Total Hip Replacement Surgery
How hip replacement works, the posterior, anterior and lateral approaches, fixation and bearing choices, what the evidence shows, and what treatment abroad involves for patients.
About This Department
Hip pain that has stopped responding to tablets, physiotherapy and rest eventually brings most patients to the same conversation, whether a hip replacement is the right next step. This article sets out what the operation actually involves, how surgeons choose between the posterior, anterior and lateral approaches, what fixation and bearing surface mean for how long the implant lasts, and what the trip involves if you are travelling abroad for it.
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What a Hip Replacement Actually Replaces
A hip joint that has worn down, most often from osteoarthritis, no longer glides the way it should. The surfaces roughen, the cartilage that once cushioned them thins away, and bone starts moving against bone. A hip replacement removes the damaged femoral head and reshapes the socket, then fits an artificial joint built from a small set of components. A stem sits inside the femur, a head sits on top of the stem, and a cup with a liner sits inside the reshaped socket, together recreating the ball and socket motion the natural joint has lost.
None of these components are interchangeable across manufacturers, and the specific combination a surgeon chooses depends on your bone quality, your activity level, your age, and often the surgeon's own experience with a particular system. What stays constant is the underlying goal. Restore a stable, pain free arc of motion that lets you stand, walk and climb stairs without the joint being the thing you think about first.
Total hip replacement, hip prosthesis surgery and total hip arthroplasty all describe the same operation. Surgeons tend to use total hip arthroplasty in clinical notes and total hip replacement in conversation with patients, and this article uses them interchangeably throughout.
When Conservative Treatment Has Run Its Course
Surgeons generally recommend replacement once pain limits ordinary daily function and has stopped responding to weight management, physiotherapy, activity modification and, for many patients, a corticosteroid or hyaluronic acid injection. Osteoarthritis accounts for the majority of these cases. Avascular necrosis, where the blood supply to the femoral head fails and the bone itself begins to collapse, and inflammatory arthritis affecting the joint over years, make up most of the rest.
Age on its own settles very little. A fit 55 year old with severe joint damage and a cautious 78 year old with moderate damage can both be reasonable candidates, and both can be reasonable people to advise waiting. What actually matters is how much the joint is limiting daily life measured against your general health and how well you are likely to tolerate anaesthesia and the physical demands of rehabilitation, a judgement a surgeon makes case by case rather than against a birthday.
Hip fracture is usually managed on a different, more urgent pathway, decided within days of the injury rather than planned months in advance, so the guidance in this article speaks to elective replacement, kept separate from fracture surgery. Active infection anywhere in the body, uncontrolled inflammatory disease, and significant untreated osteoporosis are situations where a surgeon will typically pause and investigate further before agreeing to operate.
Posterior, Anterior or Lateral, Three Ways to Reach the Joint
Every hip replacement reaches the same joint, but three established routes get there, and the choice shapes early recovery more than most other decisions made before surgery. None is correct for every patient, and a surgeon experienced in one route will usually outperform a surgeon less familiar with another, whichever approach a particular clinic favours.
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| Approach | Route to the joint | What it tends to offer |
|---|---|---|
| Posterior | From behind, working between muscles repaired at closure | A wide, familiar view suited to most hips including complex anatomy, at the cost of some early positioning precautions |
| Direct anterior | From the front, passing between muscle planes instead of cutting through them | Often fewer movement precautions and quicker early strength, though it is technically demanding and not every build suits it |
| Lateral | From the side, through part of the abductor muscle group | Good stability against dislocation in many hands, with a slower return of pain free abductor strength while that muscle heals |
A Canadian cost diary study following 104 patients for a year after surgery found the overall outpatient cost of recovery was statistically similar across all three approaches, although patients recovering from an anterior approach used somewhat more nursing visits early on, reflected in a higher allied health cost for that group specifically. The approach changes the texture of early recovery. It does not, on this evidence, change what the year afterwards costs you in follow up care.
Cemented, Cementless or a Hybrid of Both
Fixation describes how the stem and cup are anchored to living bone, and it is a separate decision from which approach reaches the joint.
Cemented fixation
A fast setting bone cement locks the implant to the bone immediately, giving stability from the moment surgery ends. This has traditionally suited older patients with softer, more porous bone, where cement can hold better than bone alone.
Cementless fixation
A textured or coated implant surface is press fit against bone that is expected to grow onto it over the following weeks. This suits patients with good bone quality and is now the more common choice in many practices, since it avoids leaving cement in the body at all.
