Total hip replacement is a step-by-step surgery to replace the ball at the top of the thigh bone (femur) and the hip socket.
Doctors use metal, ceramic, or plastic replacement parts. They may be attached to the bones in one of two ways:
Your doctor may use general anesthesia. This means you'll be asleep during surgery. Or a doctor may use regional anesthesia. This means you can't feel the area of the surgery. You'll have medicine that makes you unaware but lightly asleep. Which type of anesthesia you get depends on your doctor and your overall health. Your doctor might also ask what you prefer.
In traditional hip replacement surgery, the doctor makes a 15- to 25-centimetre cut (incision) on the side or the back of your hip. Some muscles and other soft tissues, such as ligaments, are cut so the doctor can get to the hip joint.
Hip replacement can also be done with one or two smaller incisions. This is called minimally invasive surgery. It may cause less blood loss and leave a smaller scar. But it can also mean a longer time in surgery, because the surgery is harder to do. And if the new hip can't be fitted properly through the smaller incision, the doctor may have to make a larger cut.
A newer type of surgery is done through a small incision in the front (anterior) of the hip. Anterior hip surgery causes less damage to muscles and other soft tissues than getting to the hip joint from the side or the back. It may help you heal faster and return to activity sooner.
Anterior surgery and minimally invasive surgery require special training and equipment. Your doctor can explain your options and help you understand the risks and benefits of each type of surgery.
Your pain will be controlled with intravenous (IV) medicine. You will probably also have medicines to prevent infection, blood clots, and nausea. If you had regional anesthesia, you may have little or no feeling below your waist for a while.
You may have a cushion between your legs. It helps keep your new hip in the correct position. You may also have a catheter. It lets you empty your bladder without getting up. To help prevent blood clots, you may be wearing compression stockings. And you may have compression sleeves on your legs. These squeeze and release your lower legs to help keep the blood moving.
On the day of surgery or the day after, you'll get out of bed with help. You will learn how to walk with a walker or crutches. By the time you leave the hospital, you will be able to safely sit down and stand up, dress yourself, use the toilet, bathe, and use stairs.
As soon as possible, you will start physiotherapy. You'll learn exercises to help you get stronger. You will also be taught how to move your body without dislocating your hip.
If you have traditional surgery, you will need to follow "hip precautions" until your hip is fully healed. Most often, this means that you:
There is a much lower risk of hip dislocation after anterior surgery, so there are fewer precautions. Your physiotherapist will teach you how to move safely. For example, while you're healing, the therapist may suggest that you:
Your doctor will let you know if you will stay in the hospital or if you can go home the day of surgery.
During the first week or so after surgery, you will need less and less pain medicine. For a few weeks after surgery, you will probably take medicine to prevent blood clots.
You may need a walker, crutches, or a cane for a few weeks. As you get your energy back, work up to taking a short walk a few times each day. If you feel any soreness, try a cold pack on your hip.
Don't drive until:
After traditional surgery, complete recovery can take at least 6 months. Recovery is usually faster after anterior hip surgery. Keep up your walking and physiotherapy exercises. They help speed your recovery.
For most people, it is safe to have sex about 4 to 6 weeks after a hip replacement. Talk to your doctor about when it is okay to have sex and what positions are safe for your hip. Some positions could cause you to dislocate your hip. That means that your doctor may want you to avoid certain positions, especially for the first few months.
Exercise (such as swimming and walking) is important for building your muscle strength. And it helps you feel better overall. Discuss with your doctor what type of exercise is best for you.
Your doctor will probably want to see you at least once a year to check your hip.
For at least 2 years after your surgery, your doctor may want you to take antibiotics before dental work or any invasive procedure. This is to help prevent infection around your hip implant. After 2 years, your doctor and dentist will decide if you still need to take antibiotics.
Total hip replacement surgery is usually done when hip pain and loss of function become severe and when treatment no longer relieves pain. Hip replacement is sometimes done after a hip fracture.
Surgery usually works well. You will probably have much less pain and be able to do most of your daily activities more easily. But recovery does take time and patience.
Most artificial hip joints will last for 10 to 20 years or longer. It depends on your age, how much stress you put on the joint, and how well your new joint and bones mend. Your weight can make a difference. Every extra kilogram of body weight adds 3 kilograms of stress to your new hip joint. Controlling your weight will help your new hip joint last longer.
The risks of hip replacement surgery can be divided into two groups:
In some places you may donate your own blood to use during surgery if needed. This is called autologous blood donation. If you choose to do this, start the donation several weeks before the surgery so that you have time to donate enough blood and rebuild your blood volume before surgery.
If you need more than one joint replacement surgery, such as a knee and a hip, talk to your doctor. There are guidelines that may help you and your doctor decide which surgery to do first.
Complete the surgery information form (PDF)(What is a PDF document?) to help you prepare for this surgery.
Other Works Consulted
American Academy of Orthopaedic Surgeons (2014). Activities after hip replacement. American Academy of Orthopaedic Surgeons. http://orthoinfo.aaos.org/topic.cfm?topic=a00356. Accessed September 19, 2016.
Charbonnier C, et al. (2014). Sexual activity after total hip arthroplasty: A motion capture study. Journal of Arthroplasty, 29(3): 640-647. DOI: 10.1016/j.arth.2013.07.043. Accessed June 6, 2016.
Imamura M, et al. (2012). Single mini-incision total hip replacement for the management of arthritic disease of the hip: A systematic review and meta-analysis of randomized controlled trials. Journal of Bone and Joint Surgery, American Version, 94(20): 1897-1905.
Meiri R, et al. (2014). Sexual function before and after total hip replacement: Narrative review. Sexual Medicine, 2(4): 159-167. DOI: 10.1002/sm2.35. Accessed June 6, 2016.
Rethman MP, et al. (2012). Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures: Executive Summary on the AAOS/ADA Clinical Practice Guideline. Available online: http://www.aaos.org/research/guidelines/PUDP/dental_guideline.asp.
ByHealthwise StaffPrimary Medical ReviewerKathleen Romito, MD - Family MedicineAdam Husney, MD - Family MedicineE. Gregory Thompson, MD - Internal MedicineSpecialist Medical ReviewerKenneth J. Koval, MD - Orthopedic Surgery, Orthopedic TraumaJeffrey N. Katz, MD, MPH - Rheumatology
Current as ofJanuary 8, 2018
Current as of: January 8, 2018
Kathleen Romito, MD - Family Medicine
& Adam Husney, MD - Family Medicine & E. Gregory Thompson, MD - Internal Medicine & Kenneth J. Koval, MD - Orthopedic Surgery, Orthopedic Trauma & Jeffrey N. Katz, MD, MPH - Rheumatology
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