Hip Replacement Surgery: What You Should Know

Other conditions that can damage hips enough to require hip replacement include:

• Serious injuries, such as car accidents or falls
• Femoroacetabular impingement syndrome (FAI or hip impingement), a condition in which the hip joint is abnormally shaped, which causes two bones to painfully rub together
• Hip dysplasia, which happens when your thigh bone (femur) doesn’t fit correctly into your hip socket. Dysplasia can lead to a dislocation. Most people who have hip dysplasia are born with it.
• Benign (noncancerous) tumors
• Cancer
• Perthes disease, a rare childhood disease that happens when the blood supply is temporarily cut off to the rounded top of the thigh bone (femur). This is the “ball” part of the ball-and-socket hip joint. The condition can cause deformation of the femur's shape after the blood flow returns.

Most people who receive hip replacements are aged 50 or older. You may be a candidate for hip replacement surgery if medication doesn't help enough and your hip pain makes it hard to stand, use stairs, or do daily activities (including sleeping).

Hip Replacement Diagnosis

Before you have a hip replacement, you will need to visit an orthopedic surgeon. The surgeon will examine you and see how your affected hip compares to your other hip. They will check your range of motion (how far you can move your hip and leg) and the strength of the muscles that support your hip and leg. The surgeon will ask about your medical history, including your symptoms, treatments you have tried, and any medications or supplements you take.

You will need several tests before scheduling a hip replacement. These may include:

• Hip X-rays
• Blood tests
• Urinalysis (testing your pee)
• Additional imaging scans such as MRI or CT scan
• Electrocardiogram (EKG) to check your heart health

Total Hip Replacement Materials

Total hip replacement implants are the artificial parts that your surgeon uses to replace your damaged ball-and-socket hip joint. The implants are typically made of four parts:

• The stem fits into your thigh bone (femur).
• The cup fits into your pelvic bone to form a socket.
• The ball fits onto the end of the stem.
• The liner is inserted into the cup and becomes your new cartilage.

In the U.S., there are currently four combinations of materials used in total hip replacements. Your surgeon will decide which is best for you. The combinations are as follows:

• Metal-on-polyethylene is a metal ball with a socket that is made of or lined with plastic (polyethylene).
• Ceramic-on-polyethylene is a ceramic ball with a socket that is made of or lined with plastic (polyethylene).
• Ceramic-on-ceramic is a ceramic ball with a socket that has a ceramic lining.
• Ceramic-on-metal is a ceramic ball with a socket that has a metal lining.

Hip Replacement Surgery Risks

While all surgery carries some risk, hip replacement surgery has a low rate of complications. The risks linked to hip replacement surgery include:

• Infections near the incision or in the deeper tissue near the hip implant. Most infections can be treated with medicine (antibiotics), but a serious infection near the new hip may require surgery to replace the artificial parts.
• Blood clots in your leg veins after surgery. If a piece of a clot breaks off and travels to your lung or heart, it can be very dangerous. You may be prescribed a blood thinner to reduce this risk.
• Developing a fracture in the healthy part of your hip joint during surgery. If the fracture is large, your surgeon may need to repair it.
• Dislocating your new hip joint from moving a certain way after surgery, especially in the first few months. Your health care professionals will teach you the correct ways to move in order to avoid a dislocation.
• Change in leg length due to muscles tightening around the new hip. This is rare and may be less noticeable with time.
• Loosening of the new joint from the bone is possible, but rare.
• Nerve damage can cause numbness, weakness, or pain at the implant site but happens rarely.

Hip Replacement Surgery Costs

The cost of hip replacement surgery varies widely, depending on where you live, the type of implant you receive, your length of hospital stay, insurance coverage, and aftercare needs.

For example: Becker’s Spine Review Healthcare Bluebook released a report of average hip replacement costs in the 30 most populous cities in the U.S. These included doctor, facility, and anesthesia fees. The costs ranged from $23,260 to $50,580.