Hybrid fixation
A cemented stem paired with a cementless cup, or occasionally the reverse, lets a surgeon match each component to what that specific bone needs, without committing to one fixation method for both sides of the joint.
A meta-analysis pooling 18 studies and 55,942 primary hip replacements found the overall periprosthetic fracture rate ran slightly higher with cementless stems than cemented ones, 1.3 percent against 0.9 percent, though the difference did not reach statistical significance across the pooled data. Stem geometry mattered more than the cement decision alone. Quadrangular tapered cementless designs actually lowered fracture risk, while certain anatomically shaped cementless stems raised both fracture and revision risk. Cementless fixation overall carried a meaningfully lower rate of aseptic loosening than cemented fixation across the same pooled studies. No single fixation method wins on every measure, which is why the decision sits with a surgeon looking at your own bone, decided case by case instead of by a fixed house rule.
What the Joint Surfaces Are Made From
The bearing is the pair of surfaces that actually articulate against each other once the joint is moving, and it is chosen separately from both the approach and the fixation method. A ceramic head against a highly cross linked polyethylene liner is the most common modern combination. Ceramic against ceramic and metal against polyethylene remain in wide use too, each carrying a slightly different risk profile instead of fitting a simple better or worse ranking.
A meta-analysis of 33 studies covering more than 120,000 hip replacements compared ceramic on ceramic bearings against the various polyethylene combinations. Revision rates, aseptic loosening and periprosthetic fracture came out broadly similar across bearing types. Ceramic on ceramic showed a lower dislocation rate than metal on polyethylene and a lower rate of osteolysis, the gradual bone loss caused by wear particles, than both metal on polyethylene and metal on highly cross linked polyethylene. The trade-off is audible rather than clinical for most patients. Ceramic on ceramic bearings squeak noticeably more often than any polyethylene based combination, a nuisance some patients notice and others never do.
None of these differences are large enough to make one bearing combination the obvious right choice for everybody. Bone quality, activity level, and how a patient weighs a small squeaking risk against a small wear advantage are the factors a surgeon actually works through with you before deciding.
What Happens on the Day of Surgery
Spinal or general anaesthesia is agreed with the anaesthetist beforehand, and many patients receive both, a spinal block for the operation itself and light sedation so nothing is felt or remembered. The surgeon makes an incision along the chosen approach, removes the damaged femoral head, and shapes the socket to accept the new cup. The femoral canal is prepared to the size and shape the chosen stem requires, the components are fitted, and the joint is moved through its expected range to check stability and leg length before closure.
A regional nerve block is commonly placed before or during the procedure to manage pain as the anaesthesia wears off, and which specific block is used has become its own area of active research, covered in the next section. The operation itself typically runs an hour to ninety minutes for a straightforward primary replacement, longer for a hip with prior surgery, unusual anatomy or significant deformity to correct.
Most protocols get patients standing and taking a few supervised steps within hours of returning to the ward, using a frame or crutches mainly for balance, since the leg can already bear weight. Physiotherapy usually starts the same day or the next morning, and how quickly that first walk happens tends to say more about a hospital's rehabilitation protocol than about the surgery itself.
Controlling Pain in the First Days
Pain control in the first 48 hours shapes how quickly a patient gets moving, and regional nerve blocks placed around the hip are now a standard part of that plan and are no longer treated as optional. Two techniques dominate current practice. A pericapsular nerve group block combined with a lateral femoral cutaneous nerve block, and a fascia iliaca compartment block.
A 2026 meta-analysis pooling 16 comparative studies found the combined pericapsular and lateral femoral cutaneous block produced lower pain scores at rest and with movement than the fascia iliaca block, alongside a lower incidence of postoperative muscle weakness and better preserved quadriceps strength. Patients receiving it also reached their first supervised walk roughly nine hours sooner on average, needed less morphine overall, and were discharged around three quarters of a day earlier. Not every hospital has adopted the newer technique yet, so it is a reasonable question to raise with your surgical team rather than something to assume is already standard wherever you are treated.
What Long-Term Data and Registries Show
Hip replacement has one of the longest and most closely tracked evidence bases in orthopaedic surgery, drawn from national joint registries that follow every implanted hip for decades. A 2026 analysis pooling 29 clinical studies with almost 1.9 million procedures recorded across eight national registries found a 93.6 percent survivorship at 20 years for modern bearing combinations, extrapolated to a predicted 92.1 percent at 30 years. Put plainly, roughly nine in ten hip replacements done today are expected to still be functioning on their original implant three decades later.
