A hip replacement removes the damaged ball and socket of your hip joint and replaces them with artificial components, typically made of metal, ceramic, and plastic. The surgery takes one to two hours, and most people walk with assistance the same day. Here’s what happens before, during, and after the procedure.
Anesthesia and Preparation
Before surgery begins, you’ll receive either spinal anesthesia (which numbs you from the waist down while you stay awake or lightly sedated) or general anesthesia. Large studies have compared the two approaches head to head, and neither has proven clearly superior. A major trial of 1,600 patients found no meaningful difference between spinal and general anesthesia in terms of death or ability to walk at 60 days. Your anesthesiologist will recommend one based on your medical history and preferences.
Once anesthesia takes effect, the surgical team positions you on the operating table, cleans the skin around your hip, and drapes the area. The surgeon then chooses one of two main routes to reach the joint.
Surgical Approaches: Front vs. Back
The two most common approaches differ in where the incision is made and how the surgeon navigates the surrounding muscles.
In the anterior approach, the incision goes through the front of the groin. The surgeon separates the muscles rather than cutting through them, which preserves most of the muscle structures and can mean less pain in the early days after surgery.
In the posterior approach, the incision is made along the back of the hip. This has been the traditional route for decades. A newer modification called the STAR technique preserves most of the posterior muscles and a key tendon called the piriformis, which allows quicker recovery and eliminates some of the movement restrictions that used to follow this approach.
Both approaches produce similar long-term results. The choice often comes down to the surgeon’s training and which technique they perform most frequently.
What Happens Inside the Joint
Once the surgeon reaches the hip joint, the procedure follows a consistent sequence regardless of which approach was used.
Removing the Damaged Bone
The surgeon dislocates the femoral head (the ball at the top of your thighbone) from the acetabulum (the socket in your pelvis). The damaged femoral head is removed, sometimes using a threaded handle for extraction. The surgeon then cuts the femoral neck to the precise length needed to fit the new implant.
Preparing and Placing the Socket
The surgeon uses a dome-shaped reamer to remove the worn cartilage lining the socket, gradually shaping it until healthy bone is exposed and the fit matches the size of the new component. The artificial socket is then secured in one of two ways.
For a cemented socket, the surgeon drills several small holes into the bone for better grip, packs bone cement into the holes and across the surface, then presses the cup into position and holds it firmly while the cement hardens. For a cementless socket, the cup is slightly larger than the reamed cavity and is hammered into place so it locks tightly against the bone. Two or three screws may be added for extra stability. A plastic liner then snaps into the metal cup to create a smooth bearing surface.
Preparing and Placing the Stem
The surgeon hollows out the canal inside your thighbone using progressively larger tools called broaches, shaping the interior to match the tapered metal stem. The stem is either cemented in place or press-fit so that your bone grows into its textured surface over the following weeks. A ceramic or metal ball is then placed onto the top of the stem, recreating the shape of your original femoral head.
Testing and Closing
Before closing, the surgeon places the new ball into the new socket and moves your leg through a range of motions, checking that the joint is stable, the leg length matches the other side, and the soft tissue tension feels right. Proper positioning and appropriate tension at this stage are critical to reducing dislocation risk later. The layers of tissue are then closed with sutures or staples, and the incision is bandaged.
Robotic-Assisted Surgery
A growing number of hip replacements use robotic-assisted platforms. The surgeon still performs the operation, but a robotic arm guides certain steps based on a 3D plan created from your imaging scans before surgery. A meta-analysis in The Journal of Arthroplasty found that robotic-assisted hip replacement places the socket component within the target “safe zone” more accurately than the conventional manual technique, and reduces overall complication rates. That said, patient-reported outcomes and pain scores have not shown a significant difference between the two. The technology improves precision, but a skilled surgeon using manual instruments still produces excellent results.
What Recovery Looks Like Week by Week
Recovery moves faster than most people expect. You’ll stand and take your first steps with a walker or crutches on the day of surgery. Some patients go home the same day, though a one- or two-night hospital stay is more common. Same-day discharge tends to be offered to patients younger than 65 who don’t have obesity, chronic anemia, or significant heart or lung disease.
By week two, many people switch from a walker to a cane. Around weeks three to four, light household chores become manageable and driving may be cleared by your surgeon. Between weeks four and six, most people can walk without a cane. Full recovery, meaning a return to all normal activities without limitations, generally takes three to six months.
Movement Precautions After Surgery
During the first six to eight weeks, your healing tissues are vulnerable and certain positions can dislocate the new joint. The American Academy of Orthopaedic Surgeons recommends the following rules, particularly after a posterior approach:
- Don’t cross your legs at the knees for at least six to eight weeks.
- Don’t bend your hip past 90 degrees. This means avoiding low chairs, leaning forward while sitting, and reaching down to the floor from a seated position.
- Don’t twist your feet excessively inward or outward when bending down.
- Use a high chair or barstool in the kitchen to keep your hip angle safe.
- Keep your operated leg facing forward and slightly in front of you when sitting or standing.
These restrictions are gradually lifted as the muscles and joint capsule heal. Patients who had the anterior approach or the newer STAR posterior technique may have fewer or no formal precautions, depending on their surgeon’s assessment.
How Long Implants Last
Modern hip implants are remarkably durable. Data from the Australian and Finnish national joint registries, covering hundreds of thousands of procedures, shows that 89% of hip replacements are still functioning well at 15 years. At 20 years, about 70% remain intact, and at 25 years, 58% are still going. Implant materials and surgical techniques continue to improve, so replacements done today are expected to perform at least as well as those numbers suggest, and likely better. For someone in their 60s or 70s, there’s a strong chance the implant will last the rest of their life.