Total Hip Replacement Surgery

Total hip replacement surgery, also known as total hip arthroplasty (THA), is one of the most common orthopedic surgeries. In this surgery, the damaged parts of the hip joint are removed and replaced with artificial parts made of metal, ceramic, or strong plastic [1].

The hip works like a ball-and-socket joint. The round top of the thigh bone fits into a cup-shaped socket in the pelvis. Smooth cartilage normally covers these surfaces so the joint moves easily and without pain. When the cartilage wears away, the bones rub against each other. This leads to severe pain, stiffness, and trouble moving [2].

There are three main surgical approaches used in total hip replacement surgery:

• Posterior approach (back): The surgeon makes an incision behind the hip. It requires cutting through important muscles and tendons at the back of the hip.
• Lateral approach (side): The surgeon accesses the hip joint from the side. This method also involves cutting some muscles, which can affect hip strength and lead to a longer healing period.
• Anterior approach (front): The surgeon works through the front of the hip. This is a modern muscle-sparing technique where the surgeon gently moves the muscles aside rather than cutting them.

Both the posterior and anterior approaches are the most widely used today and deliver excellent long-term results. The posterior approach offers very good surgical exposure and is familiar to most surgeons. The anterior approach often allows faster early recovery, less pain in the first weeks, shorter hospital stays, and a lower risk of hip dislocation because it preserves more muscle tissue. The choice between them depends on the patient’s condition, anatomy, and the surgeon’s recommendation [3][5].

Posterior Approach (Back Approach): The surgeon makes an incision at the back of the hip. The patient is positioned on their side. This traditional method provides excellent visibility of the hip joint. The surgeon detaches some muscles and tendons to access the joint (these are repaired at the end of the procedure), removes the damaged femoral head, prepares the acetabulum and femur, inserts the prosthetic components, and closes the wound. This approach has been used successfully for decades and remains a reliable option for many patients [5].

Anterior Approach (Front Approach): In the direct anterior approach, the surgeon reaches the hip joint from the front of the body. This method is muscle-sparing; the doctor gently moves the muscles aside rather than cutting through them. This is considered a modern, preferred technique compared with the older posterior (back) approach. The surgeon removes the damaged ball of the thigh bone, inserts a new ball on a stem into the thigh bone, and places a new cup in the pelvis. The result is a smooth, pain-free new joint [3].

Figure 1. Illustration showing a normal hip joint (A) compared to a hip after replacement surgery (B).

When Might You Need Total Hip Replacement Surgery?

Total hip replacement is recommended when hip pain and disability become severe enough to significantly affect daily life and when non-surgical treatments such as medications, physiotherapy, walking aids, or steroid injections no longer provide adequate relief [2].

1. Osteoarthritis (the most common cause)

This is the “wear and tear” type of arthritis. Over decades, the cartilage that cushions the hip joint gradually breaks down. It is the leading reason for hip replacement worldwide, especially in people over 60 years of age.

2. Rheumatoid Arthritis

This is an autoimmune condition where the body’s immune system attacks the joints, causing long-term inflammation that destroys cartilage and bone.

3. Avascular Necrosis (Osteonecrosis)

When blood supply to the femoral head is cut off due to fractures, long-term steroid use, or alcohol misuse, the bone tissue dies and the joint collapses [3].

4. Hip Fracture

In older adults, a broken hip from a fall may be best treated with a hip replacement rather than internal fixation, especially when the blood supply to the femoral head is disrupted.

5. Post-Traumatic Arthritis

Previous hip injuries or fractures can damage the cartilage and lead to arthritis years later [1].

Signs that you may need a hip replacement: persistent hip or groin pain even at rest or at night; difficulty walking, climbing stairs, or rising from a chair; stiffness that limits the ability to lift or rotate the leg; pain that no longer responds to anti-inflammatory medication or physiotherapy; and significant reduction in quality of life due to hip disability.

Advantages of Total Hip Replacement Surgery

Total hip replacement is considered one of the most successful elective surgical procedures in all of medicine. Its benefits are well-established and supported by decades of research [2].

1. Dramatic Pain Relief

The most immediate and profound benefit is the relief of chronic, debilitating hip pain. The vast majority of patients report near-complete pain elimination after recovery.

