Hip arthroplasty

What is hip arthroplasty?

Arthroplasty is a medical term for surgeries that remove, replace or reconstruct damaged or diseased joints to restore function.

Types of hip arthroplasty

Related but different procedures, there are two kinds of arthroplasty used for hip pain treatment:

• Hip resurfacing
• Hip replacement

Hip resurfacing

Although once popular among surgeons as a treatment option for certain patients, hip resurfacing is a procedure that has largely fallen out of favor.

Hip replacement

A surgeon considers which parts of your hip joint are damaged and need to be replaced to determine whether you need a partial or total hip arthroplasty.

Partial hip replacement

Partial hip replacements, or hemiarthroplasties, are primarily performed by surgeons on patients with broken hips.

Total hip replacement

According to the Agency for Healthcare Research and Quality, more than 450,000 total hip replacements are performed in the United States annually. Surgeons use various approaches to access the hip joint during arthroplasty, differing in incision location, muscle impact, and recovery experience.

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Bilateral (double) hip replacement

During a bilateral hip replacement, both hip joints are replaced at the same time. This procedure can involve total or partial hip replacements.

Hip revision

Also known as a repeat hip replacement, hip revision tends to be more complex than a standard total hip replacement. It’s a procedure to repair or replace a previous hip replacement (total or partial) that has worn out, loosened, or caused complications. Depending on the extent of bone loss caused by the first implant, a bone graft may or may not be required as part of the procedure.

Watch Dr. Anthony F. Infante Jr. explain hip replacement options

Other hip surgeries

In addition to hip arthroplasty, some of the other specialized procedures that surgeons use to treat hip pain and mobility issues include:

• Hip fusions (arthrodesis)—which may be recommended when hip replacements aren’t suitable—fuse the hip bones to eliminate joint movement.
• Girdlestone procedures (resection arthroplasty)—often used for patients with severe infections from failed hip replacements—involve removing damaged parts of the hip joint without replacing them.
• Hip osteotomies—commonly performed on younger patients with hip deformities—reshape or reposition hip bones to improve alignment and function.
• Hip arthroscopies are a type of minimally invasive procedure in which small cameras are used to diagnose and treat hip joint problems.
• Core decompressions—with or without BMAC (bone marrow aspirate concentrate)—treat avascular necrosis by relieving pressure in a patient’s hip, promoting bone healing, and restoring blood flow, potentially delaying or preventing a patient’s hip arthroplasty need.

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5 surgical approaches for hip replacement

The five main surgical approaches used in hip replacement surgeries include anterior, anterolateral, direct lateral, posterior, and superior.

Anterior approach

• Incision location: At the front of the hip, near the groin.
• Muscle impact: Spares muscles by working between them without cutting.
• Recovery experience: Generally allows for fewer movement restrictions and a quicker recovery.

Anterior hip replacement is a muscle-sparing approach that may result in less pain and a faster return to normal activities.

Learn more about the anterior hip replacement approach

Anterolateral approach

• Incision location: On the side and front of the hip.
• Muscle impact: Detaches some muscles on the side of the hip, which are later reattached.
• Recovery experience: Offers good stability with moderate precautions to prevent hip dislocation.

This hip replacement approach reduces the risk of hip dislocation and benefits patients with muscle weakness.

Direct lateral approach

• Incision location: Directly on the side of the hip.
• Muscle impact: Cuts through the abductor muscles (gluteus medius and minimus), essential for walking.
• Recovery experience: During recovery, it may result in temporary muscle weakness and a limp; standard precautions to prevent dislocation apply.

This approach to hip arthroplasty provides excellent access to the hip joint and has a low risk of dislocation.

Posterior approach

• Incision location: Along the back of the hip, near the buttocks.
• Muscle impact: Involves cutting and then reattaching the muscles at the back of the hip, including the gluteus maximus.
• Recovery experience: Requires stricter precautions to prevent dislocation; may have a slightly longer recovery time.

This traditional approach to hip replacement provides excellent visibility of the hip joint during surgery.

Modern hip arthroplasty

In addition to the five surgical approaches to hip replacement, surgeons may employ innovative options to tailor an arthroplasty procedure to your needs.

Advancements in hip replacement operations aim to improve surgical precision, reduce recovery time, and provide better overall patient outcomes, and they include some of the following options:

• Minimally invasive hip replacement: This hip arthroplasty innovation uses smaller incisions (“micro-incisions”) to reduce muscle and tissue damage, potentially leading to a quicker recovery and better cosmetic results.
• Mako robot-assisted hip replacement: This hip arthroplasty technique employs robotic technology to help the surgeon place the artificial joint with enhanced precision from patient-specific 3-D models. Mako technology also helps remove diseased bone, preserve healthy bone, and assist the surgeon in positioning the total hip implant based on the patient’s anatomy.
• Computer-assisted (image-guided) hip replacement: This technology for hip arthroplasty incorporates digital imaging and navigation tools, which help surgeons enhance precision and improve overall implant placement accuracy.
• Cementless (press-fit) hip replacement: This method, used during hip arthroplasty, involves securing implants without bone cement, allowing natural bone growth to hold them in place instead.
• Outpatient (same-day) hip replacement: Patients who choose this option can avoid a hospital stay and return home on the same day as their surgery.

Listen to Dr. David M. Donohue explain what’s important in hip reconstruction

Prosthetic components used in hip replacements

The design and materials used to create an implant for hip arthroplasty surgery have come a long way. Some of the artificial components used today during hip joint replacement surgeries include:

• A metal stem is placed into the hollow center of the femur to replace the damaged femoral head. This stem is either cemented (or press-fit) into the bone.
• A metal or ceramic ball on the stem’s upper part replaces the removed damaged femoral head.
• The damaged cartilage surface of the socket (acetabulum) is removed and replaced with a metal socket.
• A plastic, ceramic, or metal spacer goes between the new ball and socket for a smooth, gliding surface.

How do I know if I need a hip replaced?

Deciding whether to undergo hip replacement is a significant step. Although it’s regarded as one of the safer orthopedic procedures, hip arthroplasty is still a major operation, so it’s natural to question whether it’s right for you.

Here are examples of when it might be time to think about having hip replacement surgery:

• You’ve exhausted conservative treatment options without satisfactory relief.
• Your pain and loss of function make it hard to perform everyday tasks and enjoy activities you love.
• You’re in good overall health and medically fit for surgery—able to tolerate anesthesia and rehabilitation.
• You’re mentally prepared for surgery and motivated to participate in the post-operative recovery process.

If you think hip arthroplasty might be right for you, schedule an appointment to discuss your symptoms, medical history, and treatment options with an experienced hip surgeon.

Watch Dr. Luis Pulido share why being a hip surgeon is the “best job in the world”

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