Hip

Total Hip Arthroplasty (Hip Replacement)

Total hip arthroplasty (THA) is one of the most transformative surgical procedures in medicine. It reliably eliminates hip pain, restores mobility, and returns patients to active lives. With modern implants, techniques, and rapid recovery protocols, the procedure has evolved dramatically: patients now walk on their new hip the same day as surgery, go home within 24 hours, and return to recreational activities within months. At Maryland Orthopedic Specialists, our adult reconstruction team performs primary total hip replacement using the most advanced implant technologies and personalized approach selection to ensure optimal, durable outcomes.

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What is total hip arthroplasty (hip replacement)?

Total hip arthroplasty replaces the damaged femoral head (ball) and acetabulum (socket) with prosthetic components designed to replicate normal hip anatomy and biomechanics. It is indicated when the hip joint is irreversibly damaged by arthritis, avascular necrosis, or other conditions, and when non-operative measures no longer provide adequate pain relief or function.

Procedure components:

Acetabular cup (socket): Titanium outer shell — fixed to the pelvis and accepts the liner
Acetabular liner: Highly cross-linked polyethylene (HXLPE) or ceramic: the articulating surface
Femoral head (ball): Ceramic or cobalt-chrome — articulates with the liner
Femoral stem: Titanium or cobalt-chrome, fixed in the femoral canal and carries the femoral head

Bearing surfaces:

Ceramic on highly cross-linked polyethylene (CoC on HXLPE): The most commonly used combination today; extremely low wear rates; HXLPE has essentially eliminated osteolysis from polyethylene wear as a revision cause
Ceramic on ceramic: The lowest wear rates; ideal for young, high-activity patients; rare risk of component fracture and "squeaking"
Metal on metal: Largely discontinued due to adverse local tissue reactions and metal ion release; rarely used today

Indications for THA:

Hip osteoarthritis (most common)
Avascular necrosis of the femoral head (Stages III–IV)
Rheumatoid arthritis and inflammatory arthropathy
Post-traumatic arthritis
Failed hip preservation surgery
Selected cases of hip dysplasia with secondary arthritis

Contraindications: Active infection, insufficient bone stock, severe neuromuscular disease, or medical comorbidities making surgery unsafe.

Symptoms — do you recognize these?

Chronic hip and groin pain that significantly impairs quality of life
Pain at rest and at night in advanced disease
Inability to perform daily activities (walking, stairs, dressing)
Failure of non-operative treatment: physical therapy, activity modification, NSAIDs, corticosteroid injections, PRP
Significant radiographic joint-space narrowing (< 1–2 mm) with loss of femoral head sphericity

Call us at (301) 515-0900. Same-day appointments available at our Bethesda and Germantown locations.

How we diagnose it

Weight-bearing AP pelvis and lateral hip X-rays: Assess joint-space narrowing, femoral head shape, acetabular coverage, and bony anatomy for implant templating
Advanced imaging (MRI or CT): Used selectively for complex anatomy, suspected AVN, or prior hardware
Pre-operative laboratory studies: CBC, metabolic panel, coagulation studies, urinalysis (to exclude infection), and anesthesia clearance
Bone density (DEXA): Ordered for patients at risk for osteoporosis; influences implant fixation strategy
Pre-operative education: Patients attend or view a joint replacement class covering surgery, recovery, and home preparation. This is shown to reduce anxiety and improve outcomes

Treatment options

Surgery is performed under regional anesthesia (spinal or epidural) in the majority of cases, reducing opioid requirements and facilitating early mobilization. General anesthesia is available when preferred. Enhanced Recovery After Surgery (ERAS) protocol: MOS uses an ERAS pathway that includes: - Pre-operative anemia optimization - Multi-modal pain management (eliminating or minimizing opioids) - Same-day or next-day ambulation - Early discharge planning - Targeted physical therapy Most primary THA patients are discharged home the same day or the next morning. Inpatient rehabilitation is rarely needed for uncomplicated primary THA.

