Total hip replacement surgery aims to relieve hip pain and increase hip
function by resurfacing the bones that meet at the hip joint. The surgeon
removes the femoral head and replaces it with an artificial one. This
prosthetic femur head is shaped like a ball, and fits perfectly into the rounded
cup prosthesis that becomes the new socket of the pelvis.
Below is a detailed description of a typical total hip replacement surgery.
The actual surgery usually takes about two hours.
Total Hip Replacement Step-by-Step Description
Surgical procedures differ depending on the patient’s needs and the
surgeon’s approach, but generally the steps are as follows:
- The patient’s vital signs are checked to make sure blood pressure,
heart rate, body temperature, and oxygenation levels are normal and
surgery can proceed. A mark is made on the hip undergoing surgery.
- Anesthesia is administered. A patient may receive general anesthesia
(be put to sleep) or be given a regional anesthesia to block sensation
from the waist down, along with a relaxant. The type of anesthesia a
patient receives is decided well ahead of time.
- The surgeon makes a 10 to 12 inch incision, usually at the side or back
of the hip, cutting through skin and then through muscle and other soft
tissue to expose the bones at the hip joint. A surgeon
performing minimally invasive total hip replacement will make a
smaller incision and/or cut through less soft tissue.
- The surgeon dislocates the joint, removing the head of femur from its
socket in the pelvis. This socket is called the acetabulum.
- The arthritic femoral head is cut off with a bone saw.
- The surgeon prepares the acetabelum for its acetabular cup prosthesis
by using a special tool called a reamer to grind down and shape the
- acetabular cup is placed into the reshaped socket. This cup may
be porous to allow the bone to grow into it over time. Other acetabular
cups are adhered with special bone cement. The type of cup and how
it is adhered to the bone can depend on the surgeon’s preference and
the patient’s physiology.
- The surgeon puts a rounded acetabular insert/liner inside the
acetabular cup. The insert may be ceramic or plastic and will facilitate
smooth movement within the new joint.
- The surgeon prepares the femur bone and inserts the prosthetic
femoral stem into it. The femoral stem is a narrow, tapered metal shaft
that fits several inches down inside the femur. The top of the stem is
designed to hold a prosthetic ball that will replace the femoral head.
- A temporary prosthetic ball is attached to the top of the femoral stem.
This ball is specially shaped to move with the new acetabulum cup
and insert. The surgeon will insert a temporary ball into the new
socket and move the hip around, checking to make sure the joint has
ease of motion and does not dislocate.
- The surgeon will remove the trial component and insert the final ball
into the new socket, checking again for ease of movement and
dislocation. The surgeon will also attempt to restore optimal leg length
using one of several clinical techniques. Finally, X-rays are often
taken to assure proper sizing and positioning of the components.
- The muscle and other soft tissues that were cut are repaired and the
skin incision is stitched or stapled back together.
- Depending on the surgeon’s preference and surgical
technique/approach to the hip, prior to transferring the patient to the
recovery room, a wedge pillow may be placed between the legs to
prevent dislocation of the hip replacement.
After surgery, patients may spend several hours in a recovery room while the
surgical anesthesia wears off. Afterwards, a patient typically is taken to a
hospital room where he or she will spend 2 to 5 days recovering before being
A surgeon may give a patient a list of recommended post-surgical
precautions. Hip precautions typically address one of two issues:
- Range-of-motion precautions These precautions are recommended
to minimize the chance of dislocation. For example, a patient may be
told not to cross his or her legs.
- Weight bearing precautions These precautions maximize the
chance that the natural bone has an opportunity to grow into the
implants. For example, a patient may be told not to stand or walk
without using crutches or a walker.