The Short Version
A total hip replacement removes the damaged surfaces of the arthritic ball-and-socket joint and replaces them with artificial components. A new socket is placed in the pelvis, and a stem with a new ball is placed in the thighbone.
The goal is straightforward: relieve the pain coming from the damaged joint, restore comfortable motion, and help you return to the activities that arthritis has taken away from you.
The Operation
What actually gets replaced?
Your natural hip is a ball-and-socket joint. The ball at the top of the thighbone — the femoral head — moves inside the socket of the pelvis, called the acetabulum.
In an arthritic hip, the smooth cartilage covering these surfaces has been damaged or worn away. During a total hip replacement, we replace the damaged joint surfaces rather than replacing your entire thighbone or pelvis.
There are four basic parts to a modern hip replacement:
- The cup: a metal shell placed into the natural socket in your pelvis
- The liner: a smooth bearing surface that fits inside the cup
- The stem: an implant that fits inside the upper part of your thighbone
- The ball: a new femoral head that attaches to the top of the stem and moves inside the liner
Together, these components create a new ball-and-socket articulation.
Most of your pelvis and thighbone remain exactly where they are. The damaged joint surfaces are removed and replaced with components designed to reproduce the function of the natural hip.
The Implants
What is the new hip made of?
Modern hip replacements usually use a combination of metal, ceramic, and highly engineered plastic.
The cup and stem
The components that attach to bone are usually made from biocompatible metals such as titanium or cobalt-chromium alloys. Their design depends partly on whether we want your bone to grow onto the implant or whether bone cement will be used to hold it in place.
The ball
The new ball can be made from ceramic or metal. Ceramic heads are commonly used in modern hip replacement because they provide a hard, smooth surface with excellent wear characteristics.
The liner
The liner sits inside the metal cup and acts as the new bearing surface. Modern highly cross-linked polyethylene — a specialized medical-grade plastic — is very commonly used.
The ball moves against this liner every time you walk or move your hip.
Does the brand of implant matter?
There are several well-established hip replacement systems. Patients sometimes arrive focused on a particular brand after seeing an advertisement or reading about one online.
I think the more important questions are whether the implant has a good clinical track record, whether its design fits the patient's anatomy and needs, and whether the surgeon is comfortable and experienced using that system.
Fixation
How do the implants stay in place?
There are two main ways a hip replacement can be attached to bone: cementless fixation and cemented fixation.
Cementless fixation
Many modern hip replacements are cementless. The implant is designed to fit securely against the bone at the time of surgery. Its surface is rough or porous so that, over time, your bone can grow onto or into that surface.
In other words, the implant is stable when we put it in, and your own bone provides longer-term biological fixation as it heals.
Cemented fixation
In other situations, bone cement can be used to secure an implant. Cemented stems have a long history of successful use and remain an excellent option for appropriately selected patients.
Bone quality, anatomy, age, implant design, and the situation we encounter during surgery can all influence which type of fixation makes the most sense.
How I Think About It
The implant should fit the patient — not the other way around.
There is not one stem, cup, bearing surface, or fixation method that is ideal for every person.
Part of planning a hip replacement is choosing components and fixation that make sense for your anatomy, bone quality, activity level, and the reconstruction we are trying to achieve.
Surgical Approach
How do we reach the hip?
The hip sits underneath several layers of muscle and soft tissue. A surgical approach is simply the pathway the surgeon uses to safely reach the joint.
Hip replacements can be performed through several approaches, including anterior, posterior, and anterolateral approaches. Each has advantages, limitations, and variations in how it is performed.
The approach is important, but it is only one part of a successful hip replacement. Implant positioning, stability, restoration of leg length and offset, soft-tissue handling, and the overall reconstruction all matter.
What happens to the muscles and tendons?
Every approach works through or around the soft tissues that surround the hip. Exactly which structures are moved, separated, released, or repaired depends on the approach being used.
The goal is to gain enough exposure to perform the reconstruction accurately while treating the surrounding soft tissues carefully.
The approach I use
In my practice, I perform hip replacement using the Mayo Modified Anterolateral Approach. It preserves the posterior soft tissues and provides versatile exposure without requiring a specialized traction table or intraoperative fluoroscopy.
I use this approach because it fits the way I think about hip reconstruction. The approach should give me the exposure I need to perform the operation well — rather than forcing the reconstruction to fit the limitations of the approach.
If you want to understand how the common approaches differ, read Anterior vs Posterior vs Anterolateral Hip Replacement.
You can also learn more about the Mayo Modified Anterolateral Approach.