That figure sits on top of everything discussed above. It does not replace it. Bearing choice moves dislocation and osteolysis risk at the margins, and fixation method moves fracture and loosening risk at similarly small margins, none of it large enough to shift the headline survivorship number much. That itself is informative. Hip replacement has matured to the point where choosing between reasonable modern options changes the texture and secondary risks of your recovery more than it changes the odds the joint eventually lasts.
Readmission data tells a complementary story about the weeks immediately after surgery rather than the decades after. An analysis of 367,199 primary hip and knee replacements in a large United States surgical database found 30 day readmission rates falling over the study period, from 4.5 percent to 3.3 percent. For hip replacement specifically, surgical complications, chiefly wound problems and blood clots, accounted for just over half of readmissions, with dislocation and periprosthetic fracture as the third leading surgical cause. Medical complications unrelated to the hip itself made up most of the rest.
Taken together, the data supports a fairly reassuring but honest picture. Serious early complications are uncommon and falling in incidence, and the implant itself is built to last most patients the rest of their working and retired life, while the specific combination of approach, fixation and bearing shapes the smaller print of your own recovery rather than the headline outcome.
Recovery From First Steps to Full Activity
Positioning precautions in the early weeks depend heavily on which approach reached your joint. A posterior approach typically comes with restrictions on deep hip flexion, crossing the leg and turning the foot inward for a defined early period, while an anterior or lateral approach usually carries fewer, protocol dependent restrictions. Ask your own surgical team exactly what applies to you instead of assuming a rule you read online applies to everyone. Recovery still follows a broadly predictable shape underneath those differences.
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| Timeframe | What is typical |
|---|---|
| Weeks 1 to 2 | Wound care, swelling control, walking distance building with a frame or crutches |
| Weeks 3 to 6 | The hip starts to feel load bearing, most patients walk without an aid, driving often returns |
| Months 3 to 6 | The hip generally stops shaping how you plan your day |
| Up to 12 months | Smaller gains in strength and confidence continue |
Age, fitness beforehand and how much muscle wasting had already set in before surgery all move these timeframes earlier or later for a given patient. A retrospective comparison of matched patients found no statistically significant difference in hospital length of stay between the direct anterior and posterior approaches once modern recovery protocols were applied to both groups equally, a reminder that the hospital's own rehabilitation programme often influences recovery speed as much as the incision does.
Fitness to fly is judged separately from fitness to walk, since long haul travel raises clotting risk after any lower limb surgery. Surgeons generally want to see a healing wound, hip movement within its expected early range, and enough time upright to be confident clotting risk has settled. Around one to two weeks is a common guide for a straightforward primary hip replacement, confirmed individually at your follow-up appointment rather than fixed in advance for every patient.
Coordinating the Trip From Referral to Discharge
Most international patients get in touch once a local surgeon has already recommended replacement, often against a waiting list stretching well past a year. Sending a recent pelvis X-ray, together with notes on treatments already tried, is the single most useful thing you can do early. It lets a reviewer speak to your specific joint rather than to hip replacement as a general topic, and tell you honestly whether the operation applies to your case and which approach is likely to fit your build. This first review is free and commits you to nothing.
Once you land, expect standard blood tests, an anaesthetic assessment, an ECG for most patients, and any imaging that has not already been reviewed remotely. Anyone on blood thinning medication or with diabetes needs this checked early enough before surgery for doses to be adjusted safely. Most private hospitals treating international patients in Turkey report an inpatient stay of roughly two to four nights for a straightforward primary hip replacement, and a companion is normally welcome to stay with you through the admission, with the exact room arrangement best settled when your quote is drawn up rather than discovered at check in.
A written discharge summary covering the implant used, its size, and the recommended rehabilitation schedule should travel home with you in a form your local doctor or physiotherapist can act on directly, without first needing to contact anyone abroad.
Staying in Touch With Your Surgical Team After You Leave
A short remote follow-up check-in, usually a video call or a messaging exchange, is normal at around two and six weeks after you fly home, to review the wound and how movement is progressing. Local physiotherapy in your home country can typically pick up the same rehabilitation plan you started abroad, and sharing your operative notes with that physiotherapist means the assessment does not need to start from nothing.
Problems severe enough to need readmission stay uncommon, though a page claiming they never happen would not be telling you the truth. What actually matters once you have flown home is simpler than the worry itself, whether the hospital that operated stays reachable and whether a local doctor can get what they need from that team without delay.
