The basic steps of a hip replacement

A hip replacement removes the damaged ball-and-socket joint at the top of your thighbone and replaces it with artificial parts. The surgeon makes an incision (usually 8 to 10 inches long), removes the worn cartilage and bone from the hip socket, and removes the head of the thighbone. They then insert a metal or ceramic ball attached to a stem into the thighbone, and fit a plastic or ceramic cup into the hip socket. The whole operation typically takes 1 to 2 hours.

Most hip replacements today use one of two surgical approaches: the anterior approach (cutting through the front of the hip) or the posterior approach (cutting through the back). Your surgeon will choose based on your anatomy and the type of implant being used. Both approaches aim to preserve muscle and tissue as much as possible, though they have different recovery timelines and movement restrictions afterward.

Key Takeaways

  • Hip replacement surgery removes the damaged joint and replaces it with metal, ceramic, or plastic parts that mimic a natural hip.
  • The surgeon typically uses either an anterior (front) or posterior (back) approach, each with different recovery restrictions.
  • The operation takes 1 to 2 hours, and you will spend 1 to 3 days in the hospital before going home.
  • Physical therapy begins within days of surgery and continues for several weeks to rebuild strength and movement.
  • Most people can return to light activities within 6 weeks and resume normal activities within 3 to 6 months.

What happens before surgery

Before your surgery date, your doctor will order blood tests, an X-ray or MRI of your hip, and possibly an EKG if you have heart concerns. You will meet with the anesthesiologist to discuss your medical history and any medications you take. About a week before surgery, you may be asked to stop taking blood thinners or certain pain medications. Your surgeon will also give you specific instructions about eating and drinking the night before—typically you cannot eat or drink anything after midnight.

Prepare your home before surgery day. You will need crutches or a walker, a raised toilet seat, a shower chair, and grab bars in the bathroom. Stock your freezer with straightforward meals and arrange for someone to drive you home and help for the first week or two. Wear loose, comfortable clothing on surgery day, and leave jewelry and valuables at home.

Anesthesia and positioning during surgery

When you arrive at the operating room, an anesthesiologist will place an IV line and give you medication to help you relax. You will receive general anesthesia (you will be asleep) or regional anesthesia (numbing from the waist down while you remain conscious). Most hip replacements use general anesthesia. Once you are asleep, a catheter is placed so you do not need to get up to urinate during recovery.

The surgical team positions you on your side or back depending on which approach the surgeon is using. The surgical site is cleaned with an antiseptic solution and draped with sterile sheets. The entire area is kept sterile throughout the operation to prevent infection.

Removing the damaged joint and inserting the implant

The surgeon makes the incision and carefully moves muscles and soft tissue aside to reach the hip joint. They dislocate the thighbone from the socket, then use a saw to remove the head of the thighbone and a reamer to enlarge and shape the hip socket. The surgeon then inserts the new socket (called an acetabular cup) into the pelvis—it may be held in place with cement, screws, or a press-fit design that relies on bone to grow into it over time.

Next, the surgeon prepares the thighbone by removing bone and shaping it to fit the new stem. The stem is inserted into the thighbone, and the new ball is attached to the top of the stem. The surgeon tests the hip to make sure it moves smoothly and is stable, then closes the incision with stitches or staples. A drain may be left in place temporarily to prevent fluid buildup.

Recovery in the hospital and first weeks at home

You will wake up in the recovery room with bandages on your hip and possibly a drain. Pain medication is given through your IV, and nurses monitor your vital signs. Most people stay in the hospital for 1 to 3 days. Physical therapists will visit your room to teach you how to move safely and use crutches or a walker. You may be able to put some weight on your leg the day after surgery, depending on your surgeon's instructions and the type of implant.

At home, keep your hip incision clean and dry until it heals (usually 2 to 3 weeks). Take pain medication as prescribed, use ice packs to reduce swelling, and elevate your leg when resting. Wear compression stockings if your surgeon recommends them to prevent blood clots. Watch for signs of infection—fever, increased redness, warmth, or drainage from the incision—and contact your doctor when ready if you notice any.

Physical therapy and regaining movement

Physical therapy is critical to your recovery and begins in the hospital. A therapist will show you exercises to strengthen the muscles around your hip and improve your range of motion. In the first weeks, exercises are gentle and focus on preventing stiffness. You will learn how to safely get in and out of bed, walk with your assistive device, and climb stairs.

After you go home, you will continue therapy either at a rehabilitation facility, an outpatient clinic, or with a home therapist visiting your house. Most people attend therapy 2 to 3 times per week for 4 to 6 weeks. The exercises gradually become more challenging as your strength improves. Your therapist will also teach you how to protect your hip—for example, not crossing your legs or bending your hip more than 90 degrees if you had a posterior approach surgery.

Timeline for returning to normal activities

Most people can walk without crutches or a walker within 3 to 6 weeks, though some take longer. You can usually drive again once you stop taking prescription pain medication and feel confident controlling the car (typically 4 to 6 weeks). Light activities like walking, swimming, and stationary cycling can usually resume within 6 to 8 weeks.

Returning to normal activities—work, sports, and hobbies—typically takes 3 to 6 months. High-impact activities like running or jumping are usually not recommended, as they can wear out the implant faster. Your surgeon will give you specific guidelines about what activities are safe for your new hip. Most modern hip replacements last 15 to 20 years or longer, depending on your age, activity level, and the type of implant used.

Possible complications and when to call your doctor

Serious complications are uncommon but can include infection, blood clots, dislocation of the hip, or nerve or blood vessel injury. Signs of infection include fever above 101°F, increasing redness or warmth around the incision, or pus or foul-smelling drainage. Blood clots may cause calf pain, swelling, or warmth in one leg. A dislocated hip feels like the hip has "popped out" and causes severe pain and inability to move the leg.

Call your surgeon when ready if you experience fever, signs of infection, chest pain, shortness of breath, calf swelling, severe pain not relieved by medication, or inability to bear weight on your leg. Less urgent but still important: contact your doctor if you have persistent swelling, stiffness that does not improve with therapy, or concerns about your recovery progress. Most people recover well and experience significant pain relief and improved mobility within a few months.

Frequently Asked Questions

Will I need a blood transfusion during hip replacement surgery?

Most people do not need a blood transfusion during hip replacement. Your surgeon will monitor blood loss during the operation. If your blood count drops significantly, a transfusion may be given, but this is not routine. You can discuss your concerns about transfusion with your surgeon before surgery.

How long does the incision take to heal?

The skin incision typically closes within 2 to 3 weeks, though the deeper tissues continue healing for several months. Keep the incision clean and dry, and do not soak it in water until your surgeon says it is okay. Avoid heavy lifting and strenuous activity during this time to prevent the incision from reopening.

Can I sleep on the side of my new hip?

This depends on your surgical approach. If you had a posterior approach, your surgeon will likely ask you to avoid sleeping on the operated side for 6 to 8 weeks to prevent dislocation. If you had an anterior approach, sleeping on your side is usually safer sooner. Ask your surgeon for specific guidance.

What if I fall after hip replacement surgery?

Falls are a concern during recovery because your hip is still healing and your balance may be off. If you fall, do not try to get up when ready. Call for help, and have someone information you. Contact your surgeon or go to the emergency room if you have pain, swelling, or inability to move your leg after a fall.

Do I need to take antibiotics before dental work after hip replacement?

This depends on how long ago your surgery was and your individual risk factors. Most surgeons recommend antibiotics before dental procedures for the first 2 years after hip replacement to prevent infection. Ask your surgeon and dentist about your specific situation.