Hip Replacement

• What is hip replacement surgery?
• Do I really need a hip replacement?
• What are the different types of hip replacement surgery?
• How does hip replacement surgery work?
• What are the risks of hip replacement?
• How should I prepare for hip replacement surgery?
• What is hip replacement recovery like?
• How long do hip implants last?
• Frequently asked questions about hip replacement

What is hip replacement surgery?

Total hip replacement surgery involves the replacement of portions of the pelvis and femur (thighbone) that form your hip joint. Also known as hip arthroplasty, the vast majority of hip replacement surgeries are performed to relieve hip pain and stiffness caused by hip arthritis. The procedure is also sometimes used to treat injuries such as a broken or improperly growing hip, and for other conditions.

Do I really need a hip replacement?

The people who best benefit from a hip replacement have these arthritis symptoms:

• Severe pain that gets in the way of work, sleep and everyday activities, and which is not relieved by anti-inflammatory medications.
• Stiffness that restricts motion and, in conjunction with the pain, makes it difficult to walk.

Healthy hip vs. arthritic hip

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

In a healthy hip, 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 condition, known as osteoarthritis, causes pain and restricts motion. An arthritic hip can make it painful for you to walk or even to get in or out of a chair. If you have been diagnosed with hip arthritis, you may not need surgery. Anti-inflammatory medications and/or physical therapy may provide relief. But, if they do not, you should consult an orthopedic surgeon.

What are the different 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 your hip are replaced with artificial implants. The socket is replaced with a durable plastic cup, which may or may not also include a metal titanium shell. Your femoral head will be 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 your femur. (Learn more about types of hip implants.)

Two other types of hip replacement surgeries are each generally appropriate for patients of specific age groups and activity levels:

• Partial hip replacement (also called hemiarthroplasty) involves replacing only one side of the hip joint – the femoral head – instead of both sides as in total hip replacement. This procedure is most commonly done in older patients who have fractured their hip.
• Hip resurfacing of the femoral head and socket is most commonly done in younger, active patients.

Video: HSS surgeon-in-chief emeritus discusses types of hip replacement surgeries

In this video, Thomas P. Sculco, MD, explains different kinds of hip replacement surgeries. (This is part 3 of a series of six videos on arthritis and total hip replacement surgery. View the complete series.)

How does hip replacement surgery work?

The two most common surgical approaches are the posterior approach and anterior approach (sometimes called the "mini-anterior approach" or "muscle-sparing hip replacement"). 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 pain relief and improvement in walking and movement within weeks of surgery.

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

Video: Minimally invasive total hip replacement

HSS surgeons Michael M. Alexiades, MD, and Peter K. Sculco, MD, discuss minimally invasive hip replacement procedures in this 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.)

What are the risks of hip replacement?

The surgery is very safe, but every surgery has risks, and infection is the most serious. You should ask your surgeon what the surgical infection rate is for hip replacements at the hospital or facility where you will have your surgery.

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 Hospital for Special Surgery had a hip replacement surgery site infection (SSI) rate that was "significantly lower than the state average" for that year, and that those infection rates at HSS had been significantly lower than the state average in each of the seven years between 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.

How should I prepare for hip replacement 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 your orthopedic surgeon, medical team and rehabilitation therapist. For additional information, read:

• Preparing for Your Surgery – Information on preoperative hip replacement classes and patient education materials about joint replacement surgery.
• Your Total Hip Replacement at HSS: What to Expect – Overview of hip replacement at Hospital for Special Surgery, from preparing in the days and weeks before your operation, through to the important steps of rehabilitation toward full recovery.

What is hip replacement recovery like?

Total hip replacement (THR) surgery takes about one and a half hours. You will most likely stay in the hospital for one or two days after your procedure. If you have THR surgery at HSS:

• Your recovery will begin directly following surgery in the Post-Anesthesia Care Unit (PACU), where your medical team will manage your pain and monitor your vital signs.
• Once the anesthesiologist is satisfied with your condition, you will be moved to an inpatient recovery room to monitor your progress.
• You will most likely have a dressing and tube on your knee for drainage, which should be removed the day after surgery.
• The pain management team will assess your medication and use a multifacted approach to ensure comfort and mobility during the rehabilitation process.
• You will begin rehabilitation with a physical therapist within 24 hours. Your therapist will help you sit up, get in and out of bed, and practice walking and climbing stairs using a walker, cane or sometimes crutches.
• You will then continue physical therapy outside the hospital for 6 to 8 weeks. After that period, most patients are able to do everyday activities and return to playing sports.

How long do hip implants last?

Generally speaking, a hip replacement prosthesis should remain effective for between 10 and 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 a hip implant does need to be replaced because it has loosened or worn out over time, this requires what is called hip revision surgery.

Frequently asked questions about hip replacement surgery

1. Can I have both hips replaced at the same time?
   Yes, healthy patients younger than 75 years old who have no history of cardiopulmonary disease may be able to have both hips replaced at once. In some cases, however, it may be better to stage the surgeries.
    
2. What are hip implants made of?
   The implants for a total hip replacement are actually three separate prostheses: the stem, the ball and the socket.
   • The stem is made out of metal, usually titanium or cobalt-chrome. This is inserted into your natural thighbone.
   • The ball is usually made out of polished metal or ceramic, and fits on top of the stem.
   • The socket is usually a combination of a plastic liner and a cobalt-chrome or titanium backing.
   Learn more by reading Understanding Implants in Knee and Hip Replacement.
    
3. Will my new hip set off the metal detector at the airport?
   Today's sensitive screening machines will detect the implant but can also effectively identify it. It is best to tell airport security that you have had a hip replacement. The machine operator will know that it is an implant rather than an unauthorized metal object contained outside the body. You may ask your doctor's office if they can provide a card that identifies that you have received a hip implant that contains metal.
    
4. How soon after surgery can I resume driving?
   Most patients can resume driving by six weeks after surgery.
    
5. What should I look for in an orthopedic surgeon?
   When looking for a hip replacement surgeon, it’s important to do your research and check the surgeon’s credentials, experience and reputation. The hospital and supporting staff, such as the anesthesiologists, where you will be having surgery is also important. HSS has one of the lowest rates of infection for hip replacement surgery, as well as a significantly lower rate of readmission compared to the national average. HSS also performs more hip and knee replacements than any other US hospital and is ranked the No. 1 hospital for orthopedics in the United States by U.S. News and World Report. No other hospital in the world focuses solely on health problems of the bones, joints and soft tissues like muscles.
   
   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.)
   
   Below, explore detailed articles and other content on this topic, or select Treating Physicians to find the best hip replacement surgeon at HSS to suit your specific condition and insurance. If you would like help finding the right doctor for you, call the number listed on this page or complete our online request form.

Hip replacement surgery articles

Get more detailed information on different types of hip replacement surgeries and related topics, such as hip arthritis and postsurgical rehabilitation.