Hip Replacement: 70 Questions Patients Ask

The worn-out ball (femoral head) and socket (acetabulum) of the hip are replaced with smooth implants: a metal cup in the socket with a plastic liner, and a stem in the thigh bone with a new ball on top. It is one of the most successful operations in medicine for relieving arthritis pain.

It is usually time when hip pain limits walking, sleep, work or the activities you enjoy, and non-surgical treatment no longer gives enough relief. X-rays show how much the joint is worn. The decision is yours, made together with Dr. Dold.

For hip arthritis, the AAOS guideline supports anti-inflammatory medication (NSAIDs), physical therapy and exercise. Steroid injections can give short-term relief. The guideline recommends against hyaluronic acid (gel) injections for the hip and against opioids for non-surgical care.¹ See hip arthritis.

Arthritis does not heal, but waiting is safe for most people as long as pain is manageable. Long delays can lead to stiffness, muscle weakness and a limp, which can make recovery slower. Severe bone loss or collapse, as in some cases of avascular necrosis, is a reason not to wait too long.

There is no strict age limit. Younger patients do very well with modern implants: in one study of patients 50 or younger, the highly cross-linked polyethylene liner showed very little wear after 20 years.² Older patients also do well; the decision depends on your health, not your age alone.

Yes. A high body mass index, poorly controlled diabetes and smoking all raise the risk of complications such as infection and wound problems.^1,3 An HbA1c (blood sugar) level of about 7.7% or higher has been linked to a higher infection risk.⁴ Dr. Dold may ask you to improve these before surgery.

For younger, active patients with hip pain but a well-preserved joint, hip arthroscopy may be an option. Once arthritis is advanced, hip replacement is usually the better choice. Dr. Dold performs both and can help you weigh them.

Yes, in selected healthy patients. Replacing both hips together means one anesthetic and one recovery, but studies show a higher risk of some complications, such as blood clots in the lungs, than doing them weeks or months apart.⁵ Dr. Dold will advise which is safer for you.

Second opinions are always welcome. Dr. Dold sees many patients for a second opinion on hip arthritis and hip replacement and can review your X-rays and records. Request an appointment.

Dr. Dold reaches the hip through the front, working in the natural interval between the tensor fasciae latae and sartorius muscles. Because muscles and tendons are moved aside rather than cut or detached, the hip’s own soft tissues are preserved. Learn more about anterior hip replacement.

Randomized trials and meta-analyses show that, compared with the posterior approach, patients have less pain in the first days, a shorter hospital stay, better function in the first weeks and stop using walking aids sooner.^6,8,9 Large series also report low dislocation rates of under 1%.^10,12 You lie on your back, which allows live X-ray to check implant position and leg length during surgery. Most patients do not need formal hip precautions.

Both are excellent operations. The anterior approach offers a faster early recovery, but the difference narrows after about 3 months, and long-term results are similar.^6,8,7 The AAOS guideline does not favor one approach over another.¹ Surgeon experience matters most: results with the anterior approach improve after a surgeon’s first 100 or so cases.^13,12

The most common is numbness or tingling on the outer thigh from irritation of a small skin nerve (the lateral femoral cutaneous nerve). When studies look for it carefully, it is common, but it affects sensation only, not strength, and usually becomes less noticeable over time.¹¹ Wound-healing problems are more likely in the skin crease at the front of the hip, especially in patients with a higher body weight.¹⁴ Surgery may take slightly longer than the posterior approach.⁸

Most patients are. Body shape, previous hip surgery, unusual anatomy or some revision cases may make another approach a better choice. Dr. Dold will tell you whether the anterior approach is right for you.

Usually about 3 to 4 inches, at the front of the hip, and often a little longer in larger patients. The goal is not the smallest possible scar but a safe, well-placed incision that lets Dr. Dold position the implants accurately. Because it sits at the front of the hip, you do not lie on it while sleeping.

The Hana® table is a specialized surgical table designed for anterior hip replacement. It holds and positions your leg precisely, allowing controlled movement of the hip during surgery and clear live X-ray images. Studies comparing a specialized table with a standard table show similar patient outcomes, so the choice is part of the surgeon’s technique.¹⁵

Dr. Dold uses OrthoGrid Hip AI®, an AI-powered platform built for anterior hip replacement. Live X-ray (fluoroscopy) images are sent to the software, which corrects image distortion and measures cup angle, hip offset and leg length in real time, so Dr. Dold can fine-tune the implants before closing. In a study of 420 hips using this platform, about 95% of cups were placed in the target zone and 98% of leg lengths were within 5 mm.^16,17 A national registry study also linked the use of fluoroscopy in anterior hip replacement to a slightly lower early revision rate.¹⁸ The technology supports the surgeon’s judgment; it does not replace it.

Leg length is planned before surgery and measured during surgery with live X-ray and OrthoGrid Hip AI®.¹⁶ Some patients feel that the operated leg is longer for the first few weeks because of muscle tightness and changes in posture; in most patients this feeling improves or goes away within a year.^19,20

The operation itself usually takes about 1 to 2 hours. You will also spend time in pre-op and in recovery.

