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Total Hip Replacement

Total hip replacement — joint replacement surgery in which the hip is reconstructed with an artificial ball and socket.

A surgical treatment in which the damaged ball and socket surfaces of the hip joint are replaced with metal, ceramic, or specialized plastic components. It reduces hip pain and makes walking and daily movements easier.

Indication

  • Advanced hip osteoarthritis with persistent pain that does not respond to medication
  • Avascular necrosis (impaired blood supply and collapse of the femoral head)
  • Displaced femoral neck fracture (hip fracture) in older patients
  • Severe joint damage in inflammatory diseases such as rheumatoid arthritis or ankylosing spondylitis
  • Advanced osteoarthritis after developmental dysplasia of the hip
  • Failure of previous hip surgery (revision planning is addressed separately)
  • Persistent pain and loss of function not responding to conservative treatment (medication, physical therapy, weight control)

Preparation

  • Detailed examination, hip and pelvic X-rays, and CT or MRI when needed
  • Blood tests, ECG, chest X-ray, and anesthesia evaluation
  • Optimization of chronic conditions (cardiac, diabetes, hypertension)
  • Anticoagulants are adjusted with physician approval; any active urinary or dental infection is treated beforehand
  • Smoking cessation is recommended; home modifications such as grab bars, raised toilet seats, and non-slip mats are advised

How it's performed

  1. General or regional (spinal/epidural) anesthesia is administered
  2. Depending on the surgical approach, an incision is made on the lateral, posterior, or anterior hip
  3. The damaged femoral head is removed and the acetabulum (socket) is prepared
  4. The acetabular component (socket) and the femoral stem are placed, and the femoral head (ball) is fitted on top
  5. Limb length, joint stability, and range of motion are tested
  6. The wound is closed in layers and a drain is placed if needed

Post-procedure

  • Hospital stay is generally 2-4 days
  • Initial walking with a walker or crutches under physiotherapy guidance begins on the same day or the day after
  • Deep vein thrombosis (DVT) prophylaxis: anticoagulant medication, mechanical compression, and early mobilization, generally for 4-6 weeks
  • During the first 6 weeks, certain positions (excessive flexion, crossing the legs, internal rotation) are avoided to reduce dislocation risk
  • Physical therapy lasts 6-12 weeks; return to daily activities generally begins between 6-12 weeks
  • Annual follow-up X-rays monitor the condition of the prosthetic components

Risks

  • Infection (superficial or deep prosthetic infection)
  • Deep vein thrombosis (DVT) and pulmonary embolism — risk is reduced with prophylaxis
  • Prosthetic dislocation (highest risk in the first 3 months)
  • Leg length discrepancy or change in gait pattern
  • Periprosthetic fracture (fracture of bone around the prosthesis)
  • Vascular or nerve injury (especially the sciatic nerve, rare)
  • Loosening or wear of prosthetic components over time; revision may be required
  • Anesthesia and general surgical risks

FAQ

How long does a hip prosthesis last?

Functional service of 15-25 years and beyond is frequently reported with modern hip prostheses. Expected longevity depends on patient age, weight, activity level, bone quality, and the bearing surface couple selected (metal-polyethylene, ceramic-ceramic, etc.).

How is the risk of clots (DVT) reduced after surgery?

Deep vein thrombosis is an important risk after total hip replacement. Risk is greatly reduced through anticoagulant medication, mechanical compression stockings or devices, early walking, adequate hydration, and avoidance of prolonged immobility. Prophylaxis generally lasts 4-6 weeks and is personalized by the physician.

Which positions and movements should I avoid?

Depending on the surgical approach, hip flexion beyond 90 degrees (excessive forward bending, sitting on low chairs), crossing the legs, and internal rotation are generally not recommended in the first weeks. A raised toilet seat, sitting upright in chairs, and an appropriate bed height are used.

How long until physical therapy and return to daily life?

A structured physical therapy program lasts 6-12 weeks. Most patients can walk independently and manage daily activities by 6-12 weeks. Activities such as swimming, cycling, and light walking are considered safe; high-impact sports and prolonged running are generally not recommended.