucial for preventing blood clots and beginning the recovery process.
• Learning to use walking aids: You will practice walking with a walker, crutches, or canes, and learn how to navigate stairs, get in and out of bed, and perform basic activities safely.
• Pain assessment: The healthcare team will regularly evaluate your pain level using a pain scale and adjust medications as needed. The goal is to keep pain controlled enough that you can participate in physical therapy.

The First Few Weeks at Home

The first weeks after returning home are a critical period of healing. During this time:

• Wound care: Keep the incision clean and dry. Your surgical team will provide specific instructions about dressing changes and when you can shower.
• Walking: Walk regularly throughout the day, gradually increasing distance. Use your walking aids as instructed - most patients use crutches or a walker for 2-6 weeks.
• Exercise: Perform the exercises prescribed by your physical therapist multiple times daily. These exercises help restore strength and mobility.
• Follow precautions: Adhere to movement restrictions to prevent dislocation (discussed below).
• Manage swelling: Elevate your leg when resting and use ice packs as directed to reduce swelling.

Movement Precautions

After hip replacement, especially in the first 3 months, certain movements can put the new joint at risk of dislocation. While surgical techniques have evolved to reduce this risk, most surgeons still recommend precautions:

• Avoid crossing your legs: When sitting or lying down, keep your legs apart.
• Don't bend your hip beyond 90 degrees: Avoid sitting in low chairs or bending to pick things up from the floor without using the recommended techniques.
• Don't twist your hip: Avoid pivoting on your operated leg or twisting at the hip.
• Use proper technique: Your physical therapist will teach you safe ways to get in and out of bed, chairs, cars, and how to dress and bathe.

These precautions are typically most important in the first 6-12 weeks while the soft tissues heal around your new joint. Your surgeon will advise when restrictions can be relaxed.

Physical Therapy and Rehabilitation

Physical therapy is essential for achieving the best outcome after hip replacement. You will work with a physical therapist who will guide you through a progressive exercise program designed to:

• Restore range of motion: Gentle stretching and movement exercises help you regain flexibility.
• Build strength: Progressive strengthening exercises focus on the muscles around your hip, thigh, and core.
• Improve walking: Gait training helps you walk normally without a limp.
• Enhance balance: Balance exercises reduce fall risk and improve confidence.

You may receive physical therapy at home, in an outpatient clinic, or both. Follow-up appointments with your physical therapist will continue for several weeks to months, with exercises becoming more challenging as you progress.

Recovery Timeline

While everyone recovers at their own pace, here is a general timeline of what to expect:

Returning to Activities

One of the goals of hip replacement is to return to the activities you enjoy. After recovery:

• Walking: Most patients can walk without aids within 3 months.
• Driving: Typically possible after 4-6 weeks, once you can perform an emergency stop safely. If your right hip was replaced, you may need to wait longer.
• Sexual activity: Usually safe to resume 4-6 weeks after surgery, using positions that don't stress the hip.
• Sports: Low-impact activities like swimming, cycling, and golf are usually possible within 3-6 months. High-impact activities like running or contact sports are generally discouraged as they may accelerate wear of the prosthesis.
• Work: Return to work timing depends on your job. Desk work may be possible within 4-6 weeks, while physically demanding jobs may require 3 months or more.

Follow-up Care

You will have scheduled follow-up appointments with your surgeon, typically at 3-4 months after surgery, and then periodically (usually annually or every few years) for the long term. These visits allow your surgeon to monitor the health of your hip replacement, check for any problems, and take X-rays to assess the prosthesis. It is important to attend all follow-up appointments even if you feel fine.

What Are the Risks and Complications of Hip Replacement?

While hip replacement is a safe and successful surgery, potential risks include infection (1-2%), blood clots (2-3%), hip dislocation (2-3%), leg length difference, nerve injury, and prosthesis loosening over time. Serious complications are rare, and following post-operative guidelines significantly reduces risk. Most patients experience excellent outcomes with minimal complications.

Like any surgery, hip replacement carries some risks. However, it is important to understand that for most patients, the benefits far outweigh the risks, and serious complications are uncommon. Your surgical team takes many precautions to minimize risks, and you can further reduce your risk by following pre- and post-operative instructions carefully.

Early Complications

These complications may occur during or shortly after surgery:

Infection: Infection occurs in about 1-2% of hip replacements. Symptoms include increasing pain, redness, warmth, swelling, or drainage from the incision, along with fever. Superficial wound infections can often be treated with antibiotics, but deep infections around the prosthesis are more serious and may require additional surgery. Prevention measures include antibiotics before surgery, sterile surgical technique, and careful wound care.

Blood clots: Deep vein thrombosis (blood clots in the leg veins) occurs in 2-3% of patients despite preventive measures. Symptoms include leg swelling, pain, and warmth. More serious is pulmonary embolism, when a clot travels to the lungs, causing breathing difficulties. Blood-thinning medications, compression stockings, and early mobilization help prevent clots.

Dislocation: The new hip can dislocate if the ball comes out of the socket. This occurs in about 2-3% of patients and is most common in the first few months before tissues heal. Following movement precautions dramatically reduces this risk. If dislocation occurs, the hip can often be put back in place without surgery, though recurrent dislocations may require additional surgery.

