Your Guide to Total Hip Replacement Surgery

The most common reason people receive total hip replacements is to treat advanced osteoarthritis. Other conditions hip replacements treat include:

• hip osteonecrosis
• hip dysplasia
• other types of arthritis

According to the American Academy of Orthopaedic Surgeons, people who benefit from hip replacement surgery include people with:

• hip pain that limits everyday activities such as walking
• hip pain that persists while resting
• hip stiffness that limits leg mobility
• insufficient pain relief from physical therapy, walking aids, and anti-inflammatory drugs

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Hip replacement implants are available in different materials. Factors such as your age, the cost, and your activity level determine which option is best for you. Opinions on the best material vary between surgeons.

The following types are or were Food and Drug Administration (FDA)-approved in the United States.

Metal-on-polyethylene

The ball of the implant is made of metal, and the socket is made of or lined with a type of plastic called polyethylene. These implants were most common up to the middle of the 1990s.

They’re still quite common and work for all types of people. But some research suggests that other types may be better suited to younger, more active people.

Ceramic-on-polyethylene

The ball of the implant is ceramic, and the socket is made of plastic or lined with polyethylene. It remains the most popular choice due to its high resistance to wear and lower risk of corrosion.

Ceramic-on-ceramic

The ball of the implant is ceramic, and the socket is lined with ceramic. A 2021 study found a lower wear rate in ceramic-on-ceramic implants at a 10-year follow-up than in ceramic-on-polyethylene. Although this type lasts longer than other types, there’s a risk of squeaking.

One of the main concerns is persistent squeaking, which various studies report occur in 0% to 33% of people.

Ceramic-on-metal

The ball of the implant is ceramic, and the socket is lined with metal. In a 2015 study, researchers concluded that they wouldn’t recommend ceramic-on-metal due to higher-than-expected levels of metal ions in the blood. This type is uncommon in the United States.

Metal-on-metal

Metal-on-metal implants were common until 2016 in the United States. They stopped being FDA-approved in 2016 due to unsatisfactory results and the production of small metal particles. In the early to mid-2000s, they made up about one-third of hip implants in the United States.

A total hip replacement usually takes about 1 to 2 hours. You’ll receive a general anesthetic through an intravenous (IV) line and will be asleep during your procedure.

Surgeons use various surgical techniques to insert the implant. Each approach has its benefits and risks. Research hasn’t shown one approach to be better than the others.

Posterior approach

The posterior approach was traditionally the most common technique. During this procedure, the surgeon makes an incision on the back of your leg close to your buttocks and cuts through your gluteus maximus muscle.

In a 2021 review of studies, researchers found very strong evidence that the posterior approach is associated with shorter operative time. But the anterior approach may decrease the length of your hospital stay and provide greater short-term restoration of function.

Direct anterior

During the direct anterior method, a surgeon makes an incision at the front of your hip. The surgeon pushes aside the muscle and tendons to access your joint.

Direct lateral

According to a 2015 study, about 60% of Canadian surgeons use the direct lateral technique. During this approach, the surgeon makes an incision on the side of your hip. They’ll detach the tendons of the gluteus medius muscle to access your joint capsule.

Like with every surgical procedure, a total hip replacement comes with some risk. Serious complications such as infection occur in less than 2% of people.

Other potential risks include:

• blood clots
• uneven legs
• hip dislocation
• nerve and blood vessel injury

Following the surgeon’s recovery instructions can give you the best chance of a smooth recovery. Most people can resume light activity about 3 to 6 weeks after surgery. The surgeon may recommend:

• pain relievers such as opioids, nonsteroidal anti-inflammatory drugs, or acetaminophen (Tylenol)
• having your stitches removed after about 2 weeks
• eating a balanced diet with an iron supplement to promote healing
• drinking plenty of fluids

Learn more about recovering from a hip replacement here.

Regular exercise after your procedure is crucial for increasing strength and mobility. Your surgeon and physical therapist may recommend 20 to 30 minutes of exercise daily during the early recovery. They may recommend exercises such as:

Ankle pumps

While sitting on a chair or lying on a bed, move your ankle up (toes toward you) and down (toes pointing away from you) slowly. You can do this with one or both ankles.

Bed-supported knee bends

While lying down on your back, slide your foot toward your buttocks while keeping your heel on your bed. Just make sure to hold the bent knee for 5 seconds before straightening.

Straight leg raises

While lying down on your back, use your thigh muscles to lift your leg off your bed with your knee fully straight. Just make sure to hold your leg in the air for a couple of seconds before lowering it.

Standing knee raises

Raise your leg until your thigh is parallel to the ground while holding a chair for balance. Just make sure to hold your raised knee for 2 to 3 counts before lowering. Do not lift your knee higher than your waist.

Standing hip extensions

Extend your leg back as far as you can while holding a chair for balance. Just make sure to hold your extended leg for 2 to 3 counts before lowering it again.

The American Academy of Orthopaedic Surgeons recommends asking a doctor if you should avoid the following while you’re still recovering:

• crossing your legs at the knee for 6 to 8 weeks
• bringing your knee higher than your hip
• leaning forward while sitting
• picking something off the floor from a seated position
• turning your feet inward or outward when bending down
• reaching down to pull up blankets in bed
• bending at the waist beyond 90 degrees

Hemiarthroplasty, or a partial hip replacement, is a simpler surgery with a shorter surgery time. In a 2018 study, researchers found partial replacement was associated with a significantly lower need for readjustment surgery.

Resurfacing is an even less invasive procedure. It involves replacing only the surface of your femur.

But resurfacing comes with its own risks. Most resurfacing procedures involve metal-on-metal surfaces. Surgeons rarely pursue this option because of the risk of metal corrosion and debris.

Here are some frequently asked questions people have about total hip replacements:

What is the success rate for total hip replacement surgery?

Many studies have found that more than 90% of people experience pain relief for at least 10 years.

Can I have both hips replaced at the same time?

You can have hip replacement surgery on both hips at the same time or one at a time. Both hips at the same time is called a bilateral procedure.

If you have both hips replaced at the same time, the surgery will take about twice as long. There’s also a higher risk of heart attack, stroke, and blood clots.

How long do hip replacements last?

In a 2019 review, researchers found that about 58% of hip replacements last 25 years. In a 2021 study, researchers found a lifetime risk of revision surgery of 27.6% in people ages 46 to 50 years, which decreased to 1.1% in people older than 90 years.

A total hip replacement is a procedure where a surgeon replaces the ball and socket of your hip with implants. It’s a common treatment for late stage osteoarthritis and other conditions that cause hip pain.

A doctor can help you figure out if you’re a good candidate for a hip replacement. Some people can benefit from less invasive procedures such as a partial hip replacement or resurfacing.

There are several different approaches to total hip replacement surgery. They each have their benefits and risks, and no one is better than the other. What’s most important is to find a surgeon you’re confident in.