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.
The people who best benefit from a hip replacement have these arthritis symptoms:
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.
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:
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.)
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.
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.)
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.
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 your orthopedic surgeon, medical team and rehabilitation therapist. For additional information, read:
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, you will begin rehabilitation with a physical therapist within 24 hours of your operation. 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.
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.
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.
Get more detailed information on different types of hip replacement surgeries and related topics, such as hip arthritis and postsurgical rehabilitation.