How Hip Replacement Surgery Works — What Patients Need to Know

Hip replacement is one of the most reliably successful operations in orthopaedic surgery. The pain relief is usually dramatic and immediate — patients who have been managing a painful, deteriorating hip for years notice a difference within days of surgery. Recovery takes months for full function, but the trajectory from the very beginning is one of steady improvement.

Understanding the operation itself — what is removed, what is put in, and how the joint is reconstructed — makes the whole prospect more manageable.

The Hip Joint and Why It Fails

The hip is a ball-and-socket joint. The femoral head — the rounded top of the thigh bone — sits in the acetabulum, the cup-shaped socket in the pelvis. Both surfaces are covered with cartilage for smooth, friction-free movement.

When cartilage wears away, the joint becomes painful. The causes vary:

1. Osteoarthritis — the most common. Progressive cartilage loss from wear, inflammation, and eventual bone-on-bone contact. Causes deep groin pain, stiffness, and a limp that worsens over time.

2. Avascular necrosis (AVN) — bone death in the femoral head from disrupted blood supply. Causes include prolonged corticosteroid use (common for kidney disease, autoimmune conditions, and other conditions in Africa), excessive alcohol, sickle cell disease, and major trauma. The femoral head collapses progressively without treatment.

3. Rheumatoid arthritis — inflammatory joint disease that destroys cartilage in both hip compartments.

4. Hip fractures — in elderly patients where fixation is not appropriate, partial or total hip replacement provides faster recovery than attempting to heal the fractured bone.

5. Post-traumatic arthritis — arthritis following hip dislocation or acetabular fracture. Common in younger patients with a history of road trauma.

What the Surgery Replaces

Total hip replacement removes and replaces three components:

The femoral head — the ball — is removed by cutting through the femoral neck. The acetabulum — the socket — is prepared by reaming away the damaged cartilage surface down to healthy bone.

Three prosthetic components are implanted:

Acetabular cup — a hemispherical shell, usually titanium or cobalt-chromium, that is either press-fitted into the prepared socket or fixed with bone cement. A plastic (polyethylene), ceramic, or metal liner sits inside it, forming the articulating surface.

Femoral stem — a tapered metal implant pressed down into the hollow of the femur, providing the foundation for the new femoral head. Cementless stems rely on bone growing into a porous surface for fixation. Cemented stems are bonded with acrylic cement.

Femoral head — a ball attached to the top of the femoral stem. Made of cobalt-chromium, ceramic, or oxidised zirconium. Sits in the acetabular liner and provides the articulation.

The combination of cup liner and femoral head determines the bearing surface — the surfaces that move against each other. Different combinations have different wear rates and longevity characteristics. For younger, more active patients, ceramic-on-ceramic or oxidised zirconium on highly cross-linked polyethylene are preferred for durability.

Minimally Invasive Hip Replacement

Traditional hip replacement used a single long incision and significant muscle splitting. Minimally invasive approaches use smaller incisions and work between rather than through muscle planes, reducing trauma.

The most muscle-sparing approach is the direct anterior approach — the surgeon comes in from the front of the hip where there is a natural interval between muscles. This preserves the major hip muscles and is associated with faster recovery and earlier return to normal gait.

Availability depends on surgeon training. Prime Medical's partner hospitals offer minimally invasive hip replacement at Artemis Hospital, Fortis FMRI, and Max Hospital in Delhi NCR.

The Surgery — Step by Step

General or spinal anaesthesia. The patient is positioned on the operating table — on their side for the posterior approach, on their back for the anterior approach.

The incision is made and the joint exposed. The femoral head is dislocated from the socket. The femoral neck is cut at the planned level and the head removed.

The acetabulum is prepared by reaming — a rotating hemispherical cutter removes the damaged cartilage surface and shapes the socket. The acetabular cup is pressed into the prepared socket or fixed with cement. Bone screws may be added for additional fixation in cementless cups.

The femoral canal is prepared by broaching — sequential rasps of increasing size shape the canal to match the femoral stem. Trial components are placed to check leg length, stability, and range of motion. Final components are implanted, the head is placed on the stem, and the joint is reduced — the ball placed back in the socket.

The wound is closed in layers. Drains are placed. The operation takes ninety minutes to two hours.

Recovery — The Timeline

1. Surgery day: Waking in recovery. Blood pressure, oxygen, drip. The physiotherapist visits within hours. Some patients stand at the bedside the same day.

2. Day one: Walking with a frame. The operated leg can bear weight. Getting in and out of bed practised with the physiotherapist.

3. Days two to four: Mobility increases. Stairs practised. Most patients are ready for discharge by day three to five.

4. Weeks one to six: At accommodation or home with a frame or crutches. Exercises daily. Hip precautions observed — typically avoiding extreme internal rotation and hip flexion beyond 90 degrees in the early weeks, particularly with posterior approach surgery.

5. Six to eight weeks: Walking without aids for most patients. Driving clearance usually at six to eight weeks.

6. Three to six months: Return to most normal activities. Low-impact exercise encouraged. High-impact activities — running, heavy lifting — generally not recommended long-term to preserve implant longevity.

Orthopaedic Hospitals in Prime Medical's Network

Artemis Hospital, Gurugram (JCI, NABH) — Prime Medical partner. Minimally invasive hip replacement. Strong orthopaedic department.

Fortis Memorial Research Institute, Gurugram (JCI, NABH, NABL) — Minimally invasive and revision hip replacement. Complex AVN cases.

Max Super Speciality Hospital, Saket, Delhi (JCI, NABH, NABL) — Full hip replacement programme including minimally invasive technique.

Indraprastha Apollo Hospital, New Delhi (JCI, NABH) — Full orthopaedic programme including revision hip replacement.

For patients from Addis Ababa, Hawassa, Mekelle, Kampala, Mbarara, Dar es Salaam, Arusha, or Banjul with hip arthritis or AVN: share your hip X-rays and a brief history with Prime Medical Solutions. A specialist reviews within 48 hours.

To book a consultation, call the number on our website.