A metal cup, usually made of titanium alloy, is fixed in the socket and lined with highly cross-linked polyethylene, a very durable medical plastic. A stem is placed in the thigh bone, and a ball, which in Dr. Dold’s practice is usually ceramic, fits on top of the stem.

Dr. Dold usually uses cementless (press-fit) implants, which have a rough surface that your bone grows onto. A cemented stem may be used when bone quality is weaker, for example in some older patients. Registry data show that cemented stems lower the risk of a fracture around the implant in patients 65 and older, and the AAOS guideline says they can be considered.^21,1 Cementless stems also perform well in older patients with good bone.²² The choice is based on your bone quality, which Dr. Dold assesses on X-ray and during surgery.

It is the plastic liner inside the cup. A special manufacturing process makes it far more wear-resistant than older plastics, which has greatly reduced wear and the bone loss it used to cause. In patients 50 and younger, one study found almost no measurable wear and no loosening after 20 years.²

Yes. Larger balls (32 mm or more) are more stable and lower the risk of dislocation compared with smaller ones.^26,24 Dr. Dold chooses the largest ball that safely fits your cup.

Yes. A systematic review found no link between nickel allergy and complications after hip replacement, and skin patch tests do not reliably predict problems.^27,28 Dr. Dold’s usual ceramic ball contains no cobalt or nickel. If you have a documented metal allergy, tell Dr. Dold so the implants can be reviewed with you.

A long time. A study in The Lancet of modern hip replacements found that about 94% were still working 20 years after surgery.²⁹ Earlier registry data, including older implant designs, found that about 58% lasted 25 years.³⁰ Today’s implants and techniques are expected to last even longer.

It may. You do not need a doctor’s note: simply tell the security officer that you have a hip replacement. The TSA Notification Card can help.^31,32

Most of Dr. Dold’s patients have spinal anesthesia with sedation, so you are relaxed and comfortable and don’t remember the surgery. International consensus recommendations favor spinal (neuraxial) anesthesia for hip replacement, as it is linked to fewer complications such as lung problems and blood clots.³³ General anesthesia is also safe and is used when spinal anesthesia is not suitable.³⁴ The final plan is made with your anesthesiologist.

Yes. Most of Dr. Dold’s anterior hip patients go home the same day. Studies show that, for suitable patients, same-day hip replacement does not increase complications or readmissions.^35,36,37 Whether it is right for you depends on your health, your support at home and how you do with physical therapy on the day of surgery.

Dr. Dold performs hip replacement at Baylor Surgicare at The Star, Medical City Frisco and other facilities in the area. The location can depend on your health needs and your insurance.

Pain is controlled with a combination of approaches: anesthesia techniques, ice, anti-inflammatory and other non-opioid medications, and a short course of stronger medication if needed. Patients having the anterior approach report less pain in the first days on average.^6,8

Transfusions are rarely needed. Dr. Dold uses tranexamic acid (TXA), a medication that reduces bleeding and is recommended by the AAOS and other specialty societies for joint replacement.^38,1

Yes. You receive an antibiotic through your IV before surgery, and doses usually continue for about 24 hours afterward. This approach follows guidance from the American Association of Hip and Knee Surgeons.^39,40

No, not routinely. Most patients do not need antibiotic pills after they go home. Antibiotics are only needed if a specific infection is diagnosed.

Most of Dr. Dold’s patients take aspirin for about 6 weeks after surgery to prevent blood clots. Large randomized trials support aspirin as an effective option for most patients after hip replacement, while patients with a higher risk of clots may need a stronger blood thinner.^41,42 Dr. Dold will tell you which medication is right for you.

The same day. Patients walk with a walker and the physical therapy team a few hours after surgery.

Most of Dr. Dold’s anterior hip patients move from a walker to a cane, or to no support at all, within about 1 to 2 weeks. In a randomized trial, anterior-approach patients stopped using all walking aids about 6 days sooner than posterior-approach patients.⁹

Yes. You start walking with physical therapy on the day of surgery and continue with exercises at home or with a therapist for several weeks, focusing on walking, strength and balance.

Yes. The therapy team will teach you how to use stairs safely before you go home: “up with the good, down with the operated” leg, using a handrail.

Most of Dr. Dold’s patients return to driving at about 2 to 4 weeks, once they are off narcotic pain medication and can control the car safely. Studies show that braking reaction time returns to normal within about a week after left hip surgery, and takes somewhat longer after right hip surgery.⁴³

Patients with desk jobs often return in about 2 to 4 weeks. Jobs that involve standing, lifting or physical labor usually take longer. In a large review, nearly 9 in 10 patients who worked before surgery returned to work.⁴⁴

Most of Dr. Dold’s anterior hip patients do not need formal hip precautions, such as limits on bending past 90 degrees or crossing the legs. Research shows that strict precautions do not lower dislocation rates even after the posterior approach.^45,46,47 Dr. Dold will tell you if your case is different.

As soon as it is comfortable. Many patients find a pillow between the knees helpful for the first few weeks.

