Hip replacement

Hip replacement is a surgical treatment based on replacing damaged hip joint surfaces with artificial components. It aims to reduce pain and improve functional movement; suitability is determined by individual assessment.

Summary: Hip replacement is a surgical option evaluated in advanced joint damage or certain hip fractures. In osteoarthritis, the inadequacy or unsuitability of non-surgical treatments is considered. In some acute fractures, waiting for these treatments is not recommended. Recovery varies from person to person; there is a possibility of infection, clots, dislocation or revision.

What is Hip Replacement?

Hip replacement is a procedure that replaces damaged surfaces in the joint formed by the femoral head and the socket in the pelvic bone. Prosthetic surgery is a type of arthroplasty. The surfaces to be replaced are determined according to the disease. The aim is to reduce pain and support movement; it is not expected that the artificial joint will restore all the properties of the natural hip.

During the operation:

• Damaged bone and cartilage surfaces are removed.
• Appropriate prosthetic components are positioned.

Comfortable Movement with Hip Replacement

After hip replacement, walking, sitting and getting up, or carrying on daily tasks may become easier. The degree of this depends on muscle strength before surgery, joint damage, accompanying illnesses and rehabilitation. Complete pain relief or unlimited performance of all movements cannot be guaranteed. Expectations are discussed with your doctor before surgery.

Hip Joint Problems Can Be Controlled with Treatment

In hip joint problems, treatment is planned based on the cause of pain and its effect on daily life. Exercise, physiotherapy, appropriate medicines and in selected cases injections can reduce symptoms. These are not applied in the same way to everyone. When options suitable for the individual prove inadequate or are not suitable, prosthetic surgery may be considered.

In Which Diseases is Hip Replacement Applied?

Hip replacement may be considered in advanced osteoarthritis, rheumatoid joint damage, avascular necrosis or certain fractures. The name of the disease alone does not constitute a decision for surgery. Examination, imaging, loss of function and general health are evaluated together. The treatment path for acute hip fractures may differ from that for progressive joint wear.

Hip Osteoarthritis (Osteoarthritis – Coxarthrosis)

Cartilage wear can cause pain, stiffness and difficulty walking. Hip replacement may be considered in advanced disease.

Rheumatoid Arthritis and Other Rheumatological Diseases

In permanent joint damage caused by inflammatory rheumatological diseases, hip replacement may be considered.

Hip Avascular Necrosis

Impairment of blood supply to the femoral head can lead to bone collapse. Treatment depends on the stage of the disease.

Hip Fractures (Particularly in Advanced Age)

In some fractures, direct hip replacement may be required; waiting for conservative treatment to fail is not recommended.

Hip Joint Damage Following Trauma

Permanent damage resulting from intra-articular fractures or dislocations may require a prosthesis.

Joint Disorders Due to Congenital Hip Dislocation

Pain and degenerative changes resulting from structural abnormalities require individualised surgical planning.

When Is Hip Replacement Considered?

Hip replacement may be considered in patients where joint damage significantly affects daily life. The duration of pain, restriction in movement, previous treatments, and the patient's expectations are important. Age alone is not the deciding factor. Bone structure and overall health are evaluated; not every patient needs to have tried all medications, injections, or physiotherapy options.

Symptoms assessed during evaluation:

• Persistent hip pain
• Night pain
• Reduced walking distance
• Difficulty with daily activities

When Is Hip Replacement Surgery Performed in Patients with Hip Osteoarthritis?

In hip osteoarthritis, the timing of surgery is determined more by a holistic assessment of the patient than by imaging alone. The impact of pain and loss of function on quality of life, the results of appropriate non-surgical treatments, and the personal surgical risks are weighed together. Not all osteoarthritis requires a prosthesis; when surgery is considered necessary, the decision is made jointly between patient and physician.

At What Stage Is Hip Replacement Surgery Considered in Hip Osteoarthritis?

It may be evaluated in cases of advanced damage, persistent pain, or significant loss of function.

When Is a Prosthesis Not Considered?

Surgery may be deferred if symptoms can be managed with appropriate non-surgical approaches.

Is the Decision for a Prosthesis Made Solely on the Basis of X-rays?

No; examination, pain, and daily activities are evaluated together.

What Happens If Hip Replacement Surgery Is Performed Too Early?

Performing surgery without a clear need may unnecessarily expose the patient to surgical risks.

What Happens If Hip Replacement Surgery Is Delayed?

Restriction in movement and muscle weakness may increase; the progression varies from person to person.

When Should a Doctor Be Consulted for Hip Osteoarthritis?

Persistent pain, sleep disturbance, or walking difficulty warrants evaluation.

How is Hip Replacement Surgery Performed?

In hip replacement surgery, the damaged joint surfaces are removed and appropriate components are fixed to the bone. The surgical approach, anaesthesia, and prosthesis selection are determined according to the individual. After placement, joint balance, movement, and limb length are checked. Possible risks include infection, bleeding, blood vessel or nerve injury, thrombosis, dislocation, or future need for revision.

Surgical Stages of Hip Replacement

1. Access to the hip joint is established.
2. Damaged surfaces are prepared.
3. Components are placed.
4. Balance is checked and the wound is closed.

