Hip replacement is a surgical procedure that replaces damaged parts of the hip joint with artificial components. This surgery is often recommended when hip pain and stiffness make daily activities difficult and other treatments have not helped. Hip replacement is one of the most successful surgeries, with most people experiencing improved mobility and reduced pain. Recovery can take several months, but many people return to normal activities and enjoy a better quality of life.

Hip replacement, also called hip arthroplasty, is a surgery to remove damaged bone and cartilage (the smooth tissue that covers the ends of bones) from the hip and replace them with artificial parts. These parts restore smooth hip movement.

The hip joint connects the thigh bone (femur) to the pelvis, where the ball-shaped end of the femur sits inside a socket (acetabulum) in the pelvic bone. Depending on the procedure, either both parts or just the ball-shaped portion of the femur may be replaced.

The artificial hip joint consists of several components:

• A metal stem is fitted into the thigh bone to support the implant.
• A metal or ceramic ball is attached to the stem to replace the femoral head.
• A socket made of metal, ceramic, or plastic is fitted into the pelvis to replace the acetabulum, the cup-shaped socket that surrounds the femoral head.
• A liner—plastic, ceramic, or metal—is placed between the parts, allowing them to glide smoothly.

These parts are secured either by cement (cemented implants) or by a press-fit technique (cementless implants) that allows bone to grow onto the implant. The artificial joint is designed to mimic the function of a healthy hip, allowing for improved movement and less pain. The procedure can be performed using traditional or minimally invasive techniques, depending on the patient’s needs and the surgeon’s approach.

There are several types of hip replacement procedures, each suited to different needs:

• Total hip replacement: Replaces both the ball of the thigh bone and the hip socket with artificial parts.
• Partial hip replacement: Replaces only the ball, leaving the native (original) socket in place.
• Revision hip replacement surgery: Replaces a prior artificial joint, usually due to wear, loosening, or other complications.
• Simultaneous bilateral total hip replacement: Replaces both hips during a single surgical procedure.

Hip replacement is recommended when hip pain and limited movement interfere with daily life and other treatments have not helped. The main reasons for needing hip replacement include joint damage from various conditions:

• Osteonecrosis, when loss of blood flow causes death and collapse of the femoral head.
• Childhood or developmental hip disorders that alter joint growth and how the joint works.
• Post-traumatic arthritis after a serious hip injury or fracture.
• Osteoarthritis, in which worn cartilage leads to pain and limited motion.
• Rheumatoid arthritis, an autoimmune disease (the immune system mistakenly attacks the body) that inflames the joint lining and damages cartilage.

Doctors may suggest surgery if these problems continue despite other treatments:

• Stiffness that makes activities of daily living difficult.
• Needing a cane, walker, or other aid to stay mobile.
• Pain that wakes a person at night or persists at rest.
• Hip pain that restricts walking, climbing stairs, or bending.

A good candidate for hip replacement is someone with hip pain or disability that limits daily activities and has not improved with other treatments. Eligibility is driven by pain level, day-to-day function, and overall health—not by age or weight alone. Most procedures are performed for people in their 50s to 80s, but good results are also seen in younger and older patients.

Candidates may have arthritis, injury, or other hip conditions that cause pain, stiffness, or trouble moving. Doctors evaluate each person individually based on medical history, overall health, and ability to safely undergo surgery and recovery. Certain health conditions may make hip replacement unsafe, such as active infection, severe heart or lung problems, or irreversible muscle weakness. The surgeon will discuss risks and benefits to help decide if hip replacement is the best option.

Preparing for hip replacement involves several steps to ensure a safe procedure and a smooth recovery. People can take steps weeks before the surgery to improve health and home safety.

Medical preparation includes:

• Attend a pre-surgery appointment for tests and evaluations.
• Review current medications with the health care provider and adjust as needed.
• Work with specialists to manage ongoing health problems.
• Address any infections or skin issues before surgery.

Lifestyle steps that can help reduce risks and support recovery include:

• Stop smoking to improve healing.
• Eat a balanced diet and keep alcohol within recommended limits.
• Do strengthening exercises for the legs and hips before surgery.
• Aim for weight loss if advised to lower surgical risks.

Home preparation involves:

• Set up support for household chores and personal care during the recovery period.
• Improve home safety by clearing obstacles and adding grab bars where needed.
• Keep important items within easy reach and prepare meals ahead of time.
• Get equipment such as a raised toilet seat or shower chair if needed.

Arrange rides for surgery and follow-up visits, since driving is usually not allowed until the surgeon says it is safe, which is often a few weeks after surgery.

Primary hip replacement is the first surgery to replace a damaged hip joint with artificial parts. (Revision hip replacement is a later surgery to replace or fix an existing artificial hip.)

During primary hip replacement, the surgeon removes damaged bone and cartilage and replaces them with artificial parts to restore a smooth, stable prosthetic joint. The operation usually takes about one to three hours in a hospital.

The main steps of the procedure are:

• The surgeon makes an incision based on the chosen approach:
• Anterior approach: The surgeon enters the joint from the front of the hip.
• Posterior approach: The surgeon enters from the back of the hip.
• Lateral approach: The surgeon enters from the side.
• Anterolateral approach: The surgeon enters between the front and side.
• The surgeon prepares the socket and fits a cup and liner.
• The surgeon removes the femoral head, then fits a stem and new ball into the femur.
• The surgeon secures the components with bone cement or by press-fit.
• The surgeon repairs nearby muscles and tendons to support the new hip.
• The surgeon repairs the soft tissues and closes the incision.

