Hip replacement

• The operation usually takes 1–2 hours; you walk with support on the day of surgery or the next day.
• Implant infection in the first year is about 1.3 %; Russian authors report about 3 %.
• By registry data about 89 % of implants work at 15 years and about 58 % at 25.
• No driving for at least 6 weeks; sex after 6–8 weeks.

How the hip is built

The hip is the largest ball-and-socket joint in the body. The head of the thigh bone (the ball) sits in the pelvic socket (acetabulum). Both surfaces are covered with smooth cartilage, so the bones glide almost without friction. The capsule and ligaments hold the ball in the socket. The buttock, groin and hip flexor muscles move the leg and steady the joint.[2]2Total Hip Replacement — AAOS OrthoInfo, 2024To the list of sources →

When the cartilage wears thin, the bones start to rub against each other. Pain, stiffness and a limp follow. The implant replaces exactly this worn ball-and-socket pair.

Causes and stages

The most common cause is coxarthrosis, or osteoarthritis of the hip. Cartilage wears away with age, overload or injury.[8]8Клинические рекомендации «Коксартроз» (ID 870_1) — Минздрав России, 2024To the list of sources → Other causes:

• dysplasia: a shallow socket from birth that makes the joint wear out early;
• avascular necrosis: part of the femoral head dies from a poor blood supply. Causes include injury, steroid medicines and some diseases;
• hip fracture, especially in older people;
• rheumatoid arthritis and other inflammatory joint diseases;
• post-traumatic arthritis after fractures of the socket.[2]2Total Hip Replacement — AAOS OrthoInfo, 2024To the list of sources →

Stages are graded on X-rays. Russia uses two scales: Kosinskaya (stages I–III) and Kellgren–Lawrence (grades 0–IV).[8]8Клинические рекомендации «Коксартроз» (ID 870_1) — Минздрав России, 2024To the list of sources → The higher the stage, the narrower the joint space and the larger the bone spurs. The decision to operate rests on how the pain affects your life. The stage on the image does not decide it alone.

In Russia more than 83,000 primary hip replacements were done in 2019.[5]5Эпидемиология эндопротезирования тазобедренного и коленного суставов и перипротезной инфекции в Российской Федерации — Травматология и ортопедия России, 27(3):84–93, 2021To the list of sources →

Indications for surgery

The Russian Ministry of Health guideline on coxarthrosis (2024) discusses replacement when two conditions meet:

• the X-ray shows Kosinskaya stage III or Kellgren–Lawrence grade III–IV;
• treatment without surgery no longer helps: exercise, weight loss, painkillers, injections.[8]8Клинические рекомендации «Коксартроз» (ID 870_1) — Минздрав России, 2024To the list of sources →

There is no absolute age or weight limit: the doctor looks at your overall health.[2]2Total Hip Replacement — AAOS OrthoInfo, 2024To the list of sources → Surgery is postponed with an active infection, including of the teeth or skin. Untreated severe heart or lung disease and untreated severe osteoporosis are other reasons to wait. So is being unable to go through rehabilitation.[8]8Клинические рекомендации «Коксартроз» (ID 870_1) — Минздрав России, 2024To the list of sources →

The navigator is not a doctor: diagnosis and treatment stay with your physician.

How the operation works: step by step4 short scenes using the knee · one click at a time

Types of operation

• Total hip replacement: the socket and the head with a stem are both replaced. It is the main operation for coxarthrosis.[2]2Total Hip Replacement — AAOS OrthoInfo, 2024To the list of sources →
• Hemiarthroplasty: only the femoral head is replaced, and your own socket stays. It is usually done for hip fractures, rarely for tumours.[1]1Hip Replacement — Cleveland Clinic, 2025To the list of sources →
• Hip resurfacing: the head is not removed but capped with a metal shell. It is used less now because of problems with metal-on-metal bearings. Candidates are mostly under 60 with strong bone, more often men.[15]15Hip Resurfacing — AAOS OrthoInfo, 2024To the list of sources →
• Revision replacement: a repeat operation to replace worn or loose parts. It is harder than a first operation and carries more risk, including infection.[4]4Periprosthetic joint infection after 1.66 million primary and revision arthroplasties (2015–2023) — PMC, 2025To the list of sources →

Surgical approach

The approach is the route to the joint: the incision site and the muscles moved or cut.[13]13Surgical approaches for total hip arthroplasty: a review of the anatomy (direct lateral / Hardinge, anterolateral, posterior, direct anterior) — PMC, 2015To the list of sources → It shapes the first weeks of recovery and the safety rules. It does not change how long the implant lasts.