Types of Anaesthesia in Hip Replacement Surgery

General or spinal/epidural anaesthesia is selected based on the anaesthetist's assessment.

How Long Does Hip Replacement Surgery Take?

The duration varies depending on anatomy, the extent of the surgery, and the procedure to be performed.

First Hours After Surgery

General condition, pain, and circulation are monitored; safe mobilisation is planned.

What Are the Types of Hip Prosthesis?

Hip prostheses are classified according to the joint surfaces replaced and the materials used. In total replacement, both the socket and femoral head surface are changed; in partial replacement, the natural socket is preserved. Selection is based on the condition, bone structure, and functional requirements. Robotic assistance is a separate method related to surgical planning and execution, not the prosthesis material itself.

Total Hip Replacement

Both the femoral head and acetabular surfaces are replaced.

Partial (Hemiarthroplasty) Hip Replacement

In certain hip fractures, the femoral head is replaced whilst the natural socket is preserved.

According to Prosthesis Material

• Ceramic–ceramic
• Ceramic–polyethylene
• Metal–polyethylene

What Is Robotic Hip Replacement?

Robotic assistance aims for precision in planning. Depending on the system, CT/MR imaging before surgery or imageless mapping during surgery may be used; the instrument may be a robotic arm or hand-held device. It is used under the surgeon's control and does not guarantee outcomes.

What Is the Recovery Process After Hip Replacement?

Recovery after hip replacement progresses with safe mobilisation, pain management, and rehabilitation. The timing of standing and weight-bearing is determined individually. Some swelling may be seen, but new or increased swelling should be evaluated. Discharge instructions are personalised; for the emergency symptoms listed below, it is not appropriate to wait for the planned follow-up appointment.

Mobilisation (Getting Out of Bed)

Getting up is started under supervision of healthcare staff, with appropriate walking aids.

Physiotherapy and Rehabilitation Process

Exercises are progressed as shown by the physiotherapist, according to muscle strength and balance.

Recovery Time and Return to Daily Life

Return to walking without aids and daily activities is determined through individual assessment.

Important Considerations During the Post-Hip Replacement Recovery Period

Movement and positioning restrictions vary according to the surgical approach. Follow your surgeon's instructions.

One or more findings in each row may be sufficient; they do not need to be present together.

When to seek care	Alarm signs
Call 112/emergency services immediately	Sudden shortness of breath, chest pain, fainting, coughing up blood, or rapid heartbeat
Call 112/emergency services immediately	Severe pain disproportionate to the injury, persistent or rapidly increasing; pain that significantly worsens with passive movement; tight swelling, numbness or weakness
Call 112/emergency services immediately	Coldness, paleness, discolouration, new numbness or loss of strength in the limb
Call 112/emergency services immediately	New confusion, slurred speech, or unstoppable bleeding
Call 112/emergency services immediately	Sudden severe pain, deformity, inability to move, or inability to bear weight; do not wait even if there has been a fall
Medical evaluation on the same day	New or increased one-sided leg swelling, leg pain, or calf tightness
Medical evaluation on the same day	Increasing redness, warmth, swelling, discharge at the wound, or separation of wound edges; fever is not required to be present
Medical evaluation on the same day	Temperature of 38°C or above, or persistent fever, with chills or deterioration in general condition; the lower threshold specified at discharge applies

Are There Alternatives to Hip Replacement?

Alternatives to hip replacement are evaluated according to the cause of pain and the degree of joint damage. Non-surgical methods aim to reduce symptoms and support daily function. They do not replace worn joint surfaces as a prosthesis does. In patients where appropriate options are inadequate or cannot be applied, surgery may be considered; certain acute fractures require a different treatment approach.

What Are the Alternative Treatment Options to Hip Replacement?

Alternative options include individualised exercise, physiotherapy, weight management, walking aids, and medications. The evidence for injections and their intended use differ; they cannot be presented as equivalent treatments. The plan is created by evaluating expected benefits and risks. Reduction in symptoms does not mean that structural joint damage has reversed.

Medication Therapies

Medications can reduce symptoms; do not start, stop, or change the dose on your own.

Physiotherapy and Exercise Programmes

Exercises shown by the physiotherapist aim to support movement and muscle function.

Intra-Articular Injections

• Corticosteroid: May provide short-term relief in selected cases.
• Hyaluronic acid: Not recommended for hip osteoarthritis; guideline support is limited.
• PRP: Evidence is uncertain; guideline recommendations advise against its use.

Lifestyle Modifications

Appropriate weight management and individually tailored activity can reduce symptoms.

Walking Aids and Assistive Devices

Crutches or other supports should be used as demonstrated by your physiotherapist.

When Do Alternative Treatments Fall Short?

Surgery may be considered when pain and limitations in daily activities persist despite appropriate treatment.

Do Hip Replacement Alternatives Provide a Permanent Solution?

The aim is symptom control; it cannot be generalised that they slow the progression of structural damage or delay surgery.

Answers to your questions about hip replacement vary depending on the cause of your condition and your individual recovery process. The explanations below provide general guidance; your discharge plan regarding post-operative weight-bearing, movement restrictions, medication use and return to activity will be tailored to you. For emergency symptoms, seek help without waiting for your next appointment.