Independent, sourced patient educationInformedSurgery
Hip Replacement Explained
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All topics
  1. What it is
  2. Who it helps
  3. Timing
  4. The procedure
  5. What a hemiarthroplasty is
  6. Hemi vs total hip
  7. Recovery after hip fracture
  8. Patient journey
  9. Recovery supplies
  10. Finding a surgeon
  11. Insurance and costs
  12. Questions to ask
  13. Implant designs
  14. Side-by-side
  15. Robotics and navigation
  16. US manufacturers
  17. What the evidence says
  18. Value analysis
  19. Resources
  20. Glossary
  21. References

Research

What the evidence says

Hip replacement is one of the most studied operations in medicine, with national registries tracking hundreds of thousands of implants. Here are the headline numbers.

~58%
of hip replacements last 25 years, national registry data6
85%
still in place at 20 years, UK cohort7
1.63%
infection within 2 years, Medicare sample8
Agreement

Implants last a long time: about 96% survive 10 years and about 85% survive 20 years.7

Agreement

Front, side and back approaches have similar dislocation and revision rates.14,16

Agreement

Smoking raises the risk of infection and wound problems; stopping helps.9

Agreement

For older adults with a broken hip, a cemented hemiarthroplasty works at least as well as an uncemented one, with fewer fractures around the implant.25,26

Changing

Routine hip precautions after posterior-approach surgery don't appear to prevent dislocation, and some patients recover faster without them.18,19

Disagreement

Blood clot prevention: aspirin causes less bleeding, but a large hip-and-knee trial found more symptomatic clots with aspirin than with enoxaparin.12

Open question

Robotics improves cup placement, but whether that leads to longer-lasting or better-feeling hips is not yet known.21,22

Open question

Dual mobility lowers dislocation in higher-risk patients, but long-term survival data are limited.20

Clinical detail
  • Symptomatic in-hospital VTE with recommended prophylaxis: 0.53% after hip arthroplasty (DVT 0.26%, PE 0.14%), about 1 in 200.11
  • CRISTAL (n=9,711, hip and knee): 90-day symptomatic VTE 3.45% with aspirin vs 1.82% with enoxaparin; aspirin was given for 35 days after THA. Most events were below-knee DVTs.12
  • Cochrane (53 RCTs, 44,371 participants): direct factor Xa inhibitors vs LMWH after hip or knee replacement or hip fracture surgery; differences in mortality and bleeding were small and the evidence was of low to very low certainty.13
  • Late infection: 0.59% between 2 and 10 years after THA in Medicare.8

Sources for this page

  1. Evans JT, et al. How long does a hip replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up. Lancet. 2019;393(10172):647-654. doi:10.1016/S0140-6736(18)31665-9
  2. Bayliss LE, et al. The effect of patient age at intervention on risk of implant revision after total replacement of the hip or knee: a population-based cohort study. Lancet. 2017;389(10077):1424-1430. doi:10.1016/S0140-6736(17)30059-4
  3. Ong KL, et al. Prosthetic joint infection risk after total hip arthroplasty in the Medicare population. J Arthroplasty. 2009;24(6 Suppl):105-109. doi:10.1016/j.arth.2009.04.027
  4. Bedard NA, et al. Tobacco use and risk of wound complications and periprosthetic joint infection: a systematic review and meta-analysis of primary total joint arthroplasty procedures. J Arthroplasty. 2019;34(2):385-396.e4. doi:10.1016/j.arth.2018.09.089
  5. Januel JM, et al. Symptomatic in-hospital deep vein thrombosis and pulmonary embolism following hip and knee arthroplasty among patients receiving recommended prophylaxis: a systematic review. JAMA. 2012;307(3):294-303. doi:10.1001/jama.2011.2029
  6. Sidhu VS, et al. Effect of aspirin vs enoxaparin on symptomatic venous thromboembolism in patients undergoing hip or knee arthroplasty: the CRISTAL randomized trial. JAMA. 2022;328(8):719-727. doi:10.1001/jama.2022.13416
  7. Salazar CA, et al. Direct factor Xa inhibitors versus low molecular weight heparins or vitamin K antagonists for prevention of venous thromboembolism in elective primary hip or knee replacement or hip fracture repair. Cochrane Database Syst Rev. 2025;1(1):CD011762. doi:10.1002/14651858.CD011762.pub2
  8. Ang JJM, et al. Comparing direct anterior approach versus posterior approach or lateral approach in total hip arthroplasty: a systematic review and meta-analysis. Eur J Orthop Surg Traumatol. 2023;33(7):2773-2792. doi:10.1007/s00590-023-03528-8
  9. Ghandour M, et al. Direct anterior approach versus posterior approach in total hip arthroplasty: a systematic review and meta-analysis. J Orthop. 2025;65:233-250. doi:10.1016/j.jor.2025.06.007
  10. Korfitsen CB, et al. Hip precautions after posterior-approach total hip arthroplasty among patients with primary hip osteoarthritis do not influence early recovery: a systematic review and meta-analysis of randomized and non-randomized studies with 8,835 patients. Acta Orthop. 2023;94:141-151. doi:10.2340/17453674.2023.11958
  11. Guo J, et al. No need for hip precautions after total hip arthroplasty with posterior approach: a systematic review and meta-analysis. Medicine (Baltimore). 2024;103(50):e40348. doi:10.1097/MD.0000000000040348
  12. Manohar M, et al. Dual mobility versus fixed bearings in complex primary total hip arthroplasty: a systematic review and meta-analysis. J Clin Orthop Trauma. 2026;80:103538. doi:10.1016/j.jcot.2026.103538
  13. Arun Kumar G, et al. Robotic-assisted versus conventional manual total hip arthroplasty: a systematic review and meta-analysis of component position accuracy, Lewinnek zone outliers, and early dislocation rates. J Robot Surg. 2026;20(1). doi:10.1007/s11701-026-03678-x
  14. Jha G, et al. Beyond robotics: a systematic review of technology integration in direct anterior approach total hip arthroplasty. J Robot Surg. 2026;20(1). doi:10.1007/s11701-026-03485-4
  15. Fernandez MA, et al. Cemented or uncemented hemiarthroplasty for intracapsular hip fracture (WHiTE 5). N Engl J Med. 2022;386(6):521-530. doi:10.1056/NEJMoa2108337
  16. Lewis SR, et al. Arthroplasties for hip fracture in adults. Cochrane Database Syst Rev. 2022;2(2):CD013410. doi:10.1002/14651858.CD013410.pub2

All references