ORTHOPEDICS + SPORTS MEDICINE
Total Hip Replacement
Replacing the worn hip joint to relieve arthritis pain and restore comfortable, confident movement.
Hip arthritis rarely changes life all at once. More often, walking becomes shorter, stairs become harder, and putting on shoes requires more effort than it once did. Pain may eventually continue at night or while resting. Total hip replacement addresses this progression by replacing the damaged surfaces of the joint with components that move together as a new ball and socket.
The decision to replace a hip is based on more than an X-ray. The care team considers the level of joint damage alongside the patient’s pain, mobility, health, and response to nonsurgical care. At Sforzo | Dillingham | Stewart Orthopedics + Sports Medicine, the objective is to develop a surgical and recovery plan that supports safer movement and a meaningful return to everyday activities.
Anatomy of the Hip
The hip is one of the body’s largest weight-bearing joints. It is formed by the femoral head, or ball at the top of the thighbone, and the acetabulum, a socket within the pelvis.
Articular cartilage covers the surfaces of the ball and socket, allowing them to glide with very little friction. A lining called the synovial membrane produces fluid that lubricates the joint, while strong ligaments and surrounding muscles contribute to stability.
When cartilage deteriorates, the joint loses its smooth surface. The resulting friction can cause inflammation, stiffness, and pain in the groin, thigh, buttock, or knee. As the damage advances, the hip may become increasingly difficult to move.
Conditions That Can Damage the Hip
Osteoarthritis is the most common reason for total hip replacement. This degenerative condition develops as cartilage wears down over time. Other conditions can also cause enough joint damage to make replacement necessary, including:
- Rheumatoid and other inflammatory forms of arthritis
- Arthritis following a previous injury
- Osteonecrosis of the femoral head
- Certain childhood hip conditions
- Severe fractures involving the hip joint
Regardless of the cause, patients are typically considered for replacement when joint damage produces persistent pain and loss of function.
When Does Hip Replacement Become an Option?
Medication, physical therapy, activity modification, injections, and walking supports may help manage hip symptoms. These treatments can be appropriate for mild or moderate arthritis, particularly when pain remains occasional and mobility is largely preserved.
Total hip replacement may be discussed when pain interferes with walking, bending, sleeping, or getting in and out of a chair. Stiffness that limits leg movement and inadequate relief from nonsurgical treatment may also indicate that the joint should be evaluated for replacement.
The assessment generally includes a review of the patient’s medical history, a physical examination, and X-rays. The surgeon evaluates hip motion, strength, alignment, and the pattern of cartilage loss. Additional imaging is used only when more information about the bone or surrounding soft tissues is necessary.
What Is Replaced During Surgery?
Total hip replacement, also called total hip arthroplasty, replaces both sides of the damaged joint.
The surgeon removes the worn femoral head and prepares the center of the thighbone for a stem. A new ball is attached to this stem to recreate the upper portion of the femur. The damaged cartilage and bone within the acetabulum are also prepared, and a new socket is positioned in the pelvis. A liner between the components creates a smooth surface for movement.
Components may be secured with bone cement or designed to allow the patient’s bone to grow against their surfaces. The method depends on bone quality, anatomy, age, and other clinical considerations.
The surgeon also works to restore appropriate joint alignment, stability, and leg length. Although the artificial hip recreates the ball-and-socket relationship, its materials and mechanics differ from those of a natural joint.
Choosing a Surgical Approach
A total hip replacement can be performed through different surgical approaches. These include anterior, posterior, and lateral approaches, which describe the direction used to reach the joint.
With an anterior approach, the surgeon reaches the hip from the front of the body and works between muscle groups. Other approaches reach the joint from the side or back. Each method has benefits and considerations, and no single approach is appropriate for every patient.
The selection may depend on:
- The patient’s anatomy and body composition
- Bone quality and joint deformity
- Previous hip procedures or surgical scars
- The surgeon’s training and experience
- Medical conditions that may affect healing
- The type of reconstruction required
The approach is one part of the surgical plan rather than the only factor influencing recovery or long-term function.
Preparing for Hip Replacement
Preparation often includes a medical evaluation to identify health conditions that could affect surgery or healing. Patients receive instructions regarding medications, skin care, dental concerns, and eating or drinking before the procedure.
The home environment may also need temporary changes. Removing tripping hazards, arranging commonly used items within easy reach, and planning for help with meals or household responsibilities can make the first weeks more manageable.
A walker, crutches, or a cane is commonly used after surgery. Patients should understand how their home is arranged before the procedure, especially if they must navigate stairs.
Walking and Physical Therapy After Surgery
Movement begins soon after total hip replacement. Early walking supports circulation, helps reduce the risk of certain complications, and begins the process of restoring mobility. An assistive device provides stability while strength and balance improve.
Physical therapy focuses on safe movement and the gradual return of hip function. Rehabilitation may include:
- Walking with proper mechanics
- Getting into and out of a bed or chair
- Navigating stairs
- Exercises for hip and leg strength
- Balance and flexibility work
- Progressing from a walker to a cane and then independent walking
Many patients resume light daily activities within several weeks, but recovery varies. Endurance, balance, and strength continue improving after the initial healing period. Driving, work, exercise, and recreational activities are resumed according to the surgeon’s guidance.
Low-impact activities are generally more appropriate for a replaced hip than repeated running, jumping, or other high-impact exercise.
When to Meet With a Hip Specialist
A consultation may be appropriate when hip pain has begun limiting walking, sleep, work, or personal care. Increasing reliance on medication or a cane, difficulty putting on shoes, and loss of hip motion are additional reasons to seek an evaluation.
Hip pain can also come from the lower back, muscles, tendons, or structures outside the joint. A specialist can identify the source of the symptoms before determining whether joint replacement should be part of the treatment discussion.
Summary
Total hip replacement is intended for advanced joint damage that can no longer be managed adequately with conservative care. The operation replaces painful surfaces, but rehabilitation is what helps the patient learn to move confidently with the reconstructed joint.
A thoughtful decision includes understanding the procedure, its risks, the work involved in recovery, and the activities the new hip is expected to support. At Sforzo | Dillingham | Stewart Orthopedics + Sports Medicine, our surgeons, guide patients through each of these considerations so they can approach surgery with a clear and realistic plan.