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:
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.
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.
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.
HSS Surgeon-in-Chief Emeritus Thomas P. Sculco, MD, discusses the different types of hip replacement surgeries. This begins with part 3 of a six-part video series on arthritis and total hip replacement surgery. Watch the complete series here.
HSS surgeons Michael M. Alexiades, MD, and Peter K. Sculco, MD, discuss minimally invasive hip replacement procedures in this February 2018 Facebook Live event. (Note: To enable sound, first, click the play button and then click the volume button that will appear on the bottom right of the screen.)
Generally speaking, a hip replacement should remain effective for between 10 or 20 years, and some can last even longer. Results vary according to the type of implant and the age of the patient. In a 2008 study of more than 50,000 patients who had THR surgery at age 55 or older, between 71% and 94% still had well-working implants after 15 years. (Source: Makela, Keijo T. MD; Eskelinen, Antti, et al. "Total Hip Arthroplasty for Primary Osteoarthritis in Patients Fifty-five Years of Age or Older: An Analysis of the Finnish Arthroplasty Registry." Journal of Bone & Joint Surgery - American Volume - Vol 90 October 01, 2008.)
When an implant does fail due to loosening or wear, a person will require hip revision surgery.
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.
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. (Source: HSS Arthroplasty Registry, 2007-2012.)
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. Hospital for Special Surgery performs better than the national average in preventing blood clots after 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.