You will receive specific wound-care instructions. A waterproof dressing usually lets you shower soon after surgery. Avoid soaking the incision in a bath, hot tub or pool until it is fully healed and Dr. Dold’s team says it is safe.

Some patients feel the operated leg is longer for the first few weeks because of muscle tightness and changes in posture. In most cases this feeling improves or goes away within a year as the muscles adapt.^19,20

This comes from irritation of a small skin nerve near the incision (the lateral femoral cutaneous nerve). It affects sensation only, not strength, and usually becomes less noticeable over time.¹¹

Many patients can travel within a few weeks. On long flights, get up and walk regularly, flex your ankles and stay hydrated to lower the risk of blood clots.³¹

Most patients can resume sexual activity once they feel comfortable, often within a few weeks. Ask Dr. Dold if you have questions about positions.

Your first follow-up visit is at about 10 to 14 days, followed by visits over the first year and then periodic check-ups with X-rays to make sure the implant is working well.

Most patients are walking comfortably and back to most daily activities within about 6 weeks. Strength and stamina keep improving for several months, and many patients say the hip continues to feel better for up to a year.

Walking starts on day one. Stationary cycling and swimming (once the incision has healed) usually follow within weeks, and golf and similar sports often resume at about 3 months, with Dr. Dold’s guidance. In a large review, about 8 in 10 patients returned to sport, on average about 6 months after surgery.⁴⁸

Possibly. Dr. Dold decides this case by case. Experienced runners may be able to return after discussion with him, usually after about 3 months. Previous experience in a sport is the best predictor of a safe return.^48,49

Most surgeons advise against high-impact contact sports, such as football, soccer and basketball, that involve collisions, falls and twisting.⁴⁹ Low-impact activities like walking, cycling, swimming, golf, doubles tennis and hiking are encouraged.

Regular activity is good for you and for your hip. A systematic review found that highly active patients had similar or better implant survival than less active patients.⁵⁰ High-impact and contact sports are still best avoided.

Yes. Kneeling does not harm a hip replacement, though it may be uncomfortable at first.

Serious complications are uncommon. Risks include infection, blood clots, dislocation, a difference in leg length, fracture around the implant, numbness on the outer thigh, wear or loosening over time, and anesthesia-related risks. Dr. Dold will review your individual risks at your consultation.

Infection of a hip replacement (periprosthetic joint infection) occurs in about 1% of patients.⁵¹ Risk is higher with obesity, diabetes, smoking and some inflammatory conditions such as rheumatoid arthritis.³

Prevention starts before surgery, by optimizing blood sugar, weight and smoking, and continues with skin preparation, IV antibiotics before and after surgery, and careful sterile technique in the operating room.^39,1

A dislocation is when the ball comes out of the socket. With the anterior approach it is uncommon: large series report rates of about 0.4% to 0.5%, lower than the posterior approach in the same studies.^10,12

Risk factors include a previous lumbar spinal fusion, which roughly doubles the risk,⁵² smaller ball sizes,²⁶ certain neuromuscular conditions and implant position. Accurate cup positioning with live X-ray and AI guidance helps lower the risk.¹⁶

Call for fever, increasing redness, warmth or drainage from the incision, calf pain or swelling, sudden severe hip pain, being unable to put weight on the leg, or pain not controlled by your medication. Go to the emergency room for chest pain or shortness of breath.

Most patients never do. A second surgery (revision) may be needed for wear, loosening, infection, instability or a fracture. Studies show that modern hip replacements last 20 years or more in the great majority of patients.²⁹

No. For routine dental cleanings and other non-invasive dental care, antibiotics are not needed. Current guidance from the American Academy of Orthopaedic Surgeons (AAOS), the American Association of Hip and Knee Surgeons and the American Dental Association concludes that routine antibiotics before dental procedures do not reduce the risk of infection in a hip or knee replacement.^{53,54,55,56,57} Read the AAOS/AAHKS guideline and the AAOS appropriate use criteria.

For most healthy patients, antibiotics are not recommended. The AAOS appropriate use criteria say antibiotics may be appropriate before invasive dental procedures for patients with a weakened immune system, for example from chemotherapy, organ transplantation or certain medications.⁵⁴ If that applies to you, Dr. Dold and your dentist will decide together.

There is no fixed rule. Routine cleanings can usually continue as normal. For planned invasive dental work, the timing is decided case by case, and the American Dental Association advises against rigid waiting periods.^53,55 Urgent dental problems should be treated promptly.

Good dental health is part of good overall health, and any dental infection or urgent problem should be treated before surgery. The AAOS guideline found that routine dental screening before joint replacement may not by itself lower the risk of infection.⁵³

Hip replacement is covered by most insurance plans when it is medically necessary. Dr. Dold accepts most major insurance plans, including Medicare and Tricare; please call 469-850-0680 to confirm your coverage. See insurance.

Stay as active as you can, follow any strengthening exercises you are given, control blood sugar and stop smoking. Arrange a ride home and help for the first few days, and set up your home so walkways are clear and things you use often are within easy reach.

Request an appointment online or call 469-850-0680. Walk-in visits are welcome Monday, Wednesday and Friday, 8:30 to 10:30 am.