Even with insurance, you will probably be responsible for some out-of-pocket costs, such as copays, deductibles, or fees for supplies or equipment that aren’t covered. Most insurance plans cover at least part of the costs of hip replacement surgery, including Medicare and Medicaid. You may be required to get prior authorization from your insurance company before having surgery.

How to Prepare for Hip Replacement Surgery

You’ll need to begin preparing for hip replacement surgery at least several weeks before your procedure. There are actions you can take to be as healthy as possible going into surgery, to help ensure good results. You can also prepare your home in advance to make your recovery safer and more comfortable.

• Speak with your surgeon and health care team about what to expect. Read any materials they provide before your surgery.
• Follow all of your doctor’s exercise recommendations to strengthen your muscles before surgery.
• If you have extra weight, try to lose some pounds before your surgery with your doctor's guidance. This can reduce your risk of complications during and after surgery.
• If you smoke, quit or cut back. Tobacco use can interfere with healing.
• Arrange for rides to and from your surgery and follow-up visits.
• Arrange in advance for help with cooking, shopping, cleaning, and laundry. You may need this for the first 2 weeks after your surgery.
• Prepare and freeze some meals ahead of time.
• Set up an area at home where you will spend most of your time recovering. You should have a stable chair with a firm seat and back that allows you to sit with your knees lower than your hips, and arms to grip when you stand.
• Move loose rugs, electrical cords, and other items that you could trip over.
• Ask your health care team about any equipment you may need to help with daily activities. Examples include a raised toilet seat, a long-handled “reacher” to grab items, safety bars in the bathroom, a bench or chair to use when bathing, crutches, and a walker.
• Have any major, planned dental procedures (such as gum work or teeth removed) before your surgery. There is a risk of bacteria entering your bloodstream during a dental procedure, which can lead to an infection in your body after hip replacement surgery. Delay any routine dental cleaning appointments until several weeks after surgery.
• As there can be some blood loss during hip replacement surgery, you may need a blood transfusion when you’re in surgery. You may want to consider donating your own blood before the surgery in case it is needed.
• You may be instructed by your doctor to stop taking certain medications, such as blood thinners, a few days to a week before your surgery. Always check with your doctor before stopping medication.
• You will be told when to stop eating or drinking anything before your surgery. Usually, the cut-off is after midnight the night before your procedure. This does not include any medications you have been instructed to take during the morning of surgery with a small sip of water.

Hip Replacement Surgery Techniques

In a total hip replacement, your orthopedic surgeon removes damaged bone and cartilage from your hip joint and replaces them with artificial implants. Hip replacement may be performed as traditional surgery through a 10- to 12-inch long incision (cut) along the side of the hip.

Some people may be eligible for minimally invasive hip replacement surgery. This is an option that is done through one or two 3- to 6-inch incisions using special surgical tools. Minimally invasive surgery usually means less pain and a faster recovery for patients. There is also less disturbance to muscles and soft tissue. 

With minimally invasive hip replacement surgery, your surgeon may make the incision on the side (lateral approach) or back (posterior approach) of the hip. Another option that has grown in popularity is the direct anterior approach. This method uses an incision on the front of the hip and a special table in the operating room. Because there is less cutting of the muscles with the direct anterior approach, recovery may be easier.

What Happens During Hip Replacement Surgery?

Hip replacement surgery can be performed traditionally or by using what is considered a minimally invasive technique. The main difference between the two procedures is the size of the incision.

During standard hip replacement surgery, you are given general anesthesia to relax your muscles and put you into a temporary deep sleep. This will prevent you from feeling any pain during the surgery or have any awareness of the procedure. A spinal anesthetic may be given to help prevent pain as an alternative.

The doctor will then make a cut along the side of the hip and move the muscles connected to the top of the thigh bone to expose the hip joint. Next, the ball portion of the joint is removed by cutting the thigh bone with a saw. Then an artificial joint is attached to the thigh bone using either cement or a special material that allows the remaining bone to attach to the new joint.

