Overview
The hip is a ball-and-socket joint. The ball is the top of the femur (femoral head). The socket (acetabulum) is part of the pelvis. A smooth lining of cartilage lets the two glide. That lining can wear away from osteoarthritis, inflammatory arthritis, bone death (avascular necrosis), or damage after an old injury. Once it does, bone grinds on bone and every step hurts. Total hip replacement resurfaces both sides of the joint with a smooth metal-and-plastic implant.
Hip replacement is a well-established operation. The first modern total hip replacement was performed in the early 1960s, and more than 450,000 are now done each year in the United States.
Source: AAOS OrthoInfo, Total Hip Replacement (accessed June 2026)
How the Procedure Works
We remove the worn femoral head and resurface both sides of the joint. The socket is shaped until healthy bone supports a new metal cup, which is pressed into place at carefully chosen angles, and a plastic liner clicks inside it. On the femoral side, we prepare the canal and seat a stem, then fit a ceramic or metal ball that rides in the liner. Cup position and leg length drive how the hip feels and how long it lasts, so we confirm both on live X-ray (fluoroscopy) before closing. The operation usually takes one to two hours.
Surgical Approaches: Anterior and Posterior
OSI surgeons perform total hip replacement through both the anterior (front) and posterior (back) approaches. The implants and the final alignment are the same either way. What differs is the path to the joint, and that choice is made for each patient based on anatomy, body build, and surgeon judgment.
Anterior (front) approach
We work through a natural plane between muscles at the front of the hip. No muscle is cut or detached from bone, and the capsule at the back of the joint and the buttock muscles stay intact. That often means fewer motion restrictions and a faster early recovery, so the strict hip precautions used after posterior surgery are generally not needed.
Posterior (back) approach
We reach the hip through the back of the buttock, splitting the large buttock muscle along its fibers and temporarily releasing the small rotator muscles beneath it. Those muscles are repaired back to bone at the end of surgery, which greatly lowers the risk of dislocation. With this approach you follow hip precautions, simple limits on how far you bend and rotate the hip, for about the first six weeks while the repair heals.
When to Consider Total Hip Replacement
We generally offer total hip replacement when your symptoms, your imaging, and a full course of non-surgical care all point the same way. The typical picture includes:
Arthritis that limits function
Hip pain from osteoarthritis, avascular necrosis (bone death from lost blood supply), or hip dysplasia (a shallow or malformed socket), with daily pain and lost function.
Exhausted non-operative care
Non-surgical care has not worked, including weight loss, low-impact exercise, anti-inflammatory medicine, and injections into the joint.
Good surgical candidate
Your medical conditions are well controlled and there is no active infection, and your bone quality and anatomy can hold an implant.
Most people who have a hip replaced are between 50 and 80 years old, but there are no absolute age limits. Candidacy is based on your pain, your function, and what your imaging shows, not your age alone.
Conditions This Treats
Risks
Every operation carries risk. This procedure is offered because the condition, when left untreated, can cause groin and thigh pain with every step, lost motion, and a slow loss of the ability to stand, walk, and sleep in comfort. The decision to proceed weighs the risks of surgery against the limitations the condition places on daily function. Surgery does not remove risk; it addresses a problem that is otherwise progressive. Whether it is appropriate is determined for each patient in consultation with the surgeon.
The risks we discuss with you before total hip replacement include:
- bleeding and infection (including rare deep infection around the implant, called periprosthetic infection)
- anesthesia risk
- blood clot in the leg or lung, reduced with blood thinners, walking, and compression stockings after surgery
- dislocation, particularly in the early recovery phase
- leg-length discrepancy
- nerve injury (rare), such as irritation of a small skin nerve at the front of the thigh or, with a posterior approach, the sciatic nerve
- a break in the bone around the implant (periprosthetic fracture)
- component loosening or wear over time
Serious complications, such as a deep infection of the new joint, occur in fewer than 2 percent of patients. Surgery is right when end-stage hip arthritis causes daily pain and lost function that has not improved with non-surgical care. If that picture does not fit you, this operation is not offered.
Source: AAOS OrthoInfo, Total Hip Replacement (accessed June 2026)
Recovery & What to Expect
Most people are up and walking with help the day of surgery and resume light daily activities within three to six weeks. Physical therapy builds the strength and balance to walk without a limp. If a posterior approach is used, you follow hip precautions for about the first six weeks; with the anterior approach those strict precautions are generally not needed. Stitches or staples come out about two weeks after surgery.
Source: AAOS OrthoInfo, Total Hip Replacement (accessed June 2026)
Outcomes & Long-Term Expectations
A replaced hip is built for a low-impact, active life: walking, swimming, golf, and biking are all realistic. High-impact activities like running and jumping are discouraged because they wear the implant faster. Modern hip implants are durable, and how long one lasts depends most on your activity level and weight rather than the brand of the implant.
Source: AAOS OrthoInfo, Total Hip Replacement (accessed June 2026)
Frequently Asked
questions we hear in clinicWhat is the difference between the anterior and posterior approaches?
The implants and the final alignment are the same either way. Only the path to the joint differs. The anterior approach goes between muscles at the front and usually avoids strict hip precautions. The posterior approach goes through the back of the buttock, with the small rotator muscles repaired at the end and hip precautions for about six weeks. Your surgeon recommends the approach that fits your anatomy.
Will I have to follow strict hip precautions afterward?
It depends on the approach. After an anterior replacement the back of the joint and the buttock muscles are left intact, so the strict precautions are generally not needed. After a posterior replacement you follow hip precautions for about the first six weeks while the repaired muscles heal.
How do you make sure my legs end up the same length?
Leg length is planned before surgery from your X-rays and measured rather than estimated. Before anything is locked in, we confirm leg lengths on live X-ray and against your other side. A leg-length difference is still a listed risk, which is why it is checked this carefully.
Could the new hip dislocate?
Dislocation is one of the risks we discuss, particularly in the early recovery phase. Cup position drives that risk, so we confirm the cup's angles on live X-ray before finishing, and with a posterior approach the small rotator muscles are repaired to lower it further.
Am I too old for a hip replacement?
There are no absolute age limits. Most patients are between 50 and 80, but candidacy is based on your pain, your function, and what your imaging shows, not your age alone.
How long does the surgery take?
The operation itself usually takes one to two hours. You spend additional time in preparation beforehand and in the recovery area afterward.
Further Reading
Outside reading we trust, plus related OSI pages:
