Total Hip Replacement Surgical Procedure

Learning about what happens during hip replacement surgery can help ease confusion and anxiety. The surgery typically takes about 2 hours. During that time the surgeon removes the arthritic (damaged) surfaces of the hip joint and replaces them with artificial ones.

Total Hip Replacement, Step-by-Step

The exact steps of the surgical procedure will depend on the patient’s needs and the orthopedic surgeon’s training and approach, but generally the steps are as follows:

• The patient’s vital signs are checked to make sure blood pressure, heart rate, body temperature, and oxygenation levels are normal and surgery can proceed. A mark is made on the hip undergoing surgery.
• Anesthesia is administered. A patient may receive general anesthesia (be put to sleep) or be given a regional/spinal anesthesia to block sensation from the waist down, along with a relaxant. The type of anesthesia a patient receives is decided well ahead of time.

  See Anesthesia for Orthopedic Surgery

• The surgeon makes an incision, usually at the side or back of the hip, cutting through skin and then through muscle and other soft tissue to expose the bones at the hip joint. Anterior hip replacement surgeries use an incision at the front of the hip.
• The surgeon dislocates the joint, removing the head of femur from its socket in the pelvis. This socket is called the acetabulum.

• The arthritic femoral head is cut off with a bone saw.
• The surgeon prepares the acetabulum for its acetabular cup prosthesis by using a special tool called a hemispheric reamer to grind down and shape the socket.

• The acetabular cup is placed into the reshaped socket. This cup is often made of porous titanium metal to allow the bone to grow into it over time, or it may be attached with special bone cement. The type of cup and how it is attached to the bone depends on the surgeon’s preference and the patient’s physiology.
• The surgeon puts a rounded acetabular insert/liner inside the acetabular cup. The insert may be ceramic or plastic and will facilitate smooth movement within the new joint.
• The surgeon prepares the femur bone and inserts the prosthetic femoral stem into it. The femoral stem is a narrow, tapered metal shaft that fits several inches down inside the femur. The top of the stem is designed to hold a prosthetic ball that will replace the femoral head.

• A temporary prosthetic ball is attached to the top of the femoral stem. This ball is size-matched to the new acetabulum cup and insert. The surgeon will insert a temporary ball into the new socket and move the hip around, checking to make sure the joint has ease of motion and does not dislocate.
• The surgeon will remove the trial component and insert the final ball into the new socket, checking again for ease of movement, potential ease of dislocation, and restoration of the proper anatomy of the hip, including leg length.
• X-rays may be taken to assure proper sizing and positioning of the components.
• The muscle and other soft tissues that were cut are repaired.
• The skin incision is stitched or stapled back together.

Keep in mind that the total surgical time may be more or less than 2 hours depending on the type of replacement procedure the orthopedist feels is most suitable.

After surgery, patients may spend several hours in a recovery room while the surgical anesthesia wears off. Afterwards, a patient typically is taken to a hospital room where 1 to 2 days are spent recovering before discharge. Some hip replacement surgeries can now be done as “same day” or “come and go” procedure.

See Postoperative Care for Hip Replacement