If you have pain in or around the hip joint, or referred pain from the hip joint, you may have trouble with everyday activities like getting dressed or bathing. Whether you are just exploring the idea of hip surgery or you have already scheduled the procedure, here are some things you should know about this very common procedure.

The hip is a ball-and-socket joint. The “ball” is made of the top of the thigh bone (femur), which fits into the “socket” of the pelvis bone. The bony surfaces are coated with cartilage, covered in membranes and connected to other bones and muscles with ligaments. This allows the joint to move freely.

Damage from injury or a medical condition can result in pain, lack of range of movement, stiffness and mobility issues. Your health care team might start your treatment with nonsurgical options for hip pain. If such treatments are not effective, you may be a candidate for hip joint surgery.

What is Hip Replacement Surgery?

The goal of hip surgery is to relieve pain and restore function. There are two types of hip replacement surgery:

• Total hip replacement (arthroplasty): In this procedure, both the ball and the socket are replaced with a metal and plastic implant. 

• Partial hip replacement (hemiarthroplasty): Instead of the ball and socket being replaced, only the ball part of the hip joint is replaced. The damaged bone and cartilage are removed, and the implant is put on the top of the thigh bone.

In a total hip replacement, surgeons make a cut (incision) in the front (anterior) of the leg, rather than the back. This helps most patients recover faster and with less pain, because key muscles are not detached during the surgery. The anterior approach also uses a smaller incision to help reduce scarring.

Average recovery time for anterior-approach hip replacement surgery is two to eight weeks, instead of the typical two to four months with conventional surgery.

Which type of surgery you have will depend on many factors, including:

• The severity of your condition
• Your age
• Your general health at the time of surgery

How Do You Know if You Need Hip Replacement Surgery?

While no two hips are the same, there are some situations that make you more likely to be a good candidate for total hip replacement surgery. Those include:

• Conditions you had at birth (congenital conditions), such as hip dysplasia, that keep your hip from working properly
• Arthritis in the hip, including rheumatoid and osteoarthritis that have worn down the cartilage in the socket
• Hip fracture in the upper part of the thigh bone
• Tumor in the bones or soft tissue of the hip

You may not be a good candidate for total hip replacement if you:

• Have infection in the hip
• Have severe obesity
• Have severe heart disease
• Have severe muscle weakness
• Have severe osteoporosis

A total hip replacement is considered the gold standard for hip joint surgery. However, you may not need or be eligible for this type of procedure. You may be a good candidate for a partial hip replacement if you:

• Have had a break in the upper part of the thigh bone
• Do not have underlying conditions such as arthritis
• Have healthy cartilage in the joint

A partial hip replacement is not as consistently successful as a total hip replacement, but your health care team will help make the determination about surgery.

Care That’s Focused on You

• Minimally invasive procedures can have you home quickly with less pain and faster recovery.
• Sophisticated pain management aims to keep you comfortable and safe.
• We have a deep commitment to getting you moving again and managing your pain so you can keep up with your physical therapy.
• With 30 orthopedic locations in Louisville, Southern Indiana and surrounding communities, we have specialists near you.
• Communicate with your provider, manage appointments, refill prescriptions and more, anytime, from a computer or mobile device with a free MyNortonChart account.

Risks and Complications of Hip Replacement

Risks associated with hip replacement surgery can include:

• Blood clots: These can form in the leg veins after surgery. This can be dangerous, because a piece of a clot can break off and travel to the lung, heart or, rarely, the brain. Clots block blood from reaching tissues and cells, causing them to die. Blood-thinning medications can reduce this risk.
• Infection: Infections can occur at the site of the incision and in the deeper tissue near the new hip. Most infections are treated with antibiotics, but a major infection near the new hip might require surgery to remove and replace the artificial parts.
• Fracture: During surgery, healthy portions of the hip joint might break or crack. Sometimes the fractures are small enough to heal on their own, but larger fractures might need to be stabilized with wires, screws, and possibly a metal plate or bone grafts.
• Dislocation: Certain positions can cause the ball of the new joint to come out of the socket, particularly in the first few months after surgery. If the hip dislocates, a brace can help keep the hip in the correct position. If the hip keeps dislocating, surgery may be needed to stabilize it.
• Change in leg length: Occasionally a new hip makes one leg longer or shorter than the other. Sometimes this is caused by a tightening of muscles around the hip. In these cases, progressively strengthening and stretching those muscles might help. Small differences in leg length usually aren’t noticeable after a few months.
• Loosening: Although this complication is rare with newer implants, the new joint might not become solidly fixed to the bone or might loosen over time, causing pain in the hip. Surgery might be needed to fix the condition.
• Nerve damage: Rarely, nerves in the area where the implant is placed can be injured. Nerve damage can cause numbness, weakness and pain.

Second Hip Replacement

Sometimes, the artificial hip parts can wear out. This can be common in people who have hip replacement surgery when they’re relatively young and still active. If this happens, you might need a second hip replacement. New materials, however, are making implants last longer.

What to Expect From Hip Surgery and Recovery

Once you and your health care team have decided on hip surgery, you will be given instructions on what to do before surgery and what to expect afterward. Norton Healthcare is committed to making you as comfortable as possible during your stay.