The doctor then prepares the surface of the hip bone by removing any damaged cartilage and attaches the replacement socket part to the hip bone. The new ball part of the thigh bone is then inserted into the socket part of the hip. A drain may be put in to help drain any fluid. The doctor then reattaches the muscles and closes the incision.

While most hip replacement surgeries today are performed using the standard technique (one long cut along the side of the hip), in recent years, some doctors have been using a minimally invasive technique. In the minimally invasive approach, doctors make one to two smaller cuts along the front, side, or back of the hip. The same procedure is performed through these small cuts as with standard hip replacement surgery, though there is less disturbance to muscles and soft tissue.

What Happens After Hip Replacement Surgery?

You may go home the same day as your surgery, or you could stay for a couple of days at the hospital if needed. While in the hospital, you may lie in bed with a wedge-shaped cushion between your legs to keep the new hip joint in place. A drainage tube will likely be placed in your bladder to help you go to the bathroom.

Physical therapy usually begins the day after surgery, and within days you can walk with a walker, crutches, or a cane. You will continue physical therapy for weeks to months following the surgery.

Hip Replacement Surgery Recovery Time

Recovery time from hip replacement surgery varies from person to person. How well and how fast you recover will depend, in part, on following your surgeon’s instructions on home care during the first few weeks. Be sure to drink plenty of fluids and eat a balanced diet to support your body in healing and regaining muscle strength. Your doctor may suggest an iron supplement.

Contact your surgeon right away if you notice any of these signs of infection or problems after your surgery:

• Severe pain
• Persistent fever or chills
• Swelling
• Bleeding, oozing, redness, or discoloration around your hip replacement scar

You should also call your surgeon if you see any warning signs of a possible blood clot in your leg, including:

• Pain in your calf and leg that is not related to your incision
• Soreness or redness of your calf
• New or increasing swelling of your leg (anywhere from your thigh to your foot)

A pulmonary embolism is what happens when a blood clot breaks off and travels to your lungs. This can be a life-threatening condition. Call your surgeon or go to the nearest emergency room if you notice any of these warning signs:

• Sudden shortness of breath
• Sudden chest pain
• Chest pain in one spot, with coughing

What Activities Should I Avoid After Hip Replacement Surgery?

For anywhere from 6-12 months after hip replacement surgery, pivoting or twisting on the involved leg should be avoided. In your first few weeks of recovery, you also shouldn't:

• Cross the involved leg past the midline of the body
• Turn the involved leg inward
• Bend at the hip past 90 degrees -- this includes both bending forward at the waist and squatting.

What Can I Do at Home After Hip Replacement Surgery?

There are a few simple measures that you can take to make life easier when you return home after hip replacement surgery, including:

• Keep stair-climbing to a minimum. Make the necessary arrangements so that you will only have to go up and down the steps once or twice a day.
• Sit in a firm, straight-back chair. Recliners should not be used.
• To help avoid falls, remove all throw rugs and keep floors and rooms clutter-free.
• Use an elevated toilet seat. This will help keep you from bending too far at the hips.
• Keep enthusiastic pets away until you have healed completely.

You should ask your doctor before returning to activities such as driving, sexual activity, and exercise.

Long-term care

You may feel some numbness in the skin around your hip replacement scar. You may also feel some stiffness. These changes may lessen over time. The implants used in hip replacements usually last for a long time. Many people who have had a hip replacement are able to use that implant for the rest of their lives. With normal living, the new hip implant will start to have some wear and tear over time. Excessive activity or having extra weight can put extra stress on your new joint and speed up this normal wear. This can cause the hip implant to loosen and become painful.

