What is hip replacement surgery?
The hip joint is described as a ball-and-socket structure due to the joint’s appearance of a ball (femoral head) fitting nicely in a cup-like socket (acetabulum). The ball is located at the top of the thigh bone (femur), and the socket is part of the pelvis. The area where the bones meet is covered by tissue called cartilage, which allows the joint to move smoothly.
In a healthy hip, smooth cartilage covers the ends of the thigh bone and pelvis. This allows the ball to glide easily in any direction inside the socket. In a hip requiring replacement surgery, the worn cartilage no longer serves as a cushion. As the bones rub together without cushioning, they become rough and cause pain. To reduce pain and improve function, an orthopaedic surgeon will remove the damaged components of the hip and insert an artificial joint, also referred to as an implant or prosthetic. Modern prosthetics are usually made of a superalloy (high-performance blend of metals), polymer (plastic), or ceramic, often in combination, for the most durable implant.
Penn Medicine’s joint replacement surgeons perform hip replacements using advanced materials and techniques for accurate and precise results. Recognized leaders in joint replacement care, our expert surgeons perform a high volume of hip replacement surgeries each year, including robotic hip replacement.
Types of hip replacement surgery
Your Penn Medicine care team will work with you to determine which type of surgery and approach is most appropriate for you based on the extent of your hip joint damage, bone quality, lifestyle, and overall health. Your options may include conventional surgery, minimally invasive techniques, or robotic hip replacement. Minimally invasive techniques are recommended whenever possible because they involve smaller incisions and less tissue disruption, which can lead to shorter recovery times.
- Total hip replacement: During this procedure, the surgeon removes the damaged parts of the hip joint and replaces them with artificial ball and socket components. Also known as total hip arthroplasty, this is the most common type of hip joint replacement.
- Partial hip replacement: This surgery replaces the ball of the hip joint only, not the socket. Also known as hemiarthroplasty, your doctor might suggest a partial hip replacement if the damage is limited to the ball of your hip. It typically works best for nondegenerative arthritis injuries (not primarily caused by wear and tear on the joints) and is typically reserved for older patients who have had a hip fracture or other medical condition that makes total hip replacement riskier.
- Bilateral hip replacement: This surgery replaces both hips at the same time. It may be recommended for people with degenerative joint disease who are experiencing severe and limiting pain in both hips and do not want to undergo surgery and postoperative rehabilitation twice.
- Hip revision surgery: This procedure removes and replaces some or all components of a previous hip implant that have failed or worn out. The typical lifespan for an artificial hip joint is 20 years. Penn Medicine performs many revisions of hip replacements that patients received in other facilities that did not last as expected.
The Penn Hip Preservation Center also offers a variety of nonsurgical and surgical alternatives to hip replacement, when appropriate. For example, hip resurfacing is an alternative to total hip replacement that keeps more of your natural bone intact. Instead of removing the entire ball of your hip joint, the surgeon trims and caps the femoral head with a metal implant. This procedure is often recommended for younger, active patients because it allows more stress on the hip joint than traditional replacements. It may also enable more natural movement since more of your original anatomy is retained.
Who might need hip joint replacement?
You may be a candidate for hip replacement if:
- Nonsurgical measures like medications and walking aids fail, and pain persists, worsens with movement, or disrupts sleep.
- Common activities become painful due to conditions like arthritis or fractures, causing stiffness, discomfort, and limitations in mobility.
- Conditions that degrade or destroy hip bone tissue, such as osteonecrosis or tumors, significantly compromising the hip.
Penn Medicine’s orthopaedic specialists will perform a comprehensive physical examination, take a complete medical history, and order diagnostic imaging tests to determine if you are a candidate for hip replacement. Hip replacements are most commonly performed in individuals between 50 and 70 years old. However, your doctor may recommend the surgery if it’s the best option to address your pain and disability, regardless of your age.
What to expect during your hip replacement procedure
During your procedure, you should not feel pain. You will either be given general anesthesia that puts you to sleep or regional anesthesia that numbs the lower half of your body. Pain experienced during and after hip replacement surgery can vary depending on several factors, including the surgical approach your doctor chooses, as well as your individual pain tolerance and overall health. Your Penn Medicine care team will work with you to develop a comprehensive pain management plan.
Hip replacement surgery is a big decision, and it’s normal to feel a bit nervous. Being proactive can help make the process smoother and boost your confidence, so take time to understand what’s involved in preparing for hip replacement surgery and hip replacement recovery.
A total hip replacement usually takes two to three hours.
- Your surgeon will make an incision at the back (anterior), front (posterior), or side (lateral) of your hip to expose the hip joint before carefully moving or detaching the muscles and tendons around the joint to gain access to the joint itself.
- Damaged or diseased parts of your hip joint, including the femoral head and any damaged cartilage in the socket, will be removed.
- The new artificial hip socket, a metal shell, will be placed into the prepared socket, and a liner inserted to allow for smooth movement of the joint.
- The upper end of your femur will be shaped and hollowed out to accommodate the implant. Then, a metal stem will be inserted into the femur and secured.
- The new artificial ball will be attached to the top of the metal stem inserted into the femur. This ball is then positioned in the new socket, creating the artificial hip joint.
- Your surgeon will check the range of motion and stability of the replacement hip joint to ensure that it functions properly before repairing and reattaching surrounding muscles and tendons and closing the incision with stitches, staples, glue, or mesh.
Minimally invasive hip replacement usually takes one to two hours.
- Your surgeon will make one or two small incisions, about three to six inches long, on the front, side, or back of the hip to access the hip joint. The location of these incisions depends on the specific approach used.
- Using specialized instruments designed for minimally invasive surgery, the surgeon will work through the small incisions to remove damaged bone and cartilage from the hip joint.
- The upper end of your femur will be prepared to receive the implant, and then imaging technology (like an x-ray) is used to visualize and guide proper placement.
- A metal stem will be inserted into the prepared femur and secured in place and the new artificial ball will be attached to the top of the stem to replace the femoral head.
- The damaged cartilage in the hip socket will be removed and replaced with an artificial socket. A liner is then placed in the new socket to allow for smooth movement of the joint.
- Your surgeon will check the stability and range of motion of the new hip joint before closing the incisions with stitches, staples, glue, or mesh.
Hip revision surgery typically takes two to four hours, depending on the complexity of the procedure.
- Your surgeon will begin by making an incision. Often your previous hip replacement incision can be used, but sometimes a new incision is needed.
- The previous damaged or failed components of the original implant will be carefully removed, along with any surrounding tissue that may be causing issues, such as infection or bone loss.
- If needed, the bone will be reshaped or reinforced to support the new implant. The replacement components—designed to restore the hip’s function and stability—will then be secured in place.
- Your surgeon will test the range of motion and stability of the revised joint to ensure proper alignment before closing the incision using stitches, staples, glue, or mesh.
Leaders in hip joint replacement, research, and care
At Penn Medicine, our orthopaedic hip surgeons use advanced techniques for precision and accuracy in every procedure. We perform a high number of hip replacement surgeries each year and participate in a wide range of joint replacement research, which enables us to bring you the latest evidence-based care. We focus on understanding your unique needs and goals as we develop a treatment plan tailored to you.
We also offer:
- Nurses and advanced practice providers to guide you throughout the process, from scheduling appointments to recovery, and answer any questions you may have along the way
- Innovative pain management to alleviate pain without increasing the risk of opioid overuse and addiction
- Same-day discharge option for motivated patients in good health with a strong recovery support system at home
- Comprehensive post-surgical rehabilitation to maximize your physical function and quality of life
- Convenient access to ongoing care, with multiple specialists often available within the same location
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