Hip surgery is a procedure that repairs or replaces damaged parts of the hip joint, most commonly to relieve chronic pain from arthritis or to fix a fracture. The most well-known form is total hip replacement, where the worn-out ball and socket are swapped for artificial components. But hip surgery actually covers several different procedures, and which one you’d need depends on your age, activity level, and what’s causing the damage.
Why Hip Surgery Is Recommended
Hip surgery typically enters the conversation after other treatments have stopped working. That means pain medications, physical therapy, and walking aids like canes haven’t brought enough relief. The American Academy of Orthopaedic Surgeons identifies four common signs that point toward surgery: hip pain that limits everyday activities like walking or bending, pain that persists even while resting or sleeping, stiffness that makes it hard to move or lift the leg, and inadequate relief from anti-inflammatory drugs or physical therapy.
The underlying problem is usually one of three conditions. Osteoarthritis is the most common, where the cartilage cushioning the joint wears down over years until bone grinds against bone. On an X-ray, a healthy hip shows a clear space between the ball and socket (that’s the cartilage), while an arthritic hip shows that space nearly gone. Rheumatoid arthritis, an autoimmune condition, can also destroy the joint lining. And fractures, particularly in older adults after a fall, sometimes damage the hip beyond what pins or screws can repair.
Types of Hip Surgery
There are three main procedures, each replacing a different amount of the joint.
Total hip replacement is the most common. It replaces the entire hip joint: the ball (femoral head), the socket (acetabulum), and part of the thighbone just below the ball. The damaged bone is removed and replaced with artificial components. This is the standard recommendation for older adults with osteoarthritis, and modern implant technology means most people do well with it.
Partial hip replacement replaces only the ball and a portion of the thighbone, leaving the natural socket intact. This is often used when the ball of the thighbone is fractured but the socket is still healthy, making it a good option for younger people who’ve had trauma to the hip.
Hip resurfacing is the most conservative option. Only the socket gets a prosthetic lining, and the natural ball is reshaped to fit into it rather than removed. Because it preserves the most bone, resurfacing can be a smart choice for younger athletes who need a high range of motion and will likely outlive their first implant. If they eventually need a full replacement later in life, more of their original bone is still available to work with.
What Happens During the Procedure
In a total hip replacement, the surgeon removes the damaged femoral head (the ball at the top of the thighbone) and prepares the socket by clearing out damaged cartilage. A metal cup is fitted into the socket, and a new ball, attached to a metal stem, is inserted into the thighbone. The new ball sits inside the new socket, recreating the joint’s natural movement.
Surgeons reach the hip joint through one of two main approaches. The anterior approach enters from the front of the hip, separating muscles rather than cutting through them. This tends to cause less pain in the first two weeks after surgery. The posterior approach enters from the back and historically carried a slightly higher dislocation risk, though modern techniques that preserve the surrounding muscles have largely closed that gap. A large randomized trial of about 400 patients found no differences in walking ability, return to function, or complications between the two approaches. Today, the complication rate for either route is roughly 1 in 1,000 operations.
Robotic-Assisted Surgery
Some surgeons now use robotic systems to help position implant components with greater precision. Robotic assistance has been linked to more accurate placement, reduced differences in leg length after surgery, and shorter hospital stays. However, research from Massachusetts General Hospital shows that patient-reported outcomes, including physical function and mental health scores, are comparable between robotic and traditional manual surgery. The technology improves technical accuracy, but the practical benefits patients feel day to day are similar either way.
What the Implant Is Made Of
Modern hip implants combine different materials for different parts of the joint. The stem that fits into the thighbone is typically made from titanium or cobalt-chromium alloys, both strong and resistant to corrosion inside the body. The socket lining is often made from a highly durable plastic called cross-linked polyethylene, which resists wear better than older plastics.
Ceramic is increasingly popular for the ball component. It’s harder and smoother than metal, which means less friction against the socket lining and less debris produced over time. When a metal ball rubs against a plastic liner, it can gradually shed tiny particles that trigger an immune response. A ceramic ball paired with a polyethylene liner significantly reduces that wear. For patients who need their implant to last decades, the choice of materials matters.
How Long Implants Last
Hip implants have become remarkably durable. A 2025 systematic review in The Lancet, drawing on global joint registry data, found that 93.6% of modern total hip replacements survive to 20 years. Extrapolating further, the predicted survival rate at 25 years is 92.8%. That means fewer than 1 in 10 patients will need a revision surgery within a quarter century of their original procedure.
Recovery Week by Week
Recovery from hip replacement is faster than most people expect. You’ll bear weight and walk on the day of surgery, typically covering several hundred feet with a walker before going home or to a recovery room. Here’s what the timeline generally looks like:
- Day of surgery through day 2: Standing and walking short distances with a walker. Pain is managed with medication.
- Week 1: Begin gentle home exercises. You’ll still rely on a walker for stability.
- Week 2: Work on improving balance and start phasing out the walker or cane. Many people can drive by this point, as long as they’re off narcotic pain medication and can press the brake pedal hard in an emergency.
- Weeks 3 to 4: Resume most daily activities. Gradually increase exercise intensity, adding about 10% more effort as tolerated.
- Weeks 5 to 6: Most people return to work. Strength and range of motion are noticeably improved. Physically demanding jobs may require more time.
- Beyond week 6: Continue building strength and stamina. Activities that caused pain before surgery become more comfortable.
Formal physical therapy isn’t always necessary. Many surgeons provide a set of home exercises that patients can do on their own with good results, though PT may be recommended for specific cases.
Risks and Complications
Hip replacement is one of the most successful operations in medicine, but it carries risks like any surgery. Blood clots are a concern because of how blood flow changes after the procedure. Clots can form in the deep veins of the leg, and in rare cases travel to the lungs. You’ll typically receive blood-thinning medication and be encouraged to move early to reduce this risk.
Infection at the wound site is possible but uncommon, and it’s usually managed with antibiotics. If infection reaches deep into the joint itself, additional surgery may be needed. A slight difference in leg length can also occur, though surgeons work to minimize this, and most people don’t notice a small discrepancy.
Preparing Before Surgery
What you do in the weeks before surgery can meaningfully shorten your recovery. Prehabilitation programs, often called “prehab,” typically begin six to eight weeks before the procedure. Working with a physical therapist, you’ll focus on strengthening the muscles of your back, legs, and core, along with cardio exercises to build stamina. Learning the post-surgical exercises in advance also helps, since you’ll already be familiar with the movements when it matters most.