Our knowledge of orthopaedics. Your best health.

Traditional Hip Replacement

To perform a traditional hip replacement:

• The surgeon makes a 10- to 12-inch incision on the side of the hip, then splits or detaches the muscles from the hip, allowing the hip to be dislocated and fully viewed.
• The surgeon removes the damaged femoral head and inserts a metal stem into the hollow center of the femur. The surgeon then places a metal or ceramic ball on the upper part of the stem. This ball replaces the damaged femoral head that was removed.
• The surgeon removes the damaged cartilage surface of the socket (acetabulum) and replaces it with a metal socket. The surgeon may use screws or cement to hold the socket in place.
• The surgeon inserts a plastic, ceramic or metal spacer between the new ball and the socket to allow for a smooth gliding surface.

(Left) The individual components of a total hip replacement. (Center) The components merged into an implant. (Right) The implant as it fits into the hip. 

Minimally Invasive Hip Replacement

The goals are similar with minimally invasive total hip replacement, but the surgeon cuts less of the tissue surrounding the hip. The artificial implants used are the same as those used for traditional hip replacement. However, specially designed surgical instruments are needed to prepare the socket and femur and to place the implants properly.

Minimally invasive total hip replacement can be performed with either one or two small incisions. Smaller incisions allow for less tissue disturbance.

Minimally invasive surgery based on a small incision or multiple incisions

Small-incision surgery using the posterior, lateral, or anterolateral approach

• For this type of minimally invasive hip replacement, the surgeon uses a single incision that usually measures 3 to 6 inches. The length of the incision depends on the size of the patient and the difficulty of the procedure. 
• The surgeon makes the incision on the side or back of the hip. The muscles and tendons are split or detached from the hip, but to a lesser extent than in traditional hip replacement surgery. They are routinely repaired after the surgeon places the implants. This encourages healing and helps prevent dislocation of the hip.

Multiple-incision surgery

• Some surgeons perform a hip replacement through two separate small incisions. The concept behind two incisions is to approach the pelvis (cup) through one incision and the femur (thighbone) through a separate incision.
• Approaching the hip in this manner may allow for less disruption of the underlying tissues compared to using one incision.
• For this procedure, surgeons often use X-ray guidance during surgery to ensure proper placement of the implants.

Minimally invasive surgery based on incision location

Direct anterior approach

Another approach to minimally invasive surgery is to change the location of the incision. In the past decade, the direct anterior approach has become popular because it requires less disruption of the underlying tissue and muscle. 

• In this approach, the surgeon makes the incision on the front of the hip.
• Less cutting of the muscle is necessary, and recovery has been reported to be faster.
• The anterior approach is often performed with the use of a special operative table and instruments.

As with traditional hip replacement surgery, after minimally invasive hip replacement, you will either go home the same day or spend 1 to 3 days in the hospital.

Physical rehabilitation is a critical component of recovery. Your surgeon or a physical therapist will provide you with specific exercises to help increase your range of motion and restore your strength.