2. Restored Mobility and Function

After healing, most patients can walk, climb stairs, swim, cycle, and return to everyday activities they had given up due to hip disease [4].

3. Long-Lasting Results

Modern hip implants are designed to last 15–25 years or longer. Studies show that over 95% of hip replacements are still functioning well 10 years after surgery [3].

4. Improved Quality of Life

Patients experience better sleep, reduced dependence on pain medication, improved mood and mental health, and the ability to return to social and recreational activities.

5. Outpatient or Short-Stay Surgery

With modern techniques, many hip replacements are now performed as outpatient or same-day procedures, meaning patients go home the same day or after just one overnight stay [5].

6. High Success Rate

Total hip replacement has a complication rate of less than 2% in most cases. It is safe even in elderly patients when properly selected and prepared.

7. Correction of Leg Length Discrepancy

Surgery can equalize leg length differences caused by hip disease, improving posture and reducing back pain.

Procedure of Anterior and Posterior Approaches

The basic steps are similar for both the posterior and anterior approaches. The main difference is the location of the incision and how the muscles are handled.

• Posterior Approach: The patient is usually positioned on their side. The surgeon makes an incision at the back of the hip, detaches some muscles and tendons (which are later repaired), dislocates the hip, prepares the socket and femur, inserts the implants, and closes the wound. This approach gives excellent visibility but requires muscle repair.

• Anterior Approach: The patient lies on their back. The surgeon makes a smaller incision at the front of the hip and works between the muscles without cutting them. The steps for preparing the acetabulum (socket), femur, and inserting the components are the same. This muscle-sparing method often allows quicker initial mobilization [3].

Step-by-Step Total Hip Arthroplasty Procedure (Anterior & Posterior Approach)

1. Before Surgery: You have blood tests, X-rays, and a full health check. The doctor explains the plan, and you stop eating/drinking before the operation.

2. Anesthesia: You are given medicine so you sleep or the lower body is numb. You lie on your back for the anterior approach or on your side for the posterior approach.

3. Incision: A small cut is made on the front of the hip for the anterior approach and at the back of the hip for the posterior approach. The surgeon works between the muscles without cutting them [3].

4. Remove Damaged Bone: The old ball is taken out.

5. Prepare the Socket: The damaged pelvis cup is cleaned, and a new artificial cup is put in.

6. Prepare the Thigh Bone: Space is made for the new stem inside the thigh bone.

7.   Place New Parts: The new ball is attached and fitted into the socket.

8. Test Everything: The surgeon checks stability, leg length, and movement.

9.  Close the Wound: The cut is closed with stitches.

10. Recovery: Many patients stand and walk (with help) on the same day. Physical therapy starts soon, and most people recover quickly in the first weeks [5].

The professional team at OSMI is highly trained and qualified to evaluate, diagnose, and treat your hip condition by using the least invasive and most effective methods available.  If you are experiencing hip pain or are concerned that you may have a hip injury, come see us at The Orthopedic and Sports Medicine Institute. Our goal at The Orthopedic & Sports Medicine Institute (OSMI) is to provide our patients with quality, cutting-edge orthopedic treatments, both surgical and non-surgical. If you would like to book an appointment, please submit an online appointment request or contact our office. We have clinic locations in Fort Worth, Mansfield, Decatur, and Willow Park.

References

Nassar JE, et al. Direct Anterior Approach and Posterior Approach for Total Hip Arthroplasty: A Systematic Umbrella Review… Orthopedic Reviews. 2025. https://doi.org/10.52965/001c.137665

Choudhary A, Pisulkar G, Taywade S, et al. A comprehensive review of total hip arthroplasty outcomes in post-traumatic hip arthritis. Cureus. 2024;16(3):e56350. https://doi.org/10.7759/cureus.56350

Bastian JD. Total hip arthroplasty, current challenges. Medicina. 2023;59(6):1011. https://doi.org/10.3390/medicina59061011

Yale Medicine. Total Hip Replacement (Direct Anterior Approach). https://www.yalemedicine.org/conditions/total-hip-replacement-anterior-approach

Outcomes of Direct Anterior versus Posterior Approaches in Total Hip Arthroplasty: A Systematic Review. J AOAO. 2024. https://doi.org/10.70709/fn76ep3