There are things you can do to help protect your new hip replacement so it lasts long-term. These include:

• Maintain a healthy weight.
• Avoid playing high-impact sports or doing activities that involve a lot of running or jumping.
• Exercise regularly to maintain strength and mobility. Low-impact activities such as walking, swimming, hiking, golf, biking, and dancing are all allowed after recovering from hip replacement surgery.
• Be careful to avoid falls and injuries.
• Tell your dentist about your hip replacement. Your orthopedic surgeon may want you to take antibiotics before dental procedures to prevent bacteria from entering your bloodstream and causing an infection in your body.
• Visit your surgeon for any recommended routine follow-up exams and X-rays.

Is Hip Replacement Surgery Safe?

Hip replacement surgery has been performed for years and surgical techniques are being improved all the time. As with any surgery, however, there are risks. As you will not be able to move around much at first, blood clots are a particular concern. Your doctor will give you blood thinners to help prevent blood clots from occurring. Infection and bleeding are also possible, as are risks associated with using general anesthesia.

Other less common concerns that you and your doctor must watch out for are:

• Your legs may not be of equal length after the surgery.
• You must be careful not to cross your legs or not to sit too low because the joint may be dislocated.
• Pieces of fat in the bone marrow may become loose, enter the bloodstream, and get into the lungs, which can cause very serious breathing problems.
• Nerves in the hip area may be injured from swelling or pressure and can cause some numbness.
• The replacement parts may become loose, break, or become infected.

Talk to your surgeon about these risks before undergoing the procedure.

How Long Will My New Joint Last After Hip Replacement Surgery?

When hip replacement surgeries were first performed in the early 1970s, it was thought that the average artificial joint would last about 10 years. We now know that about 85% of the hip joint implants will last 20 years. Improvements in surgical technique and artificial joint materials should make these implants last even longer. If the joint does become damaged, surgery to repair it can be successful but is more complicated than the original procedure.

Takeaways

If your hip pain isn’t relieved by medication or other treatments and is keeping you from enjoying the activities of daily life, a total hip replacement can help. During a total hip replacement, an orthopedic surgeon removes the damaged bone and cartilage from your hip joint and replaces them with artificial replacement parts called implants. After recovery, most people are able to return to doing most activities, with less pain and stiffness.

Hip Replacement Surgery FAQs

What can’t you do after a hip replacement?

For the first 6 weeks after surgery, you will need to be extra careful about how you move when sitting, bending, or sleeping. These precautions will help you recover properly and avoid moving your artificial hip out of position (dislocation). After a full recovery, usually 3 months after surgery, you can do most activities but should avoid running, jumping, or high-impact sports.

What are the three rules after hip replacement?

Your surgeon will tell you how to move or position your body in order to avoid dislocating your new hip (moving it out of position). These rules, such as sitting with your knees lower than your hips, are called hip precautions. You will need to follow these precautions for at least 6 weeks. The most important of these are:

• Don’t bend at the waist more than 90º.
• Don’t cross your legs.
• Don’t twist your legs or turn your feet in or out too much.

How long are you on bed rest after a hip replacement?

Exercise and movement are very important to your recovery after hip replacement surgery. Your surgeon will have you moving as soon as 24 hours after your surgery. While you will have to follow certain rules about moving during the weeks after surgery, you will not be put on bed rest. Within 3-6 weeks of your surgery, you should be able to resume most normal daily activities.

What is the newest procedure for hip replacement?

Current hip replacement surgery involves the surgeon making an incision (cut) in one of the following places (or a combination) to reach the hip joint:

• Posterior approach (back of the hip)
• Lateral or anterolateral approach (side of the hip)
• Anterior approach (front of the leg) 

There are advantages and disadvantages to each approach, but all can be done through small incisions for less bleeding and a faster recovery.

Some of the newer technologies used for hip replacement surgery include:

• Robotic-assisted surgery, in which the surgeon controls a robotic arm, for highly precise movements and placement of parts
• Computer navigation that uses 3D imaging to help the surgeon position the hip socket
• 3D printing technology to make custom implants