Overview
Total hip replacement removes the worn ball and socket of an arthritic hip and replaces them with a metal stem and ball that fit into the femur and a metal cup lined with polyethylene that fits into the pelvis. It is one of the most reliable operations in orthopaedics: the deep groin pain of arthritis is gone by the time the incision has healed, and modern implants are expected to last 20 years or more in most patients.
Dr. O'Donnell performs the operation through a posterior approach, which gives a clear view of the socket for accurate implant positioning. Patients walk with a walker the same day and go home the same day or the next morning.
Who It's For
The timing is decided by symptoms, not by the X-ray. Candidates have hip arthritis confirmed on weight-bearing X-rays, and pain that limits walking distance, disturbs sleep, makes it hard to put on shoes and socks, and has not responded to anti-inflammatories, a cane and an ultrasound-guided steroid injection. Age is not a limit in either direction; a 45-year-old with end-stage arthritis and an 85-year-old in good health are both candidates. The same operation is used for osteonecrosis of the femoral head and some hip fractures.
A patient with early arthritis and tolerable pain is better served by non-operative care, because the operation carries the same risk whether the arthritis is mild or severe. Groin pain with catching in a younger patient whose X-rays show preserved joint space is more likely a labral tear or impingement, treated with hip arthroscopy. Pain that runs down the leg below the knee is more often from the spine.
Joint-space narrowing on an X-ray is not by itself an indication for hip replacement; many people with arthritic X-rays have little pain. Dr. O'Donnell recommends the operation when the groin pain and loss of rotation on exam, the X-ray and the limits on walking and sleep all agree, and anti-inflammatories, activity change and an injection have been tried. The hip arthritis page explains how a finding is weighed.
What the Procedure Involves
Most patients have a spinal anesthetic with sedation, which lowers blood loss and clot risk compared with a general. Through an incision over the back of the hip, Dr. O'Donnell divides the short external rotator muscles and opens the capsule to dislocate the ball backward. The arthritic femoral head is removed, the socket is reamed to healthy bone and a titanium cup with a highly cross-linked polyethylene liner is press-fit into it. A titanium stem is press-fit down the femoral canal with a ceramic ball on top; bone grows onto both components over the following weeks, so cement is rarely needed.
Leg length and offset are checked against the other side before the final components are chosen, and the hip is tested through its full range for stability before the capsule and rotator muscles are repaired back to bone. That repair is what allows the posterior precautions to be relaxed at 6 weeks. The operation takes about 90 minutes.
Risks & How They Are Minimized
Dislocation is the risk particular to the posterior approach. It is minimized by accurate cup position, a larger femoral head, a careful capsular repair, and the 6 weeks of posterior precautions described below. Blood clots are the most common serious complication of any hip replacement and are prevented with spinal anesthesia, walking on the day of surgery, and a blood thinner, usually aspirin 81 mg for 14 days or longer for higher-risk patients. Infection is guarded against with antibiotics before the incision and screening for nasal bacteria and skin problems beforehand; a deep infection is uncommon but serious, which is why dental work is held off for several months afterward.
A leg-length difference of a few millimeters is common and usually unnoticed; larger differences are avoided by templating the X-rays and measuring during the operation. Sciatic nerve stretch is rare and is guarded against by protecting the nerve throughout the exposure. A crack in the femur during stem insertion is uncommon and is fixed at the same sitting.
Recovery & Rehabilitation
Rehabilitation is fast and follows one rule for the first 6 weeks: protect the repaired capsule from the positions that can dislocate a new hip. Weight bearing is unrestricted from day one.
| Phase | Timing | What happens |
|---|---|---|
| Mobility & precautions | Weeks 0–2 | Walker or crutches, weight bearing as tolerated. Ankle pumps, quad and glute sets, gentle hip strengthening within precautions, gait and transfer training. Advance when transfers and walking are safe and independent. |
| Strengthening & gait | Weeks 2–6 | Progressive glute and quad strengthening, balance training, stationary bike with a high seat. Walker weaned to a cane and then to nothing as balance allows. Precautions continue. Advance when gait is normal without an assistive device. |
| Strengthening | Weeks 6–12 | Precautions lifted at about 6 weeks once confirmed at the follow-up visit. Progressive resistive hip and core strengthening, single-leg balance, endurance conditioning. Advance when independent with daily activities. |
| Return to activity | Months 3–6 | Continued strengthening. Walking for fitness, cycling, swimming and golf as cleared. Running and jumping are avoided long term to protect the implant. |
Desk work from home is possible within 1 to 2 weeks. Driving resumes when off narcotic medication and able to brake hard without hesitation, typically 3 to 4 weeks for a right hip and about 2 weeks for a left. Golf and cycling return at around 3 months; hiking and doubles tennis by 6 months.
Protocol summary
Precautions: weight bearing as tolerated with a walker or crutches from the day of surgery, weaned as strength and balance allow; posterior hip precautions for about 6 weeks (no hip flexion past 90°, no adduction past midline, no internal rotation of the operated hip); use a raised toilet seat, wedge cushion and reacher, and avoid low chairs and bending forward at the hip. Low-impact activity only long term.
Criteria: patients progress when transfers and gait are safe and independent; then when gait is normal without an assistive device; then when independent with daily activities and strength is improving symmetrically. Precautions are lifted at about 6 weeks after confirmation at the post-operative visit.
Physical Therapy Protocol
Total Hip Replacement PDF ↗Frequently Asked Questions
How long does it take to walk normally after a hip replacement?
You walk with a walker on the day of surgery and most patients move to a cane within 2 to 3 weeks and to no aid by 4 to 6 weeks. A normal gait without a limp usually takes 6 to 12 weeks as the gluteal muscles regain strength. Walking is the main exercise of the first month.
What are the posterior hip precautions and how long do they last?
For about 6 weeks: do not bend the hip past 90° (no low chairs or bending to reach the feet), do not cross the legs or bring the operated leg past the midline, and do not turn the foot inward. A raised toilet seat, wedge cushion, reacher and sock aid make daily tasks possible. Dr. O'Donnell lifts the precautions at the 6-week visit once the capsular repair has healed.
How long until I can drive after hip replacement?
When you are off narcotic pain medication and can move your foot from the gas to the brake without hesitation. For a right hip that is usually 3 to 4 weeks; for a left hip with an automatic transmission, about 2 weeks. Slide into the seat backward with the seat reclined.
How long does a hip replacement last?
Current data suggest that most modern hip replacements with a ceramic head and cross-linked polyethylene liner are still working 20 years after surgery, and wear rates with these materials are low enough that many will last considerably longer. Avoiding running and jumping and treating any infection promptly are the main things a patient can do to protect the implant.
Is hip replacement done as an outpatient?
For healthy patients with help at home, yes; many go home the same day from Bayside Surgery Center once they have walked with therapy and pain is controlled. Patients with significant medical conditions or who live alone stay one night. Either way, the first therapy session happens on the day of surgery.
This page is for general education and is not a substitute for a medical evaluation. The right procedure depends on your individual diagnosis, anatomy, and goals. Kevin O'Donnell, MD sees patients from Coral Gables, Miami, Brickell, Pinecrest and Coconut Grove at 475 Biltmore Way, and out-of-town patients by telemedicine.