Hip Replacement

Hip replacement surgery, or hip arthroplasty, provides pain relief and restores movement to people who have hip pain or stiffness.

Most hip replacements are performed to remedy hip arthritis. This is where cartilage between the bones of the hip joint wears down. The bones then scrape together, causing more damage, as well as pain and stiffness. Arthritis of the hip can make it painful for a person to walk or even to get in or out of a chair. Not all patients need surgery. Anti-inflammatory medications can sometimes offer sufficient pain relief. When they do not, a person should meet with an orthopedic surgeon. This surgery can also be used to fix injuries such as bone breaks, hips that grow incorrectly, and other conditions.

Most people who get a hip replacement have these symptoms:

• Severe pain that gets in the way of their work and everyday activities
• Pain that is not relieved by taking anti-inflammatory medications

Anatomy of the Hip Joint

The hip joint is a ball-and-socket joint. The ball, at the top of the femur (thighbone) is called the femoral head. The socket, called the acetabulum, is a part of the pelvis. The ball rotates in the socket, allowing the leg to move forward, backward, and sideways.

Soft tissue called cartilage covers the ball and the socket to help them glide together smoothly. If this cartilage wears down or gets damaged, the bones scrape together and become rough. This causes pain and can make it difficult to move the leg.

Types of Hip Replacement Surgery

The most common type of hip replacement surgery is called a total hip replacement (THR). In this surgery, worn-out or damaged sections of the hip are replaced with artificial implants. The socket is replaced with a titanium metal shell and a plastic liner. The femoral head is removed and replaced with a ball made from ceramic or a metal alloy. The new ball is attached to a metal stem that is inserted into the top of the femur. (Learn more about types of hip implants.)

The two most common surgical approaches are called the posterior approach and anterior approach . To begin the operation, the hip replacement surgeon will make incisions on either the back (posterior) or front (anterior) of the hip. Both approaches offer rapid recovery, pain relief, and improvements in walking within weeks of surgery.

(The THR animations below launch in a pop-up viewer)

Not all patients need a THR. Active people under age 60 may be able to have what is called hip resurfacing or surface replacement. This is similar to a THR, except that it retains the patient's femoral head. Active males under the age of 60 may be candidates for a hip resurfacing.

Video: Dr. Sculco on Hip Replacement

HSS Surgeon-in-Chief Emeritus Thomas P. Sculco, MD discusses hip replacement surgery. This is Part 3 of a six-part video series from 2008 on arthritis and total hip replacement surgery. Watch the complete series here.

How Long Does a Hip Replacement Last?

Large population studies show that about 95% of patients have a well-functioning hip replacement 10 years after surgery. After 20 years, the success rate is still about 80% to 85%. Since 2000, new bearing surface materials and uncemented fixation has significantly reduced the need for hip revision surgery due to loosening or wear.

Hip Replacement Surgery at HSS: Unmatched Expertise – Exceptional Success Rates

HSS is ranked the No. 1 U.S. hospital for orthopedics by U.S. News and World Report. Why? No other hospital in the world focuses solely on health problems of the bones, joints, and soft tissues like muscles. Hospitals that perform a surgery many times a year get the best results for their patients. HSS does more hip and knee replacement surgeries than any other US hospital.

Source: Hospital Compare. *Data Collection Period is October 1, 2012 - September 30, 2013.
Excludes cases with major complications or comorbidities.

The success rate for hip replacement surgery at HSS is very high. In a study, HSS interviewed patients to learn about their progress. Two years after their surgeries, 99.4% of patients said they had relief from pain, 98.8% said their ability to move was improved, and 97.8% said their quality of life was better because of their surgery.

Lower Risks at HSS

The surgery is very safe, but every surgery has risks, and infection is the most serious. HSS is a leader in preventing infection. A New York State Department of Health report stated that out of more than 160 hospitals in New York that did hip replacements in 2014, only HSS had a hip replacement infection rate that was "significantly lower than the state average," adding that "Hospital for Special Surgery was significantly lower in each of the past seven years (2008-2014)." (Source: New York Department of Health, 2015)

Other risks include blood clots in the leg or pelvis, and accidental hip dislocation during or after recovery. HSS ranks in the top 0.1% of US hospitals in regard to problem-free joint replacement surgery. Only 3.4% of HSS patients need to return to the hospital because of a problem after surgery – lower than the national average of 4.8%. (Source: Medicare “Hospital Compare”, Risk-Adjusted, 2010-2013.) Of that 3.4%, many of the patients complex medical problems and return for non-orthopedic conditions.

Innovative Research and Surgical Techniques

Hospital for Special Surgery performed its first THR surgery in 1967 and been on the cutting edge of technology and surgical innovation ever since. Starting in 1977, our biomechanics researchers collected 25,000 joint implants to create the world’s largest database of joint replacements. Working with our surgeons, they have developed more than 2,400 customized implants for individual HSS patients, as well as standardized implants used by hospitals around the world.

HSS surgeons pioneered minimally invasive hip replacement that shortens surgical cuts to three to four inches, down from between 8 to 12 in traditional THR surgery. Special surgical tools and training for the surgeon are required. HSS has also developed regional anesthesia techniques that reduce the chance of surgical infection by 50% and do not require the patient to be placed under general anesthesia.

Preparing for Your THR Surgery

There are certain steps patients can take both before and after surgery to improve recovery time and results. It is important to follow the instructions and guidance provided by the hip replacement surgeon, medical team and rehabilitation therapist.

THR surgery takes about 1 1/2 hours. The patient usually stays in the hospital for one or two days. At HSS, patients start rehabilitation with a physical therapist within 24 hours of their operation. The therapist will help the patient sit up, get in and out of bed, as well as walk and climb stairs using a walker, cane, or sometimes crutches. Patients continue physical therapy outside the hospital for 6 to 8 weeks. After that, most patients return to playing sports and doing everyday activities.

More information for patients:

• Your Total Hip Replacement at HSS: What to Expect
• Your Diet and Preparing for Surgery
• Your Pathway to Recovery: A Patient's Guide to THR

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