Hip replacement has been called “the operation of the century,” and for good reason. Roughly 450,000 total hip arthroplasties are performed in the U.S. each year, with patient satisfaction rates above 90 percent according to the American Academy of Orthopaedic Surgeons. A hip replacement swaps a worn ball-and-socket joint for metal, ceramic, or polyethylene components, and most patients are walking with a cane within days. The procedure is far less painful than many expect. This guide explains how the surgery is performed, what recovery looks like by week, and the trade-offs between modern surgical approaches.
What Hip Replacement Is and Who Needs It
Total hip arthroplasty (THA) replaces the femoral head with a metal stem and ball, and resurfaces the acetabulum (socket) with a metal cup containing a polyethylene or ceramic liner. Most procedures are done for end-stage osteoarthritis, but the operation is also indicated for hip fractures in older adults, avascular necrosis of the femoral head, rheumatoid arthritis, and certain congenital hip disorders, per Mayo Clinic.
Candidates typically describe groin or buttock pain, stiffness when getting out of a car, and trouble putting on socks. When weight loss, NSAIDs, physical therapy, and activity modification stop controlling symptoms, surgery enters the conversation. Imaging often shows joint-space narrowing or femoral head collapse, but symptoms drive the decision. For broader background on degenerative joint disease, see our comprehensive condition library.
How the Procedure Is Performed
Hip replacement takes 60 to 120 minutes. Surgeons use one of three primary approaches: anterior (front), posterior (back), or lateral (side). The anterior approach has gained popularity because it spares major muscles and may allow earlier walking, although evidence on long-term differences is mixed. The posterior approach offers excellent visualization and is the most widely used. Anesthesia is typically spinal with light sedation.
After the incision, the surgeon dislocates the joint, removes the femoral head, reams the socket, and presses or cements the cup into place. A stem is inserted into the femoral canal, the new ball attaches to the stem, and the joint is reduced. Many systems use modular components so the surgeon can fine-tune leg length and stability intraoperatively. Cleveland Clinic notes that hospital stays now average one to two days, and outpatient hip replacement is increasingly routine in healthy patients.
Preparation and What to Expect on the Day
Preoperative work-up mirrors other major joint surgeries: medical clearance, labs, and dental evaluation to reduce hematogenous infection risk. Many programs require enrollment in a “joint class” that walks through expectations, equipment needs, and home setup. Throw rugs go away, a raised toilet seat appears, and a walker waits by the bed. Smoking cessation at least four weeks before surgery markedly reduces wound complications and is non-negotiable in many practices.
On the day, expect to walk within hours of leaving the recovery room. Multimodal pain control with acetaminophen, NSAIDs, gabapentin in some cases, and short-course opioids has become standard. Posterior approach patients receive “hip precautions” for six weeks: no bending past 90 degrees, no crossing legs, and no internal rotation. Anterior approach patients usually have no restrictions.
Recovery Timeline and Rehab
The first two weeks center on walking, swelling control, and home exercises. Most patients transition from a walker to a cane between two and four weeks, and many discontinue assistive devices entirely by six weeks. Driving resumes between two and six weeks once you are off opioids and have adequate reaction time. Return to desk work commonly occurs at two to four weeks; physical labor takes longer.
By three months, most patients walk normally, climb stairs without thought, and resume golf, swimming, cycling, and hiking. Full recovery, including the resolution of mild stiffness and gait asymmetry, usually takes six to 12 months. AAOS data suggest 90 to 95 percent of hip replacements last 15 to 20 years, and second-decade survivorship has improved with modern bearings. Many surgeons now allow doubles tennis and recreational skiing, though running and impact sports remain discouraged to extend implant life.
Risks, Complications, and Outcomes
Major complications occur in roughly 2 to 4 percent of cases. Dislocation rates are around 1 to 3 percent for primary THA and are higher in the first six weeks, particularly with the posterior approach. Mayo Clinic notes infection rates of about 1 percent, blood clot risk of 1 to 3 percent despite chemoprophylaxis, leg length discrepancy in a small percentage of patients, and periprosthetic fracture risk that rises with osteoporosis. Loosening, polyethylene wear, and rare implant failures may eventually require revision surgery.
When to seek emergency care: Call 911 or go to the nearest emergency room if you experience sudden chest pain or shortness of breath (possible pulmonary embolism), calf swelling or pain (DVT), a sudden popping sensation followed by an inability to bear weight (possible dislocation), heavy incision bleeding, or fever above 101 F with wound drainage.
Alternatives and When Surgery May Not Be Needed
Conservative treatments can sustain function for years before surgery is necessary. Structured physical therapy, weight loss, low-impact aerobic exercise, NSAIDs, and intra-articular corticosteroid injections all play a role. Hyaluronic acid injections are less standardized for the hip than the knee. Activity modification, including switching from running to cycling or swimming, often stretches the timeline meaningfully.
Younger patients with hip impingement may benefit from arthroscopic labral repair before arthritis develops, while patients with avascular necrosis caught early sometimes avoid replacement with core decompression. If your hip pain is mostly mechanical and you also have a worn knee, your surgeon may sequence a knee replacement with the hip operation. For shoulder concerns that develop from compensatory mechanics, our shoulder replacement guide covers the same decision framework.
Cost Considerations
Total billed costs for a hip replacement in the U.S. typically run $30,000 to $70,000 without insurance, with significant geographic variation. Medicare typically pays $12,000 to $15,000 under the bundled payment model, and ambulatory surgery centers have started offering all-in cash prices in the $20,000 to $30,000 range for healthy patients. Insured out-of-pocket costs commonly land at $1,500 to $5,000 once deductibles and coinsurance are applied. For strategies on price-shopping surgery and using HSA funds, our healthcare costs guide goes deeper.
Frequently Asked Questions
Anterior vs posterior hip replacement: which is better?
Both approaches yield excellent long-term outcomes. Anterior hip replacement may allow slightly faster early recovery and fewer dislocations, but it has a steeper learning curve and a small risk of lateral femoral cutaneous nerve irritation. Posterior is more versatile and remains the most common in the U.S. Surgeon experience matters more than the approach itself.
How long does a hip replacement last?
According to multiple national registries, 80 to 90 percent of hip replacements last at least 20 years. Ceramic-on-polyethylene and ceramic-on-ceramic bearings have improved long-term wear. Younger and more active patients have faster wear and may need eventual revision.
When can I sleep on my side after hip replacement?
Most surgeons allow side sleeping with a pillow between the knees at four to six weeks. Posterior approach patients are typically asked to sleep on the back initially. Anterior patients often have no formal sleep restrictions.
Can I run after a hip replacement?
Most surgeons recommend against running, singles tennis, and other repetitive impact sports because they accelerate implant wear. Cycling, swimming, hiking, golf, and elliptical training are all encouraged.
What to Discuss With Your Surgeon
The right time to consider hip replacement is when groin or buttock pain has changed your daily life and conservative care has run its course. Ask the surgeon about annual volume, infection and dislocation rates, the surgical approach they use most often, and the discharge plan. Inquire about implant material choices and how that affects long-term wear. A high-volume surgeon who explains trade-offs candidly is the single best predictor of a smooth experience and durable result.