Different conditions can affect your hips over time, from arthritis to a sudden fall. Doctors usually recommend medication, physical therapy, or lifestyle adaptations as first-line therapies. However, total hip arthroplasty may be warranted if:
- the function of the joint and the cartilage lining have deteriorated
- you’re experiencing significant pain and having trouble getting restful sleep
- you’re unable to accomplish everyday tasks, like climbing stairs
- you’re unable to particulate in activities you used to enjoy, like hiking or biking
Total hip arthroplasty is surgery that involves replacing one or both hip joints. It’s widely considered to be one of the safest and most effective surgeries.
If you’re considering the procedure, read on to learn more about whether it’s right for you and what to expect if you make the decision to have a total hip arthroplasty.
Total hip arthroplasty. Illustration by Jason Hoffman
Your hip is where the top of your thighbone — called the femur — meets the pelvis and forms a ball-and-socket joint.
The hip joint has two parts:
- Femoral head: the ball-shaped top of your femur
- Acetabulum: the socket in your pelvis where the top of your femur slots in
The hip joint is surrounded by cartilage and ligaments that cushion, limit, and control the movement of the joint.
Over the course of a lifetime, different conditions and excessive wear and tear can affect this joint, causing increasing pain and difficulty walking. The result can be a joint that’s so damaged you may need total hip arthroplasty.
Some conditions that could cause hip damage requiring surgery include:
- osteonecrosis, which happens when blood supply is cut off or greatly reduced to the joint, causing damage
- osteoarthritis
- rheumatoid arthritis
- post-traumatic arthritis, which happens after a traumatic hip injury or fracture
- childhood hip disease
- hip dysplasia
Total hip arthroplasty stats
Total hip arthroplasty is fairly common. The number of people seeking it is growing each year.
Older statistics showed about 450,000 people a year were getting the surgery in the United States. A 2019 analysis projected that the number would grow to 652,000 by 2025.
About
Primary approaches to a total hip arthroplasty
Total hip arthroplasty involves a surgeon removing one or both hip joints and replacing them with prostheses (manufactured replacement parts).
There are many ways your surgical team can perform a total hip arthroplasty. The three most common approaches are:
- posterior (back incision)
- direct lateral (side incision)
- direct anterior (front incision), also called “muscle sparing” because the surgeon doesn’t cut through muscles with this approach
Types of joint replacement
If you undergo total hip arthroplasty, a surgeon will replace the socket of your hip with a sturdy cup made of plastic and metal. They will replace the top, or ball, of your femur — called the femoral head — with a ball made of metal or ceramic.
The ball is then fitted onto a metal stem that’s placed into your femur, or thighbone. Some stems are porous, allowing your bone to grow into it and secure it. Others are cemented in. The new femoral head is then pressed into the prosthetic socket.
Your doctor will make recommendations for your prostheses based on:
- your age
- activity level
- the quality of your bone
The benefits of the procedure include:
- increased quality of life
- increased joint function
- increased mobility
- reduced pain
- lower risk of falls
- less risk of becoming homebound
- better mental health
- longer life span
- reduced long-term healthcare expenses
In general, the surgery is recommended for people with hip conditions that are getting worse, not improving with other methods, or causing excessive pain or difficulty walking or moving.
The most common reason for total hip arthroplasty is end-stage degenerative hip osteoarthritis (OA). It affects about
Other top reasons doctors recommend total hip arthroplasty include:
- Congenital hip disorders: hip conditions present at birth, such as hip dysplasia, when the femur doesn’t fit into the hip socket properly
- Inflammatory arthritis: a
type of arthritis that causes joint pain, swelling, warmth, and tenderness in the joints - Hip osteonecrosis (ON): happens when the blood supply to the femur is cut off or severely disrupted, causing the joint to degrade or collapse. ON is less common than OA. It typically shows up in younger people, generally between ages 35 and 50. About
10% of total hip arthroplasty surgeries are due to ON.
Nonsurgical treatment options
When your discomfort or trouble moving increases, your doctor will likely diagnose the underlying issue and make other suggestions before recommending surgery. Those suggestions might include:
- medication
- physical therapy
- lifestyle changes
- weight loss
- assistive devices, like canes or walkers
When nonsurgical treatments no longer provide enough relief, your doctor may recommend total hip arthroplasty.
