Total hip replacement

The hip is a ball-and-socket joint: the head of the femur fits into the acetabulum of the pelvis, both covered by cartilage that allows smooth movement.

When that cartilage wears away, bone rubs on bone and pain, stiffness and loss of function appear. The prosthesis replaces these surfaces with artificial components that recreate the movement.

The first step is always to exhaust non-surgical treatment: weight loss, physiotherapy, analgesia and activity modification. A replacement is considered when those measures no longer control the pain.

Before surgery a general assessment is done to arrive in the best possible condition: conditions such as diabetes or anemia are optimized, medication is reviewed and any focus of infection (dental, urinary or skin) is treated, because reducing it lowers the risk of prosthetic infection.

The surgery is planned on your radiographs, measuring the size and position of the components to reproduce the hip's anatomy and match the length of the legs.

It is usually performed under spinal anesthesia, often supplemented with sedation, which helps with pain control and early recovery. The joint is approached through a route that spares the muscles as much as possible; there are different approaches (posterior, anterolateral or direct anterior) and the choice is tailored to each patient.

Most people stay in hospital for one or two days. From the postoperative period, measures are started to prevent thrombosis and to walk early.

Most patients stand and walk with assistance the same day or the day after surgery, first with a walker and then with canes, progressing gradually with physiotherapy.

In the first weeks weight-bearing is done with support and range of motion and strength are worked on; many patients set aside their canes and resume light activities and driving over the course of a few weeks, depending on their progress.

Return to usual activities is gradual, and your team will give you specific precautions depending on the surgical approach —for example, certain positions best avoided at first to protect the stability of the prosthesis.

Hip replacement is one of the operations that most improves quality of life in well-selected patients, with pain relief and recovery of walking in most cases.

Modern prostheses have good long-term survivorship, though they are not forever: over the years they can wear or loosen. Walking, swimming or cycling are recommended activities; repeated impact and high-impact sports accelerate wear. Periodic check-ups allow the state of the prosthesis to be followed over time.

The decision to operate is made together: we discuss your symptoms, their impact on daily life, the expected benefits, the risks and the alternatives. Surgery does not guarantee an outcome; it aims to improve pain and function in selected patients.