Is It Time for a Hip Replacement?

What patients can expect before, during and after hip replacement surgery.

Hip replacement surgery is among the most common procedures in the United States. An estimated 544,000 hip replacement surgeries are performed each year, according to the American College of Rheumatology.

That number is expected to increase as the population ages — and as a younger subset of patients undergoes the procedure. Nathanael Heckmann, MD, is an orthopedic surgeon with USC Orthopaedic Surgery, part of Keck Medicine of USC, who also sees patients at USC Verdugo Hills Hospital. Dr. Heckmann, who specializes in joint replacement procedures, says more advanced prosthetics mean artificial joints are lasting for years, even decades, longer than in the past.

“Hip and knee replacements are some of the most successful procedures across all surgical disciplines,” Dr. Heckmann says. “If hip pain is compromising your quality of life, there is no reason to wait longer before replacing it.”

How do you know if you need a hip replacement?

Daily pain that prevents patients from participating in regular physical activities is the most common reason for a total hip replacement. An orthopedic specialist may suggest surgery if noninvasive options such as physical therapy, medications, injections or lifestyle modifications have not eased the pain.

Dr. Heckmann describes total hip replacement as the standard of care. “Unlike knees, we do not typically recommend partial hip replacements.”

As for reasons not to have hip replacement, he says a patient should hold off on surgery if their pain is not debilitating. “If you do not have severe arthritis, your hip hurts only occasionally and you are still able to walk and do your usual activities, then we would not preemptively replace a hip,” Dr. Heckmann explains.

How long does hip replacement surgery take?

On average, hip replacement surgery takes between 90 minutes to three hours depending on the complexity of the case. “The surgery itself is very straightforward,” Dr. Heckmann explains. “We remove the arthritic parts of the hip joint and replace them with metal and ceramic-on-plastic components.”

The surgeon accesses the hip joint by making an incision in the front of the hip (anterior), back of the hip (posterior) or lateral (side of the hip).

Due to advancements in minimally invasive techniques, “the recovery time is pretty equivalent regardless of where the incision is,” Dr. Heckmann says. He adds that minimally invasive methods have also made it far less common for patients to experience hip and leg numbness immediately after hip replacement surgery.

Patients can expect a hip replacement scar along the incision, but it will become less noticeable as it heals. Many patients go home the same day or spend one night in the hospital.

What is the recovery timeline after a hip replacement operation?

In the leadup to hip replacement surgery, it is important to stay as active as possible. “Maintaining strength, flexibility and endurance is paramount because it really helps with the postoperative recovery,” Dr. Heckmann emphasizes. “The patients who have such bad arthritis where they become sedentary and deconditioned have a much harder time and a much more protracted recovery.”

After the surgery, patients should keep their new hip as straight as possible for the first six weeks. Patients should avoid crossing their legs or putting their hip in any abnormal positions. Icing the hip and keeping the leg elevated can help reduce any initial swelling or postsurgical pain.

Getting up and walking every day is paramount to a successful recovery because it prevents stiffness and serious issues such as blood clots. Dr. Heckmann says he advises patients to walk at least three times per day and to increase the duration of each walk as they recover.

However, he cautions patients to take it slow to allow their hip to heal. “As my surgery has become less invasive, patients have less surgical pain and end up overexerting themselves because they are feeling so good,” Dr. Heckmann says. “Trying to do too much too early can set your recovery back.”

After focusing on walking during the first six weeks, patients can start to gradually increase their physical activity. Dr. Heckmann says most surgeons will encourage patients to wait three to six months before engaging in more vigorous activities such as hiking, skiing or playing sports.

How long does a hip replacement last?

Patients who undergo a total hip replacement can expect the prosthetic joint to last 20 to 30 years, or even longer.

Dr. Heckmann says since the prosthetic materials used today “wear down at an exceedingly low rate,” surgeons are less hesitant to perform a hip replacement on patients in their 40s or 50s.

“Hip replacement allows people to return to the activities they enjoy, whether that is golfing or swimming or hiking,” he says. “Do not give up your younger years of life and live in pain when you have an option to alleviate it now.”

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