A hip replacement is a surgical procedure that removes a damaged hip joint and replaces it with an artificial one made of metal, ceramic, or plastic components. It is one of the most successful and common orthopedic surgeries performed today, with roughly 85% of implants still functioning at 15 years and 58% lasting 25 years or more, based on data from national joint registries covering more than 215,000 procedures.
Why People Need a Hip Replacement
The most common reason for hip replacement is osteoarthritis, a condition where the cartilage cushioning the joint wears away over time. Without that cartilage, bone grinds against bone, causing pain, stiffness, and limited range of motion. Other conditions that can damage the hip enough to warrant surgery include rheumatoid arthritis, avascular necrosis (where the bone loses its blood supply and deteriorates), and fractures that don’t heal well.
Surgery is typically recommended when conservative treatments have stopped working. The American Academy of Orthopaedic Surgeons outlines several specific signs that point toward surgery:
- Hip pain that limits everyday activities like walking or bending
- Pain that persists while resting, during the day or at night
- Stiffness that makes it difficult to move or lift the leg
- Inadequate relief from anti-inflammatory medications, physical therapy, or walking aids
Recommendations are based on pain and disability, not age. While the procedure is most common in people over 60, younger patients with severe joint damage are candidates too.
Total vs. Partial Hip Replacement
In a total hip replacement, both sides of the joint are replaced: the ball (the rounded top of the thighbone) and the socket (the cup-shaped part of the pelvis). The surgeon fits a metal stem into the thighbone, attaches a new ball to the top of that stem, and lines the natural socket with a new cup and liner.
A partial hip replacement, called a hemiarthroplasty, replaces only the ball. The natural socket is left intact. This is most often used for elderly patients with displaced hip fractures rather than arthritis. It’s a shorter, less invasive operation, but if the socket wears down later, it may need to be converted to a total replacement.
What the Implant Is Made Of
The artificial joint has several components, and surgeons choose materials based on your age, activity level, and anatomy. The main combinations are:
- Metal ball on plastic liner: The most widely used combination. A metal or ceramic ball articulates against a polyethylene (high-grade plastic) liner inside a metal cup. Modern polyethylene liners have significantly improved wear properties compared to older designs, which extends implant life.
- Ceramic on ceramic: Both the ball and the liner are ceramic. This produces extremely low wear and is often chosen for younger, more active patients.
- Ceramic on plastic: A ceramic ball paired with a polyethylene liner. This combines the scratch resistance of ceramic with the proven track record of modern plastic liners.
- Dual mobility: A design where a smaller ball sits inside a larger plastic ball, which moves within a metal cup. This gives extra stability and is often used in patients at higher risk of dislocation.
Metal-on-metal implants were once common but have fallen out of favor due to concerns about metal particles being released into the surrounding tissue.
Surgical Approaches
Surgeons reach the hip joint from different directions, and the approach affects early recovery and movement restrictions afterward. The two most common are the posterior approach (from the back of the hip) and the anterior approach (from the front).
The anterior approach separates the muscles rather than cutting through them, which can mean less pain in the first couple of weeks and fewer movement restrictions after surgery. The posterior approach has historically been associated with a slightly higher dislocation rate, but modern technique modifications have largely eliminated that gap. Today, the complication rate for either approach is about 1 in 1,000 operations.
Patients who undergo the posterior approach often report more stiffness in the first two weeks compared to the anterior approach, but those differences disappear quickly. A newer modification of the posterior approach preserves most of the muscles and tendons, allowing for quicker recovery and no movement precautions afterward, similar to the anterior approach. Your surgeon’s experience with a particular technique matters more than the approach itself.
Robotic-Assisted Surgery
Some surgeons now use robotic systems during hip replacement to improve the precision of implant placement. A 2025 meta-analysis of five studies found that robotic-assisted surgery produced significantly less limb-length discrepancy compared to conventional surgery, meaning the operated leg is more likely to match the other leg’s length after the procedure. The robotic system also improved the accuracy of cup positioning within the pelvis.
However, patient-reported outcome scores (like the Harris Hip Score, a standard measure of hip function and pain) did not significantly differ between robotic and conventional approaches. The technology improves technical precision, but whether that translates to a noticeably better experience for the patient over the long term is still being evaluated.
What Recovery Looks Like
Most people are standing and taking steps within hours of surgery. Some patients now go home the same day, though this is typically reserved for younger patients without obesity or significant heart, lung, or blood conditions. A one- to two-night hospital stay remains more common.
The first two weeks focus on managing pain and swelling while doing gentle exercises prescribed by a physical therapist. By week two, many people transition from a walker to a cane. During weeks three and four, you’ll walk longer distances and feel steadier on your feet. Light household chores become manageable, and some people are cleared to drive.
By weeks four to six, most people can walk without a cane, start gentle exercises like cycling on a stationary bike, and return to work if their job isn’t physically demanding. Full recovery, meaning you’ve regained your strength and can move without thinking about the hip, generally takes three to six months. Higher-impact activities like hiking or doubles tennis are often possible once healing is complete, though your surgeon will guide you based on your specific implant and bone quality.
Risks and Complications
Hip replacement is considered a low-risk procedure, but like any surgery, complications can occur. Blood clots are one of the more closely monitored risks. Deep vein thrombosis or pulmonary embolism occurs in roughly 1% to 3% of cases, which is why blood-thinning medication and compression devices are standard after surgery. In a large cohort study of over 29,000 patients, the rate of blood clots at 30 days was 1.19%.
Infection around the implant is uncommon but serious, occurring in about 1% to 2% of cases. Early infections can sometimes be treated without removing the implant, but deeper or delayed infections may require additional surgery. Dislocation, where the ball slips out of the socket, is another concern, particularly in the first few months before the surrounding tissues have fully healed. Modern surgical techniques and implant designs have brought dislocation rates down considerably.
Other possible complications include a difference in leg length after surgery, stiffness, nerve injury, and fractures around the implant. Most of these are rare with experienced surgeons and proper patient selection.
How Long the Implant Lasts
Modern hip replacements are remarkably durable. Data from the national joint registries of Australia and Finland, covering more than 215,000 procedures, show that about 85% of total hip replacements last at least 15 years. At 25 years, 58% are still functioning without needing revision surgery. Improvements in materials, particularly in plastic liner technology and ceramic components, mean that implants placed today are likely to outlast those numbers.
When a hip replacement does eventually wear out, a second procedure called a revision can be performed. Revision surgery is more complex than the original operation and typically has a longer recovery, which is one reason surgeons weigh the decision carefully for younger patients who may outlive their first implant.