Total Hip Replacement

Total hip replacement (total hip arthroplasty) replaces the damaged hip joint with an artificial implant consisting of a metal ball and socket. Over 450,000 hip replacements are performed annually in the US. The procedure has a success rate exceeding 95%.

Hip replacement treats severe arthritis (osteoarthritis, rheumatoid, or post-traumatic), avascular necrosis, hip fractures, and bone tumors. It is recommended when pain significantly limits daily activities and conservative treatments are no longer effective.

Preparation includes pre-operative testing, medical optimization, stopping certain medications, and arranging post-operative support at home. Pre-surgical exercises to strengthen the hip and leg muscles can improve recovery outcomes.

Under general or spinal anesthesia, the surgeon removes the damaged femoral head and acetabulum and replaces them with prosthetic components. Anterior, posterior, and lateral surgical approaches are used. The procedure takes 1-2 hours.

Hospital stay is 1-3 days. Physical therapy starts immediately. Weight-bearing is typically allowed the same day. A walker or cane is used for 2-6 weeks. Most patients return to normal activities within 3-6 months. Hip precautions may apply for 6-12 weeks.

Risks include dislocation (2-3%), blood clots, infection, leg length inequality, fracture, nerve injury, implant loosening, and wear of components over time.

Non-surgical alternatives include physical therapy, weight loss, anti-inflammatory medications, corticosteroid injections, assistive devices, and activity modification. Hip resurfacing is an option for younger, active patients.

Covered by Medicare and most insurers when medically necessary. Prior authorization and documentation of failed conservative treatment are typically required.