Hip Replacement

What Is a Hip Replacement?

In a hip replacement surgery, bone and cartilage that form the hip joint are replaced with artificial implants. Doctors call this a hip arthroplasty. People who have hip pain or stiffness may find it hard to exercise, walk, or bend over. A hip replacement can relieve joint paint to help them do all of these things and improve their quality of life.

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 kind of hip replacement surgery is called a total hip replacement. 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 ceramic or plastic liner. The ball and a section of the upper femur are removed. A new ball, made from a metal alloy, is attached to a metal stem that is inserted into the top of the femur. (Learn more about types of hip implants.)

To begin the operation, the hip replacement surgeon will make incisions (cuts) on the back or side of the hip, or on the front of the thigh. Accessing the hip joint from the back of the hip is called the posterior approach. This is the most common method used in the United States. Accessing the hip joint from the front of the thigh is called the anterior approach. Anterior hip replacement surgery does not require the surgeon to cut the thigh muscle. For this reason, it can reduce pain and offer even shorter recovery times. However, it requires special tools and training, and is not suitable for all patients.


Total Hip Replacement, Posterior Approach

animation hip replacement anterior approach
Hip Replacement, Anterior Approach

 

Not all hip replacement patients need a total hip replacement. Active people under age 60 may be able to have what is called hip resurfacing or surface replacement. This is similar to a total hip replacement, except that it retains more of the patient’s natural bone.

Who Should Get a Hip Replacement?

Most hip replacements are performed to help people who have hip arthritis. Arthritis is when the cartilage between the bones of a joint wear down. The bones then scrape together and cause more damage, as well as pain and stiffness. This can make it painful for a person to walk, or even to get in or out of a chair. Not all arthritis patients need hip surgery. For some, anti-inflammatory medications can offer relief. When medication doesn’t help, a person should meet with an orthopedic surgeon.

Hip replacements are also used to fix injuries, such as breaks, and for hips that grow incorrectly. Most patients are over age 55, but the number of younger people who get hip replacement surgery to keep up an active lifestyle is increasing. As a result, hip implants are being designed to last longer. An athlete with a hip impingement may get a hip replacement to continue playing a sport. Regardless of age, 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, or by using canes or walkers
  • Stiffness in the hip that slows them down

How Long Does Hip Replacement Surgery Take?

A hip replacement surgery takes about two hours. The patient usually stays in the hospital for two or three days. The average time for full recovery is two to three months. Learn more about what to expect in the days before, during and after a hip replacement surgery.

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 six to eight weeks. After that, most patients return to playing sports and doing everyday activities. Learn more about recovery from our hip replacement guide for patients.

How Long Does a Hip Replacement Last?

The success rate for hip replacements 10 years after surgery is 90-95%. After 20 years, it is 80-85%. If any piece of the artificial hip wears or loosens over time, it may need to be replaced. This is called hip revision surgery.

Hip Replacement Surgery at HSS: Unmatched Expertise – Superior 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 hip replacement 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

 

Lower Risks

Hip replacement is very safe, but every surgery has risks, and infection is the biggest. 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, 2014

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.)

Innovative Research and Surgical Techniques

Hospital for Special Surgery performed its first hip replacement surgery in 1967 and has been on the cutting edge of technology and surgical innovation ever since.

Since 1977, our biomechanics researchers have collected and studied 25,000 joint implants to make the world’s largest database of joint replacements. Working with our orthopedic 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.

In recent years, HSS surgeons pioneered a procedure called minimally invasive hip replacement that shortens surgical cuts from 8-12 inches down to only 3-4. This reduces blood loss and speeds up recovery. Special surgical tools and training for the surgeon are required. It is not appropriate for all patients, but it is highly successful.

HSS has also developed regional anesthesia techniques that reduce the change of surgical infection by 50% and do not require the patient to be placed unconscious by general anesthesia.

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