Independent, sourced patient educationInformedSurgery
Hip Replacement Explained
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All topics
  1. What it is
  2. Who it helps
  3. Timing
  4. The procedure
  5. What a hemiarthroplasty is
  6. Hemi vs total hip
  7. Recovery after hip fracture
  8. Patient journey
  9. Recovery supplies
  10. Finding a surgeon
  11. Insurance and costs
  12. Questions to ask
  13. Implant designs
  14. Side-by-side
  15. Robotics and navigation
  16. US manufacturers
  17. What the evidence says
  18. Value analysis
  19. Resources
  20. Glossary
  21. References

Overview

How the operation is done

Every team does things a little differently. This is the general sequence.46,47,48

  1. Anesthesia. Often a spinal anesthetic with sedation, or general anesthesia. A nerve block may be added for pain control.
  2. The incision. The surgeon reaches the hip from the back (posterior approach), the side (lateral approach) or the front (direct anterior approach).
  3. Removing the damaged ball. The worn ball at the top of the thighbone is removed.
  4. Preparing the socket. The socket is shaped and the metal cup is pressed or cemented in place, then the liner is fitted.
  5. Placing the stem. The inside of the thighbone is shaped and the stem is fitted, either press-fit so bone grows onto it, or with bone cement.
  6. Checking the new joint. The ball is attached and the surgeon tests stability and leg length before closing.

The operation usually takes about one to two hours. Many people stand and walk with a walker the same day, and some go home the same day.46,47

Front, side or back?

All three approaches work well. Studies comparing the anterior and posterior approaches find similar rates of dislocation, revision and fracture. The anterior approach tends to mean a slightly faster early recovery and shorter stay, but it takes longer to perform and has a higher risk of nerve injury.14,15,16 Your surgeon's experience with an approach matters more than the approach itself. See anterior vs posterior hip replacement.

Clinical detail
  • RCT meta-analysis (24 trials, 2,010 patients): DAA added about 17 minutes of operative time and shortened stay by about 0.33 days vs posterior; Harris Hip Score better at 6 weeks; no difference in dislocation, fracture or VTE.14
  • RCT meta-analysis (17 trials, 1,575 patients): DAA had lower day-1 pain and better 1-month function, no difference at 3 months, and a higher risk of nerve injury (RR 7.37).15
  • Pooled RCT and observational data (44,477 patients): no difference in revision (RR 0.90) or dislocation (RR 0.78) between DAA and posterior.16
Value analysis

Approach choice affects OR time, table and retractor needs, fluoroscopy use and length of stay. Because outcomes are broadly similar, surgeon familiarity is the main driver. See value analysis.

Sources for this page

  1. Ang JJM, et al. Comparing direct anterior approach versus posterior approach or lateral approach in total hip arthroplasty: a systematic review and meta-analysis. Eur J Orthop Surg Traumatol. 2023;33(7):2773-2792. doi:10.1007/s00590-023-03528-8
  2. Liu R, et al. Comparative efficacy of direct anterior approach versus conventional surgical approaches in total hip arthroplasty: a systematic review and meta-analysis of randomized clinical trials. J Orthop Surg Res. 2025;20(1):837. doi:10.1186/s13018-025-06227-8
  3. Ghandour M, et al. Direct anterior approach versus posterior approach in total hip arthroplasty: a systematic review and meta-analysis. J Orthop. 2025;65:233-250. doi:10.1016/j.jor.2025.06.007
  4. American Academy of Orthopaedic Surgeons, OrthoInfo. Total hip replacement. orthoinfo.org/bodypart/hip-thigh/total-hip-replacement
  5. Mayo Clinic. Hip replacement. mayoclinic.org/tests-procedures/hip-replacement
  6. MedlinePlus (US National Library of Medicine). Hip joint replacement. medlineplus.gov/ency/article/002975.htm

All references