The Main Factors Behind the Price of Hip Replacement Surgery
Treat any fixed figure quoted before a specialist has reviewed your imaging with some caution. For a hip replacement, price moves with the implant materials chosen, the surgical approach, whether one or both hips need replacing, how many nights you stay in hospital, and whether physiotherapy and follow-up consultations are itemised separately or folded into the package.
Ask what a quoted figure includes and excludes in writing. Surgery and implant, hospital stay, airport transfers, interpreting and follow-up appointments are the items that most often appear in one clinic's quote and quietly disappear from another's. Revision surgery, or a hip complicated by prior fracture fixation or significant dysplasia, generally costs more than a straightforward primary case, reflecting the additional planning and operating time involved.
Cost is one of the main reasons patients look beyond Western Europe or North America for orthopaedic care, since private treatment in Turkey typically runs well below what comparable surgery costs there. Biruni prices its packages to keep the surgical team, the hospital stay and follow-up support at one consistent level regardless of which country a patient is arriving from, though nothing beyond that general positioning can be stated honestly until a specialist has actually reviewed your imaging.
Details Worth Confirming Before You Book
A sound clinical plan is only one half of a trip like this. Two separate conversations are worth having before you commit to dates.
Clinical questions to raise
Ask directly which approach and which fixation and bearing combination your surgeon recommends for your specific hip, and why, rather than accepting a single default answer for every patient. A team confident in its own reasoning will walk you through the choice rather than brushing past it.
Logistics to confirm before you book
Find out how many companions can travel with you and confirm the room arrangement in writing rather than leaving it to be settled at check in. Raise language coverage on the international patients team directly, and ask separately whether a female physician can be requested if that matters to you. Dietary requirements, prayer facilities, and the expected turnaround for a visa invitation letter are worth raising in the same conversation, since a hospital experienced with international patients should have ready answers for all three.
Frequently Asked Questions
How long does hip replacement surgery take?
Which surgical approach is best, posterior, anterior or lateral?
How long does a hip replacement last?
Is there a best age for hip replacement surgery?
How long do I need to stay in Turkey after the operation?
What movements should I avoid after hip replacement surgery?
Written by the Biruni Hospital medical editorial team.
Reviewed by Dr Yunus Emre Yavuz, Orthopaedics.
Scientific References
- Pentland V, Thompson Z, Dayimu A, Demiris N, Bohm E, Campbell D. Survivorship of modern total hip replacement to 30 years, systematic review, meta-analysis, and extrapolation of global joint registry data. Lancet. 2026;407(10531):855-866. doi:10.1016/S0140-6736(25)02305-0
- Boutros M, Awad G, Hamdan KB, Rubin L, Mansour E. Ceramic-on-ceramic versus polyethylene-based bearings in total hip arthroplasty, a meta-analysis. European Journal of Orthopaedic Surgery and Traumatology. 2026;36(1). doi:10.1007/s00590-026-04825-8
- Borazjani R, Ayatizadeh SH, Sattarian M, Moein SA, Mont MA, Kreuzer SW. Quadrangular taper cementless designs are associated with lower risks of postoperative periprosthetic fracture compared with cemented stems and other cementless designs following primary total hip arthroplasty, a systematic review and meta-analysis. The Journal of Arthroplasty. 2026. doi:10.1016/j.arth.2026.01.031
- Barton KI, Kooner P, Petis SM, Somerville LE, Marsh JD, Howard JL. There is no difference in outpatient costs within one year post total hip arthroplasty when comparing surgical approach. The Journal of Arthroplasty. 2026;41(9):2593-2598. doi:10.1016/j.arth.2025.12.039
- Jain D, Khanna P, K A, Garg N, Batra S, Malhotra R. Length of hospital stay between direct anterior approach and posterior approach in primary total hip arthroplasty. Hip and Pelvis. 2026;38(3):251-256. doi:10.5371/hp.2026.38.3.251
- Metoxen AJ, Ferreira AC, Zhang TS, Harrington MA, Halawi MJ. Hospital readmissions after total joint arthroplasty, an updated analysis and implications for value based care. The Journal of Arthroplasty. 2022;38(3):431-436. doi:10.1016/j.arth.2022.09.015
- Li J, Zhang X, Zu C, Chen Q, Lian L, Zhu Z. Meta-analysis of PENG+LFCN versus FICB on ERAS related outcomes, postoperative pain, motor function and recovery in hip surgery. Journal of Investigative Surgery. 2026;39(1):2663595. doi:10.1080/08941939.2026.2663595
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