Leg length difference: After surgery, the operated leg may be slightly longer or shorter than the other leg. Surgeons take careful measurements during surgery to minimize this, but small differences are common. Most differences are minor and do not cause problems; significant differences may require a shoe lift.

Nerve or blood vessel injury: Rarely, nerves near the hip can be stretched or damaged during surgery, causing numbness, weakness, or pain. Most nerve injuries improve over time. Significant blood vessel injury is very rare.

Later Complications

Some complications may develop months or years after surgery:

Prosthesis loosening: Over time, the prosthetic components may loosen from the bone, causing pain and reduced function. This is more common in younger, more active patients and may eventually require revision surgery. Modern implant designs and surgical techniques have significantly extended the lifespan of hip replacements.

Prosthesis wear: The bearing surfaces of the hip prosthesis gradually wear down with use. This wear can produce tiny particles that may cause inflammation and bone loss around the implant (osteolysis). New materials have greatly reduced wear rates.

Late infection: Infections can occur even years after surgery, often spreading from infections elsewhere in the body (dental, urinary, skin). This is why good dental hygiene is important, and you should inform your dentist that you have a hip replacement. Some procedures may require preventive antibiotics.

Bone fracture: The bones around the prosthesis can fracture, especially in patients with weakened bones (osteoporosis). Preventing falls is important for long-term prosthesis health.

Prosthesis Lifespan

Modern hip replacements are designed to last a long time. Studies show that:

• Over 95% of hip replacements are still functioning well after 10 years
• About 80-85% last 20 years or longer
• Some prostheses last 25-30 years or more

Younger, more active patients are more likely to need a revision surgery during their lifetime. Maintaining a healthy weight and avoiding high-impact activities can help extend the life of your hip replacement.

What Results Can You Expect After Hip Replacement?

Hip replacement surgery has excellent outcomes, with over 95% of patients experiencing significant pain relief and improved mobility. Most patients can return to daily activities within 6-12 weeks and enjoy an active lifestyle with their new hip. The surgery is consistently rated as one of the most successful in medicine, dramatically improving quality of life for people with severe hip arthritis.

The vast majority of people who undergo hip replacement surgery are very satisfied with the results. The surgery typically provides dramatic improvement in pain and function that can be life-changing for people who have suffered from debilitating hip arthritis or injury. Understanding what outcomes to expect can help you set realistic goals for your recovery.

Pain Relief

The primary goal of hip replacement is to eliminate pain, and the surgery is highly effective at achieving this. Most patients experience substantial pain relief within weeks of surgery. The chronic, deep aching pain of arthritis is typically gone almost immediately after surgery, replaced only by temporary surgical discomfort that gradually fades. Many patients describe the difference as remarkable, allowing them to sleep comfortably for the first time in years and resume activities they had abandoned due to pain.

Improved Mobility

Hip replacement restores mobility by providing a smooth, pain-free joint surface. After recovery, most patients find they can:

• Walk without a limp or walking aids
• Climb stairs normally
• Get in and out of chairs, cars, and bed without difficulty
• Bend to put on shoes and socks
• Return to hobbies and activities like gardening, golf, swimming, and dancing

Return to Activities

A successful hip replacement can allow you to return to most activities you enjoy. Low-impact activities such as walking, swimming, cycling, golf, tennis (doubles), and dancing are generally well-tolerated. Many people find they can be more active after surgery than they were for years before, when pain limited their activities. However, high-impact activities like running, jumping, and contact sports are generally discouraged as they may accelerate wear of the prosthesis.

Long-term Satisfaction

Research consistently shows that patient satisfaction after hip replacement is very high, typically ranging from 90-95%. Hip replacement is considered one of the most successful operations in medicine when measured by improvement in quality of life. Most patients say they wish they had done it sooner and would recommend the surgery to others.

When Is Hip Replacement Surgery Not Recommended?

Hip replacement may be postponed or not recommended if you have an active infection anywhere in your body, open wounds or sores on your legs, recent heart attack (within 6 months), uncontrolled diabetes, or severe medical conditions that make surgery too risky. These factors increase the risk of complications, so they need to be addressed before elective surgery can proceed.

While hip replacement is appropriate for most people with severe hip pain and disability, there are certain situations where surgery may need to be delayed or reconsidered:

• Active infection: Any infection in your body - whether in the skin, urinary tract, teeth, or elsewhere - significantly increases the risk of infection spreading to the new joint. Surgery is typically postponed until the infection is fully treated.
• Skin wounds or ulcers: Open sores on your legs, particularly near the hip, can harbor bacteria and increase infection risk.
• Recent heart attack: Surgery is usually delayed for at least 6 months after a heart attack to reduce cardiac complications.
• Severe obesity: Significantly increased body weight raises the risk of complications and may make surgery technically more difficult. Weight loss may be recommended before surgery.
• Uncontrolled medical conditions: Poorly managed diabetes, heart disease, lung disease, or other serious conditions may need to be optimized before elective surgery.
• Unrealistic expectations: If a patient expects the surgery to achieve outcomes beyond what is realistically possible, counseling about realistic goals is important.

The decision about whether to proceed with surgery is made on an individual basis, weighing the potential benefits against the risks for each patient.