Some surgeons use smaller incisions and preserve more muscle; for some patients, this may speed early recovery.

Hip replacement is generally safe, but like any surgery, it carries risks and possible complications. The main risks and complications include:

• Blood clots: Clots can start in the leg veins and become dangerous if an embolus (a blood clot fragment that breaks off and enters the bloodstream) travels to the lungs. Signs include leg swelling, pain, redness, and sudden chest pain or shortness of breath. To lower the risk after surgery, the surgical team prescribes blood thinners, compression stockings, and early walking.
• Infection: The wound or the area around the artificial joint can become infected. Signs include fever, chills, redness, swelling, drainage, or simply increasing pain. Minor infections may be treated with antibiotics, but deep infections may require additional surgery.
• Dislocation: The artificial hip can come out of place, particularly during the first few months after surgery. This may cause pain, swelling, or a popping sensation. The joint can often be put back in place without surgery, but repeated dislocations will need additional surgery.
• Leg length difference: After surgery, one leg may feel longer or shorter. Surgeons try to avoid this, but a small difference may remain. Sometimes a shoe lift is needed.
• Loosening or wear of the implant: Over time, the artificial joint may loosen or wear out, causing pain or loss of function. Revision surgery to change components may be needed if this happens.
• Nerve or blood vessel injury: Rarely, nerves or blood vessels around the hip can be damaged during surgery, leading to weakness, numbness, or bleeding.
• Ongoing pain or stiffness: Some people continue to have pain or stiffness after surgery.
• Bruising and swelling: These are common after surgery and usually improve in the first few weeks.
• Metal sensitivity or adverse local tissue reaction: In rare cases, people may react to certain materials used in the artificial joint, especially with metal-on-metal implants.

Recovery after hip replacement involves gradual improvement in mobility, strength, and pain relief. Many people stay in the hospital for about one to two days after surgery, and some return home the same day when health and the surgical plan allow.

Early recovery steps include:

• Walking with crutches or a walker, usually starting the day of surgery.
• Doing exercises recommended by a physical therapist to strengthen the hip and improve movement.
• Managing pain with medicines as prescribed.
• Caring for the wound by keeping it clean and dry and changing dressings as instructed.
• Wearing compression stockings and taking blood thinners to prevent blood clots.

At home, people should:

• Avoid sitting in low chairs or crossing their legs.
• Use assistive devices for daily tasks, such as dressing sticks, reachers, and raised toilet seats.
• Gradually increase activity, starting with short walks and light chores.
• Follow the surgeon’s specific hip precautions; these may include not bending the hip more than 90 degrees and not twisting the leg.
• Arrange for help with meals, bathing, and household tasks for the first few weeks.

People typically transition away from crutches or a walker within two to four weeks as swelling and discomfort lessen. Stitches or staples are usually removed around 10 to 14 days after surgery. Most can drive again after about four weeks, but the timing for returning to work varies with job demands.

Full recovery can take up to six months, with continued improvement in strength and mobility. People should avoid high-impact activities, such as running or contact sports, but can enjoy low-impact activities like walking, swimming, and cycling.

There are several alternatives to hip replacement that may be tried before surgery. These include:

• Medicines such as acetaminophen or anti-inflammatory drugs can help reduce pain.
• Physical therapy and exercise programs to strengthen muscles and improve joint function.
• Activity changes that reduce strain on the hip, such as using walking aids or avoiding certain movements.
• Weight loss to reduce stress on the hip joint.
• Steroid injections (corticosteroids) into the hip to reduce pain and swelling.
• Wearing special footwear or insoles to improve support.

Other surgical options may include hip resurfacing (reshaping the femoral head and placing a metal cap on it), partial hip replacement, or procedures to repair or realign the joint. The choice of treatment depends on the person’s age, overall health, and severity of hip damage.

Most people who have hip replacement experience significant improvement in pain, mobility, and quality of life. Many artificial hip joints last at least 25 years, and some last even longer. Satisfaction rates are generally high, and most people return to normal daily activities. Major complications are uncommon.

Outcomes can vary based on age, overall health, activity level, and the type of implant used. Younger, more active people may need another replacement if the joint wears out sooner. Regular follow-up with the surgeon helps monitor the condition of the artificial hip and identify any problems early.

With proper care and activity changes, people can enjoy many years of improved function and less pain after hip replacement surgery.

“Yale Medicine, through the division of hip and knee joint reconstruction, distinguishes itself through a rare blend of historic surgical leadership and futuristic technology,” says Elie Mansour, MD, a Yale Medicine orthopaedic surgeon who specializes in hip and knee replacement and reconstruction. “All surgeons are fellowship-trained to deal with any primary or revision hip replacement surgery. Furthermore, every surgery is tailored to the patient’s unique anatomy, using cutting-edge technology in the field of hip replacement, including navigation and robotic surgery. An increasing percentage of patients discharged home on the same day after total hip replacement is another proof of the commitment of Yale Medicine to improving patient experience and satisfaction.”