The comparison figures come from a meta-analysis of 48 studies and 46,367 hips.[3]3Direct anterior versus posterior approach in total hip arthroplasty: systematic review and meta-analysis — Frontiers in Surgery, 2025To the list of sources → The anterior approach gives a small early gain in function: about 3 points of 100 on the Harris Hip Score. The difference fades over time. Skin nerve injury rates with the anterior approach did not differ in the meta-analysis.[3]3Direct anterior versus posterior approach in total hip arthroplasty: systematic review and meta-analysis — Frontiers in Surgery, 2025To the list of sources → Ask your surgeon how many operations they do a year with the chosen approach.

What you will be given

A hip implant has four parts:

1. Cup (acetabular component): a metal hemisphere fitted into the prepared socket. It is usually porous titanium alloy, so bone can grow into it.
2. Liner: a polyethylene or ceramic insert inside the cup. The head moves against it.
3. Head: a ball of ceramic or cobalt-chrome alloy, usually 28, 32 or 36 mm across.
4. Stem (femoral component): a metal rod inside the canal of the thigh bone. The head fits onto its tapered end.[2]2Total Hip Replacement — AAOS OrthoInfo, 2024To the list of sources →

Preparation

Preparation starts several weeks before the operation.[2, 8]2Total Hip Replacement — AAOS OrthoInfo, 20248Клинические рекомендации «Коксартроз» (ID 870_1) — Минздрав России, 2024To the list of sources →

A few more points:

• Skin. Treat any skin infections: infection can spread to the implant.
• Smoking. Stop smoking: it slows healing.
• Weight. Ask your doctor whether you should lose weight.
• Prehabilitation. Strengthen your legs and arms, since you will lean on them. Practise walking with crutches.
• Home. Bathroom grab rails, a raised toilet seat, slip-on shoes and a long shoehorn.[2, 8]2Total Hip Replacement — AAOS OrthoInfo, 20248Клинические рекомендации «Коксартроз» (ID 870_1) — Минздрав России, 2024To the list of sources →

The day of surgery

Spinal anaesthesia is used most often. An injection in the back numbs the legs, and you can doze. General anaesthesia is used less often. The anaesthetist chooses the method with you.[2]2Total Hip Replacement — AAOS OrthoInfo, 2024To the list of sources →

The operation usually takes 1–2 hours.[1]1Hip Replacement — Cleveland Clinic, 2025To the list of sources → An antibiotic is given before the incision. Medicines against blood clots are prescribed after surgery.[8]8Клинические рекомендации «Коксартроз» (ID 870_1) — Минздрав России, 2024To the list of sources →

In hospital

On day one you are helped to sit, then to stand with a walker.[2]2Total Hip Replacement — AAOS OrthoInfo, 2024To the list of sources → Walking early lowers the risk of clots and pneumonia.

• Days 0–1. First steps with a walker or crutches. Ankle pumps: bend and straighten the ankles.[11]11Total Hip Replacement Exercise Guide — AAOS OrthoInfo, 2024To the list of sources →
• Days 2–3. Walking in the ward and corridor. Learning to use a high chair and toilet, and a sock aid.
• Days 3–5. Stairs with a physiotherapist.
• Before discharge. A check X-ray, training in the safety rules, anticoagulants and a rehabilitation plan.[8]8Клинические рекомендации «Коксартроз» (ID 870_1) — Минздрав России, 2024To the list of sources →

In the UK patients go home after 1–3 days.[9]9Hip replacement — NHS, 2024To the list of sources → In the US they often leave on the day of surgery or the next day.[2]2Total Hip Replacement — AAOS OrthoInfo, 2024To the list of sources → In Russian clinics the early inpatient stage lasts up to 1–2 weeks.[8]8Клинические рекомендации «Коксартроз» (ID 870_1) — Минздрав России, 2024To the list of sources → Private clinics discharge sooner. Pain after surgery is normal and is treated with several medicines at once. Do not put up with it: tell the nurse.

