Hip Replacement
Hip replacement surgery, also known as hip arthroplasty, provides pain relief and restores movement to people who have hip pain or stiffness caused by hip arthritis. The procedure is also sometimes used as a treatment for injuries such as a broken hip, a hip that is growing incorrectly and for other conditions.
Most hip replacements, however, are performed to remedy hip arthritis. This is when the cartilage between the bones of your hip joint wears down. Your bones then scrape together, causing more damage, as well as pain and stiffness. Arthritis of the 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.
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
To understand hip replacement, you need to understand the structure of the hip joint. 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 causes pain and can make it difficult to walk.
What Are the Different Types of Hip Replacement?
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.)
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)
Not all patients need a THR. If you are an active people under the age of 60, it may be appropriate for you to have what is called hip resurfacing or surface replacement. This is similar to a THR, except that it retains your natural femoral head rather than replacing that with an implant.
Video: Dr. Thomas P. Sculco on Hip Replacement
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.
Facebook Live 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 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.)
How Long Does a Hip Replacement Last?
Generally speaking, a hip replacement 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.
How Should I Prepare for a 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 the hip replacement surgeon, medical team and rehabilitation therapist.
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 time frame, most patients are able return to playing sports and doing everyday activities. Visit Preparing for Your Surgery to find information on pre-op hip replacement classes and to read additional patient education materials about joint replacement surgery.
What Are the Risks?
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.
Hip Replacement Surgery at HSS: Unmatched Expertise – Exceptional Success Rates
Hospitals that perform a surgery many times a year get the best results for their patients. HSS does more hip and knee replacements than any other hospital in the United States. HSS 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 find the best hip replacement surgeon at HSS 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.
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