Your surgical team will usually perform the procedure in a hospital or medical facility. It takes about 1.5 hours. You will be under general anesthesia.
Some people may be able to have outpatient surgery, in which they get the surgery and are able to come home the same day. However, most people undergoing total hip arthroplasty require a hospital stay of a night or two after surgery.
Recovery is usually fairly speedy. Most people are up and using a walker or cane to get around after about a day. Full healing can take up to 6 weeks or more depending on your physical condition before the surgery.
Here are some things you can do to prepare for your recovery:
- get into an exercise routine
- lose weight if needed
- prepare your recovery environment
Helpful items for after surgery
- assistive devices, such as a walker or cane
- non-slip socks
- slide-on shoes or shoes with Velcro
- toilet seat support rails
- grab bars in the shower
- a grabber tool that can help you reach items
Although total hip arthroplasty is considered one of the safest and most successful orthopedic surgeries you can get, there is some risk of complications.
Venous thromboembolism events (VTE)
VTE is a rare but potentially serious side effect in which blood clots develop and stop the flow of blood to a portion of your body. A clot can also sometimes break off and travel to your lungs, which could potentially be fatal.
However, the risk of VTE is small: Its likelihood is less than 1% for first surgeries and up to 2.5% for joint revision surgeries, according to
Dislocations
The majority of total hip arthroplasty dislocations occur in the first month. They happen in about
Risk factors are:
- a revision total hip replacement
- being older than 70
- components not being placed properly
- neuromuscular conditions, such as Parkinson’s disease
- drug and alcohol misuse
Fracture
Total hip arthroplasty can sometimes lead to small fractures in the bone around the new components. It’s rare, affecting
Other possible side effects
Other side effects can include:
- prosthetic joint infection
wound complications , such as infectionsciatic nerve palsy - leg length discrepancy (LLD)
iliopsoas impingement heterotopic ossification vascular injury
When to call a doctor
Call 911 or local emergency services if you experience chest pain or shortness of breath after your surgery. Call your doctor right away if you have:
- a bad smell or fluid draining at the incision site
- a fever above 100.4°F (38°C)
- chills
- increasing pain or redness at the surgical site
- worsening hip pain
- swelling in your legs not related to the surgery
There are many ways to choose the right surgeon. Some suggestions from the American Association of Hip and Knee Surgeons include:
- asking family and friends
- getting a referral from your physician
- choosing a board certified surgeon, such as from the:
How much you will end up paying for a total hip arthroplasty can vary widely depending on whether you have Medicare, Medicaid, private insurance, or no insurance.
Where you have the procedure and who covers it will ultimately determine the price tag. It’s best to check with your insurance so you can plan for the expense.
Some factors that go into the bottom line include:
- who performs your surgical services
- where you have your procedure (the facility, location, and region)
- contractual agreements by your insurance provider (some provide “bundled payments,” in which the entire procedure carries one price tag)
- implant and rehabilitation costs
Is total hip arthroplasty the same as total hip replacement?
Yes. A total hip arthroplasty is the same as a total hip replacement.
Can you have both hips replaced at the same time?
Yes. You can have both hips replaced at the same time. This is called a double hip replacement.
It’s worth noting that with a double hip replacement, there’s a higher risk of:
- heart attack
- stroke
- blood clots
- need for a blood transfusion
- death
Are there other approaches to restoring hip mobility and reducing pain to consider before a total hip arthroplasty?
Your healthcare team will likely recommend you try lifestyle changes, medication, physical therapy, or pain management before recommending surgery.
Who should not have a total hip arthroplasty?
According to
- a hip infection or sepsis
- an active or ongoing infection
- a severe case of vascular dysfunction
A doctor may also not recommend surgery if you:
- have an unmanaged health condition, such as diabetes
- have obesity
- smoke cigarettes
Total hip arthroplasty is a procedure in which a damaged hip socket is removed and replaced with prostheses.
It’s considered one of the safest and most effective orthopedic surgeries. It’s done to reduce pain and disability, and increase mobility and quality of life.
A total hip arthroplasty takes a couple of hours. It can be performed on an outpatient basis or require a couple of nights’ stay in a hospital.
Most people are up and walking within a day or two and recover fully in a few weeks.