Surgical Procedure

Total Hip Arthroplasty (Hip Replacement)

Complete hip joint replacement removing the arthritic femoral head and acetabulum and replacing them with metal, ceramic, and polyethylene components. Anterior approach technique is available for eligible patients, preserving more muscle tissue.

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Recovery & rehabilitation

Timeline:

Day of surgery: Ambulation with a walker or cane
1–2 weeks: Walking short distances; driving restrictions (2–6 weeks depending on operative side and approach)
4–6 weeks: Discontinue assistive devices; return to light desk work
6–8 weeks: Outpatient PT completed for most patients; independent with home program
3 months: Return to most recreational activities (golf, cycling, light hiking)
6 months: Full unrestricted activity (swimming, doubles tennis, doubles pickleball, low-impact sports)

Precautions: Certain movement restrictions (hip precautions) are used in the first 6 weeks with the posterior approach to minimize dislocation risk while soft tissues heal. The anterior approach typically requires fewer positional restrictions.

Implant longevity: Modern THA with HXLPE bearing surfaces achieves > 90% implant survival at 20 years. This means the vast majority of patients who receive a total hip replacement today will not require revision surgery in their lifetime.

Frequently Asked Questions

Am I too young for a hip replacement?

Modern implants are durable enough that age is not a barrier. The decision is based on pain severity, functional limitation, and failure of non-operative care, not age. Patients in their 40s and 50s with severe hip arthritis can and do undergo THA with excellent long-term results.

What activities can I do after THA?

The American Academy of Orthopaedic Surgeons and most hip surgeons support low-impact activities: cycling, swimming, hiking, golf, doubles tennis, and walking. High-impact repetitive sports (running, basketball) are generally discouraged long-term due to theoretical implant wear concerns, though many patients resume them.

How is THA different from hip resurfacing?

Hip resurfacing preserves more femoral bone and uses a larger femoral head, reducing dislocation risk. It is suitable for young, active men with good bone quality. However, metal-on-metal bearing concerns have significantly reduced resurfacing use. Our team will discuss whether resurfacing is appropriate for your specific case.

What are the main risks?

Serious complications are uncommon but include infection, blood clot (DVT/PE), nerve injury, dislocation, leg-length discrepancy, and aseptic loosening over time. Our team uses proven risk-reduction protocols for each of these.

Will I need a blood transfusion?

Transfusion is rarely needed with modern surgical techniques and ERAS blood conservation protocols. Pre-operative hemoglobin optimization, tranexamic acid, and meticulous surgical technique have reduced transfusion rates to < 2% for primary THA.

Meet the specialists

Brian McCormick, MD

Adult Reconstruction · Hip and Knee Replacement

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Related conditions

Hip Osteoarthritis

Medically reviewed by Brian McCormick, MD

Last reviewed May 1, 2026

References

Learmonth ID, Young C, Rorabeck C. The operation of the century: total hip replacement. Lancet. 2007;370(9597):1508–1519. https://doi.org/10.1016/S0140-6736(07)60457-7
Mancuso CA, Salvati EA, Johanson NA, Peterson MG, Charlson ME. Patients' expectations and satisfaction with total hip arthroplasty. J Arthroplasty. 1997;12(4):387–396. https://doi.org/10.1016/S0883-5403(97)90194-7
Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am. 2007;89(4):780–785. https://doi.org/10.2106/JBJS.F.00222
Stambough JB, Nunley RM, Curry MC, Steger-May K, Clohisy JC. Rapid recovery protocols for primary total hip arthroplasty can safely reduce length of stay without increasing complications. J Arthroplasty. 2015;30(4):521–526. https://doi.org/10.1016/j.arth.2014.10.009
Garvin KL, Hartman CW, Mangla J, Murdoch SB, Martell JM. Wear analysis in THA utilizing oxidized zirconium femoral heads. J Arthroplasty. 2009;24(6 Suppl):73–76. https://doi.org/10.1016/j.arth.2009.04.016
American Academy of Orthopaedic Surgeons. Total Hip Replacement. OrthoInfo. https://orthoinfo.aaos.org/en/treatment/total-hip-replacement/