Goals & Expectations
What can a hip replacement realistically improve?
The primary reason to replace an arthritic hip is to relieve pain coming from the damaged joint.
As that pain improves, patients commonly find it easier to walk, stand, use stairs, get in and out of a car, put on shoes and socks, exercise, travel, and participate in everyday life.
Hip motion often improves as well, although the amount of motion you ultimately have depends on several factors, including how stiff the hip was before surgery.
What might hip replacement not fix?
A hip replacement treats the hip joint. It does not automatically correct every source of pain around the hip, pelvis, or leg.
For example, pain coming from the lower back, nerve irritation, chronic gluteal tendon problems, or other conditions may still be present after the arthritic joint has been replaced.
This is why getting the diagnosis right before surgery matters so much.
Will my legs be exactly the same length?
Leg length is carefully considered during hip replacement, but stability and proper reconstruction of the hip also have to be respected.
Some patients already have a true or apparent leg-length difference before surgery. After surgery, the legs may also temporarily feel different as the pelvis, muscles, and walking pattern adjust.
The goal is to restore the mechanics of the hip as accurately as possible while creating a stable reconstruction.
How long does a hip replacement last?
Modern hip replacements are designed for long-term use, and many function well for decades.
No artificial joint can be guaranteed to last for the rest of every patient's life. Longevity depends on factors such as age, activity, implant fixation, wear, bone quality, and whether complications develop over time.
I want patients to return to an active life. At the same time, the components are mechanical devices, and long-term follow-up remains worthwhile even when the hip feels great.
Understanding Risk
What are the important risks of hip replacement?
Hip replacement is a highly successful operation, but it is still major surgery. No surgeon can make the risk of a complication zero.
Important risks include:
- Infection around the incision or the implanted joint
- Blood clots in the leg or, less commonly, clots that travel to the lungs
- Dislocation or instability of the new ball-and-socket joint
- Fracture of the femur or pelvis during or after surgery
- Leg-length difference
- Nerve or blood-vessel injury
- Wound-healing problems
- Implant loosening or wear over time
- Need for another operation if a major complication or future implant problem occurs
- Medical complications such as heart, lung, kidney, or other problems surrounding surgery
Your individual risk is not determined by a generic list. Medical conditions, smoking, weight, nutrition, diabetes, medications, prior surgery, bone quality, and many other factors can change the risk profile.
Part of preparing for joint replacement is identifying the risks we can improve before surgery and making sure the expected benefit of the operation makes sense for you.
The Goal
A technically good X-ray is not the finish line.
The reason to perform a hip replacement is to help you live better with less pain and better function.
My job is to build a stable, durable reconstruction. The larger goal is getting you back to walking, working, traveling, exercising, spending time with family, or simply moving through your day without your hip constantly making decisions for you.
Common Questions
Frequently asked questions
Is the entire hip removed?
No. The damaged femoral head is removed and the damaged surfaces of the socket are prepared for the implants. Most of your femur and pelvis remain in place.
Will I set off airport security?
You may. Modern security equipment can detect orthopedic implants. You can simply tell security personnel that you have a hip replacement if additional screening is requested.
Can my body reject the implant?
Hip implants are not transplanted organs, so the body does not reject them in the same way it can reject an organ transplant. Reactions to implant materials can occur, but clinically important reactions are uncommon.
Do all hip replacements use cement?
No. Many modern hip replacements use cementless components designed for bone growth onto the implant. Cemented fixation is also well established and may be appropriate in certain patients.
Will I need another hip replacement someday?
Possibly, but not necessarily. Modern hip replacements often last for decades. Younger patients have more years in which wear, loosening, infection, fracture, or another problem could eventually require revision surgery.
Can I be active after hip replacement?
Yes. Returning patients to an active life is one of the major goals of the operation. Walking, cycling, swimming, golf, hiking, and many other activities are commonly possible after recovery. Your specific activity goals should be discussed with your surgeon.
Key Takeaways
What I want you to remember
- A hip replacement replaces the damaged surfaces of the ball-and-socket joint — not your entire femur or pelvis.
- Modern replacements generally combine metal components with a ceramic or metal ball and a specialized bearing liner.
- Components can be cementless, cemented, or occasionally a combination depending on the patient and reconstruction.
- Surgical approach matters, but it is only one part of a successful hip replacement.
- The main goals are relief of arthritic pain, restoration of function, stability, and a durable reconstruction.
- Hip replacement is highly successful, but it remains major surgery with real risks that should be understood before proceeding.