Hip Replacement Procedure Steps: What Happens Before, During & After

Hip replacement surgery is a common procedure that helps people regain movement and reduce pain caused by severe joint damage. The procedure involves removing the damaged parts of the hip joint and replacing them with artificial components designed to restore function. Knowing the steps of this surgery can make the process feel clearer and less overwhelming.

During the operation, a surgeon makes an incision, removes the worn-out bone and cartilage, and places a new ball and socket into the hip. The artificial joint may be made of metal, ceramic, or durable plastic, and it is designed to work much like a natural hip. Understanding how these steps fit together provides a clear picture of what actually happens in the operating room.

Learning about the process also helps set expectations for preparation, recovery, and long-term care. With the right information, anyone facing this surgery can feel more confident about what lies ahead and how each stage supports healing.

Key Takeaways

• Hip replacement replaces damaged joint parts with artificial components
• The procedure follows a clear series of surgical steps
• Recovery and long-term care are important for the best outcome

Understanding Hip Replacement and Common Causes

Hip replacement surgery addresses damage to the hip joint that leads to pain, stiffness, and loss of mobility. The joint’s structure, the conditions that harm it, and the reasons doctors recommend surgery all play a role in deciding if a patient needs total hip replacement.

Structure of the Hip Joint

The hip joint is a ball-and-socket joint. The ball is the femoral head at the top of the thigh bone, and the socket is the acetabulum in the pelvis. This design allows smooth rotation and movement in multiple directions.

Cartilage covers both the ball and socket, creating a low-friction surface that helps the bones glide easily. A thin layer of synovial fluid also reduces wear.

When cartilage wears down, bones rub together and cause pain. Over time, this leads to stiffness, swelling, and reduced function. The hip joint then struggles with tasks such as walking, bending, or climbing stairs.

Damage to the hip joint often progresses slowly, but once cartilage loss becomes severe, non-surgical treatments usually provide limited relief. At this stage, patients often explore surgical options like total hip arthroplasty.

Causes of Hip Pain and Disability

• Arthritis is the most common cause of hip pain that leads to replacement surgery. Osteoarthritis results from long-term wear and tear of cartilage. It typically develops with age and causes stiffness, swelling, and limited movement.
• Rheumatoid arthritis is an autoimmune condition that inflames the joint lining. This chronic inflammation damages cartilage and bone, leading to deformity and pain.

Other causes include hip fractures, often from falls, and conditions such as avascular necrosis, where reduced blood supply weakens the bone. Some people also develop hip problems from childhood disorders that alter joint alignment.

When these conditions progress, everyday activities like standing up, sitting, or walking become difficult. At this point, many patients seek medical evaluation to discuss surgical treatment options such as total hip replacement.

When Hip Replacement Is Recommended

Doctors recommend hip replacement when pain and disability no longer improve with nonsurgical treatments. Common conservative options include medication, physical therapy, walking aids, and activity changes.

If these methods fail, total hip replacement may be considered. During this procedure, the surgeon removes damaged bone and cartilage and replaces them with artificial components that restore smoother movement.

Candidates often report severe pain in the groin, buttock, or thigh that limits daily life. Imaging tests such as X-rays confirm joint damage. According to the Mayo Clinic, arthritis damage is the leading reason for surgery.

Patients who undergo total hip arthroplasty typically do so to regain mobility, reduce pain, and return to normal activities after other treatments have failed.

Preoperative Evaluation and Preparation

Patients preparing for hip replacement surgery go through several important steps that help ensure safety, reduce risks, and improve recovery. These steps involve medical testing, education about the procedure, and exercises to strengthen the body before surgery.

Medical Assessment and Imaging

A medical evaluation is completed to confirm that the patient is healthy enough for surgery. This often includes blood tests, an electrocardiogram, and sometimes a chest x-ray to check heart and lung function. Doctors may also review current medications and allergies to prevent complications.

Imaging studies, such as X-rays or an MRI, give surgeons a clear view of the joint. These images help determine the extent of damage and guide decisions about implant type and placement.

Other assessments may include a urine test, stress test, or consultation with specialists if the patient has conditions like diabetes or heart disease. Each step is designed to lower surgical risks and plan for the safest approach.