The main stages of the day of surgery

Recovery plan

The 90° rule

While the capsule heals, an awkward movement can make the head slip out. Which movements are risky depends on the approach, so check with your surgeon. After the most common, posterior approach the rules are:[8, 9]8Клинические рекомендации «Коксартроз» (ID 870_1) — Минздрав России, 20249Hip replacement — NHS, 2024To the list of sources →

• Do not bend the hip beyond 90°. Do not bend down to your feet or sit on low seats.
• Do not cross the midline. Do not cross your legs. Sleep on your back, or on the healthy side with a 10–15° wedge between the knees.
• Do not turn the leg inwards. Your toes should not point at the other leg, especially when you turn your body.

After a direct anterior approach the rules are different and usually milder. Avoid over-extension, such as stepping back while leaning back. Avoid turning the leg outwards. Many clinics now relax the rules, but your surgeon decides. Unrestricted movement is usually allowed after 6–12 weeks.[1]1Hip Replacement — Cleveland Clinic, 2025To the list of sources →

Exercises by phase

The programme follows the AAOS OrthoInfo guide.[11]11Total Hip Replacement Exercise Guide — AAOS OrthoInfo, 2024To the list of sources → Your physiotherapist will tailor it to you.

Muscle soreness is normal. Sharp joint pain or a painful click means stop and call your doctor.

Complications and how often they happen

Serious complications are rare.

Diabetes, obesity, smoking and immune-suppressing medicines raise the risk of infection. Before surgery you can lose weight, stop smoking and control your blood sugar. That lowers the risk, though it does not remove it.

What to expect after a year

Most patients say the arthritis pain has gone. They return to walking, work and daily life.[2]2Total Hip Replacement — AAOS OrthoInfo, 2024To the list of sources →

• Leg length. The surgeon tries to make the legs equal. For stability, the operated leg sometimes ends up slightly longer. Often it is only a feeling after years of limping, and it passes. A true difference is corrected with an insole.[2]2Total Hip Replacement — AAOS OrthoInfo, 2024To the list of sources →
• Numbness around the scar and on the outer thigh usually fades over time.
• Clicks and squeaks. Soft clicks with some movements are normal. Ceramic-on-ceramic bearings can squeak, usually rarely and without pain. A new loud noise is a reason to see your surgeon.
• Sport. Walking, swimming, cycling, golf and classic cross-country skiing are fine. Running, jumping and contact sports speed up wear and are not recommended.[2]2Total Hip Replacement — AAOS OrthoInfo, 2024To the list of sources →
• Airport metal detectors may go off, which is normal. A certificate is not required, but you can carry your discharge summary.[2]2Total Hip Replacement — AAOS OrthoInfo, 2024To the list of sources →
• Dentist. Before procedures that cause bleeding, a preventive antibiotic may be prescribed. Discuss this with your surgeon and dentist.[2]2Total Hip Replacement — AAOS OrthoInfo, 2024To the list of sources →

Hip replacement is part of the state guarantee programme. Most primary operations are paid by compulsory health insurance (OMS). Complex and revision cases go under a federal VMP quota.[7]7Травматология и ортопедия по квоте (ВМП): как получить — gosmed.ru, 2025To the list of sources →

You will need a referral on form 057/u and a medical summary.[14]14Приказ Минздрава России от 02.09.2025 № 519н: форма направления 057/у и порядок её ведения — Минздрав России, 2025To the list of sources → The route, documents and appeals are on the quota and OMS page.

A paid operation gives more choice, but it does not guarantee a better result.