Preoperative Testing For Hip Replacement

Your preoperative testing will be scheduled within 30 days before your surgery. Tests include a medical evaluation, blood samples, electrocardiogram, stress test, chest X-ray and urine sample. The tests will show the doctor how ready your body is for surgery or whether you have any conditions that may need special attention before moving forward.

You will also discuss:

• Advance directives
• Dietary restrictions or allergies
• Medical conditions
• Medications and supplements you take
• Primary care provider and any specialists
• Prior surgeries

Blood Donation

You may lose some blood during your surgery, so you may wish to donate blood for yourself in case it’s necessary. Your surgeon may recommend taking iron supplements before surgery, which can help build your blood supply and reduce the need for a blood transfusion.

Weight Management

Excess body weight can increase your risk of infection and other complications. Our providers can help you to determine what is a reasonable and realistic weight loss goal for you. You should be able to achieve this goal through reduced calorie intake and regular physical activity.

Lifestyle Adjustments Before Surgery

There are several small changes you can make that may make surgery recovery easier.

• Adjust your medications: To avoid complications, do not take medications that cause bleeding (blood thinners, for example). You should take only medications recommended by your surgeon.
• Avoid alcohol: In the days leading up to your surgery, you should avoid alcoholic beverages, which can cause increased bleeding and dehydration.
• Identify a caretaker: Make arrangements to have someone transport you safely home after surgery and to stay with you for a few days.
• Prepare your home: This may include installing a toilet seat lift and shower chair, adjusting your bed height, rearranging your closet/dresser/kitchen/bathroom to put your most-used items within easy reach, preparing meals to store in the freezer and removing tripping hazards such as rugs and cords.
• Quit smoking: Smoking can prevent bones, tissue and skin from healing and can make it more difficult for the body to fight off infection. However, research shows that if you quit smoking before surgery, your risk of complications goes down.
• Schedule dental care: Schedule dental procedures for at least six weeks prior to surgery, and do not schedule anything further until three months after surgery. Germs in your mouth can enter the bloodstream and potentially infect your new joint.

In addition, light exercise prior to surgery will help strengthen the muscles surrounding the hip joints, which may also make recovery easier.

Hip replacements are performed at a hospital. Often you can go home the same day as your surgery. Sometimes you might need to stay a night or two for observation or to resolve complications.

A typical, uncomplicated total hip replacement surgery has the following steps.

1. Once in the operating room, you will get an IV line in your hand or arm. A urinary catheter may be inserted as well.
2. You will receive anesthesia, either general (whole body) or below-the-waist (epidural), depending on the recommendation of your anesthesiologist and orthopedic surgeon.
3. The surgeon will place you in an appropriate position to access the hip joint and make an incision. The incision’s location depends on which approach (front, back or side) the surgeon uses.
4. The surgeon will remove the head of the femur (the ball part of the joint) and make an opening in the top of the femur. They will insert the stem of the ball prosthesis, with or without cement. The ceramic replacement head will be attached to the top of the femur implant.
5. The surgeon removes the damaged cartilage from the acetabulum (the socket part of the joint) and attaches the new cup.
6. Your surgeon will bend and move your leg to ensure that it functions properly.
7. Layers of tissue will be closed with stitches that dissolve. The outermost layer of skin is closed with surgical glue. No stitches will need to be removed after your surgery.
8. You will be taken to the recovery room for a couple hours and then transferred to a hospital room. The surgeon will let you know when it is safe to go home, which could be the same day, depending on your condition.

After Hip Surgery

Often you can go home the same day as your hip surgery. Sometimes you will stay in the hospital for a few days. It will depend on how well you can walk in the hours after.

Recovery is a gradual process. Walking and physical therapy exercises will help speed your recovery. Here’s what to expect at certain time increments after your surgery.

• Six weeks: Most patients are able to participate in most daily activities.
• Three months: Most joint replacement patients have regained the strength and endurance they had before surgery.
• Six months: Most patients can expect full recovery, depending on the type of surgery, overall health and the success of rehabilitation.

When Can I Go Back to Work?

This depends on the type of work you do, as well as your own recovery progress. If you have an office or desk job, you can expect to return after four to six weeks. With more physical jobs that require lifting, extensive walking or travel, you might need up to three months to recover fully. Your surgeon will tell you when you can return to work and whether there are limitations.

When Can I Drive?

In most cases, you will be able to resume driving about four weeks after surgery. To drive, you must be off pain medications. However, you should not drive a car or any other motor vehicle until your surgeon says it’s OK to do so.

What Activities Should I Avoid After Hip Surgery?

It’s important to keep your new joint moving. However, you should return to normal activities gradually. You will be instructed by your joint replacement care team to avoid specific positions and activities that could put stress on your new joint. Avoid high-impact activities, and consult your surgeon before participating in a new exercise routine or a physically demanding sport.

Staying in touch with your health care team is critical to your recovery. Be sure to attend all follow-up appointments, follow the doctors’ guidelines and let them know if you have any questions or concerns.

Next Steps

We care for thousands of people with hip conditions every year. That means our providers have the commitment and experience to give you a precise diagnosis and treat your condition with sophisticated techniques that can get you moving again with less pain and fewer complications.

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