Patient Education and Planning

Patients are encouraged to attend education sessions or classes that explain what happens before, during, and after surgery. At some hospitals, these sessions are part of structured programs such as hip replacement classes.

During these meetings, patients learn about anesthesia, pain relief options, and the expected hospital stay. They also receive instructions about diet restrictions, stopping certain medications, and arranging support at home.

Planning often includes preparing the living space for recovery. Examples include removing loose rugs, installing grab bars, or arranging for help with meals and transportation. These changes make recovery safer and more manageable.

Pre-Surgery Physical Therapy

Many surgeons recommend a program of pre-surgery physical therapy, sometimes called “prehab.” The goal is to build muscle strength around the hip and improve flexibility. Stronger muscles can make it easier to walk and reduce strain on the new joint after surgery.

Common exercises include:

• Quad sets (tightening thigh muscles)
• Hip abductions (moving the leg outward)
• Gluteal sets (tightening buttock muscles)
• Straight leg raises

Even light activity, when safe, can improve circulation and help with endurance. Patients who follow these exercises often find rehabilitation after surgery more manageable and less painful.

Step-by-Step Hip Replacement Procedure

The hip replacement procedure involves careful preparation, removal of diseased bone and cartilage, and placement of artificial parts that restore joint function. Each stage focuses on safety, precision, and proper alignment to ensure the new joint works smoothly.

Anesthesia and Patient Positioning

The operation usually begins with general anesthesia or a regional nerve block. General anesthesia keeps the patient fully asleep, while a regional block numbs the lower body but allows the patient to remain awake. The choice depends on medical history, risks, and surgeon's preference.

Once anesthesia takes effect, the patient is positioned on the operating table. The most common positions are lateral (side-lying) or supine (lying on the back). Positioning matters because it affects surgical access and implant alignment.

Padding and supports are used to keep the body stable. This step helps protect nerves and soft tissues during the procedure. Careful positioning also reduces the risk of complications like dislocation after surgery.

Surgical Approach and Exposure

Surgeons use different approaches to access the hip joint. The posterior approach is common and involves an incision along the back of the hip. The anterior approach uses an incision at the front of the hip. Each method has benefits and risks, and the choice depends on the patient’s anatomy and the surgeon’s training.

The incision is made through the skin, fat, and muscle layers. In the posterior approach, the gluteus maximus muscle is split, and the external rotators are released to expose the joint. In the anterior approach, muscles are spread apart rather than cut.

Once the joint is exposed, retractors hold tissues aside, giving the surgeon a clear view of the femoral head and acetabulum.

Removal of Damaged Hip Structures

The next step involves removing diseased or worn-out parts of the hip. The surgeon dislocates the femoral head from the socket. A neck osteotomy is performed, which means cutting through the upper femur to remove the femoral head.

The socket, or acetabulum, is then cleaned of cartilage and shaped with a reaming tool. This creates a smooth surface to hold the artificial cup. The femoral canal is also prepared by reaming and broaching, which shapes the bone for the femoral stem.

This stage ensures that all damaged tissue is removed and that the bone surfaces are ready to accept the prosthetic parts.

Implantation of Prosthetic Components

With the joint prepared, the surgeon places the prosthetic components. A metal socket (acetabular cup) is inserted into the acetabulum, sometimes secured with screws for stability. A plastic or ceramic liner is then snapped into the cup to create a smooth surface.

Next, the femoral stem is inserted into the hollowed femur. The stem may be cemented in place or press-fit to allow bone to grow around it. A metal or ceramic ball is attached to the top of the stem, replacing the femoral head.

The new ball is then placed into the socket, recreating the joint. The surgeon checks leg length, joint stability, and range of motion before closing the incision. Careful testing at this stage helps prevent dislocation and ensures proper function of the new hip.

Recovery, Rehabilitation, and Long-Term Care

Recovery after hip replacement surgery involves careful monitoring, structured pain management, and progressive physical activity. Patients typically regain mobility within weeks, but long-term success depends on building muscle strength, protecting the new joint, and following medical guidance.

Immediate Postoperative Care

Right after surgery, patients are closely monitored in the hospital. Vital signs, wound condition, and circulation in the operated leg are checked often. Nurses encourage ankle pumps and gentle leg movements to prevent blood clots.

Most patients stand and take a few steps with a walker on the same day as surgery. According to the Southern California Orthopedic Institute, many can bear full weight immediately, though assistive devices reduce the risk of falls.

Hospital stays are usually short, often one to two days. Before discharge, patients learn how to safely get in and out of bed, use the bathroom, and walk short distances. Education on wound care and infection signs is also provided.

Pain Management Strategies

Pain relief is essential for early recovery. Surgeons often prescribe a combination of medications, including acetaminophen, anti-inflammatory drugs, and sometimes short-term narcotics. Ice packs and elevation help reduce swelling.

By the second week, many patients taper off stronger medications. Most people experience significant pain reduction within the first two weeks. Patients are encouraged to use the lowest effective dose to avoid side effects.

Non-drug strategies also play a role. Positioning the leg with pillows, using supportive chairs, and practicing deep breathing can ease discomfort. Consistent pain control allows patients to move more comfortably and engage in physical therapy sooner.

Early Mobilization and Physical Therapy

Early mobilization prevents stiffness and supports healing. Patients usually begin walking with a walker or a cane within 24 hours. Short, frequent walks are encouraged, and activity is gradually increased each day.

Physical therapy focuses on restoring the range of motion and muscle strength. Simple exercises include ankle pumps, heel slides, and glute squeezes. By weeks 3–4, most patients can walk without assistive devices and resume light daily activities.

Therapists also teach safe techniques for bending, sitting, and climbing stairs. These practices protect the new joint and reduce the risk of dislocation.

Follow-Up and Long-Term Outcomes

Follow-up visits with the surgeon ensure the hip is healing correctly. X-rays may be taken to check the implant position. Stitches or staples are often removed after 10–14 days.

By weeks 5–6, many patients return to work, depending on job demands. Low-impact exercises such as swimming, cycling, and walking are recommended for long-term joint health. High-impact sports are discouraged.

Most patients achieve strong pain relief and improved mobility within three months. Studies show that with ongoing strengthening and flexibility training, people can maintain excellent function for many years after hip replacement surgery.

Frequently Asked Questions

What are the preparatory steps before undergoing hip replacement surgery?

Doctors usually begin with a physical exam, medical history review, and imaging such as X-rays or MRI scans. These steps help determine if the patient is a good candidate. Patients may also need to adjust medications, stop smoking, and complete pre-surgical tests like blood work. Some doctors recommend exercises to strengthen muscles before surgery.

Can you outline the typical surgical process for a hip replacement?

During surgery, the damaged femoral head is removed and replaced with a metal stem. An artificial ball, often ceramic or metal, is attached to this stem. The surgeon also removes damaged cartilage from the hip socket and places a metal cup with a plastic liner inside. This creates a smooth surface for movement

What post-operative care is required after a hip replacement?

Patients usually begin walking with assistance the same day or the next day after surgery. Physical therapy helps restore strength and mobility. At home, patients must follow instructions on wound care, medication, and activity restrictions. Doctors often advise avoiding certain movements to prevent dislocation while the joint heals.

How long is the recovery period following a hip replacement procedure?

Most people spend 1–3 days in the hospital, though some may go home the same day. Initial recovery takes several weeks, with many patients walking without aids by 4–6 weeks. Full recovery and return to regular activities often take 3–6 months, depending on age, health, and adherence to rehabilitation.

What potential risks should be considered before having hip replacement surgery?

Risks include infection, blood clots, joint dislocation, and differences in leg length. Some patients may also experience wear of the artificial joint over time. Complications are uncommon, but doctors review each patient’s health history to assess personal risk factors before surgery.

What are the signs that indicate the need for a hip replacement?

Severe hip pain that limits daily activities, such as walking or climbing stairs, is a common sign. Stiffness that makes it hard to move the leg also suggests advanced joint damage. When nonsurgical treatments like medication, injections, or physical therapy no longer provide relief, hip replacement may be considered.

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