Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Total hip arthroplasty

Greg A Erens, MD
Marianna Crowley, MD
Section Editor
Daniel E Furst, MD
Deputy Editor
Monica Ramirez Curtis, MD, MPH


Total hip arthroplasty (THA) is one of the most successful orthopedic procedures performed today. For patients with hip pain due to a variety of conditions, THA can relieve pain, can restore function, and can improve quality of life. Sir John Charnley, a British orthopedic surgeon, developed the fundamental principles of the artificial hip and is credited as the father of THA. He designed a hip prosthesis in the mid to late 1960s that still sees use today. It is estimated that over 300,000 total hip arthroplasties are performed each year in the United States alone [1].

The normal hip functions as a "ball-and-socket" joint. The femoral head (ball) articulates with the acetabulum (socket), allowing smooth range of motion in multiple planes. Any condition that affects either of these structures can lead to deterioration of the joint. This, in turn, can lead to deformity, pain, and loss of function. The most common condition affecting the hip in this way is osteoarthritis. Other conditions that may affect the hip adversely include inflammatory arthritis (rheumatoid arthritis, psoriatic arthritis, spondyloarthropathies, etc), developmental dysplasia, childhood hip disorders (Legg-Calve-Perthes disease, slipped capital femoral epiphysis, etc), trauma, neoplasms, and osteonecrosis. (See appropriate topic reviews.)

THA is a procedure whereby the diseased articular surfaces are replaced with synthetic materials, thus relieving pain and improving joint kinematics and function. Preoperative and operative issues related to THA are discussed in this topic review. Intraoperative and postoperative complications of THA are listed briefly below (see 'Complications' below) and are presented in more detail separately. (See "Complications of total hip arthroplasty".)

THA is an elective procedure and should be considered as an option among other alternatives. The decision to proceed with THA is made with an understanding of the potential risks and benefits. A thorough understanding of both the procedure and the anticipated outcome is an important part of the decision-making process. For the appropriate candidate, THA can be a life-altering procedure that relieves pain, improves function, and enhances quality of life.


Published results of total hip arthroplasty (THA) demonstrate excellent clinical, functional, and radiographic results. These results vary depending upon the implant, the surgical technique, the type of fixation, the biomaterials, the patient's age, and a myriad of other factors. THA may be performed successfully in patients ranging from the very young [2-4] to older adults (over 80 years of age) [5]. However, young and active patients must be made aware that premature failure of the replaced joint may occur if activity levels are not reduced [2,3]. Impact activities, manual labor, heavy lifting, and high-intensity sports should be avoided.

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Oct 2017. | This topic last updated: Sep 14, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. HCPUnet, Healthcare Cost and Utilization Project. Agency for Healthcare Research and Quality. http://hcupnet.ahrq.gov (Accessed on December 20, 2012).
  2. Crowther JD, Lachiewicz PF. Survival and polyethylene wear of porous-coated acetabular components in patients less than fifty years old: results at nine to fourteen years. J Bone Joint Surg Am 2002; 84-A:729.
  3. Duffy GP, Berry DJ, Rowland C, Cabanela ME. Primary uncemented total hip arthroplasty in patients <40 years old: 10- to 14-year results using first-generation proximally porous-coated implants. J Arthroplasty 2001; 16:140.
  4. McLaughlin JR, Lee KR. Total hip arthroplasty in young patients. 8- to 13-year results using an uncemented stem. Clin Orthop Relat Res 2000; :153.
  5. Keisu KS, Orozco F, Sharkey PF, et al. Primary cementless total hip arthroplasty in octogenarians. Two to eleven-year follow-up. J Bone Joint Surg Am 2001; 83-A:359.
  6. Beswick AD, Wylde V, Gooberman-Hill R, et al. What proportion of patients report long-term pain after total hip or knee replacement for osteoarthritis? A systematic review of prospective studies in unselected patients. BMJ Open 2012; 2:e000435.
  7. Katz JN, Wright EA, Wright J, et al. Twelve-year risk of revision after primary total hip replacement in the U.S. Medicare population. J Bone Joint Surg Am 2012; 94:1825.
  8. Mancuso CA, Salvati EA. Patients' satisfaction with the process of total hip arthroplasty. J Healthc Qual 2003; 25:12.
  9. Ibrahim SA, Stone RA, Han X, et al. Racial/ethnic differences in surgical outcomes in veterans following knee or hip arthroplasty. Arthritis Rheum 2005; 52:3143.
  10. Cram P, Lu X, Kaboli PJ, et al. Clinical characteristics and outcomes of Medicare patients undergoing total hip arthroplasty, 1991-2008. JAMA 2011; 305:1560.
  11. Hunt LP, Ben-Shlomo Y, Clark EM, et al. 90-day mortality after 409,096 total hip replacements for osteoarthritis, from the National Joint Registry for England and Wales: a retrospective analysis. Lancet 2013; 382:1097.
  12. Cleves MA, Golden WE. Assessment of HCFA's 1992 Medicare hospital information report of mortality following admission for hip arthroplasty. Health Serv Res 1996; 31:39.
  13. Bayliss LE, Culliford D, Monk AP, 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; 389:1424.
  14. Glyn-Jones S, Thomas GE, Garfjeld-Roberts P, et al. The John Charnley Award: Highly crosslinked polyethylene in total hip arthroplasty decreases long-term wear: a double-blind randomized trial. Clin Orthop Relat Res 2015; 473:432.
  15. Fortin PR, Penrod JR, Clarke AE, et al. Timing of total joint replacement affects clinical outcomes among patients with osteoarthritis of the hip or knee. Arthritis Rheum 2002; 46:3327.
  16. Sprenger TR, Foley CJ. Hip replacement in a Charcot joint: a case report and historical review. Clin Orthop Relat Res 1982; :191.
  17. Namba RS, Paxton L, Fithian DC, Stone ML. Obesity and perioperative morbidity in total hip and total knee arthroplasty patients. J Arthroplasty 2005; 20:46.
  18. McCalden RW, Charron KD, MacDonald SJ, et al. Does morbid obesity affect the outcome of total hip replacement?: an analysis of 3290 THRs. J Bone Joint Surg Br 2011; 93:321.
  19. Dowsey MM, Choong PF. Obesity is a major risk factor for prosthetic infection after primary hip arthroplasty. Clin Orthop Relat Res 2008; 466:153.
  20. Dowsey MM, Choong PF. Early outcomes and complications following joint arthroplasty in obese patients: a review of the published reports. ANZ J Surg 2008; 78:439.
  21. Chee YH, Teoh KH, Sabnis BM, et al. Total hip replacement in morbidly obese patients with osteoarthritis: results of a prospectively matched study. J Bone Joint Surg Br 2010; 92:1066.
  22. David TS, Vrahas MS. Perioperative lower urinary tract infections and deep sepsis in patients undergoing total joint arthroplasty. J Am Acad Orthop Surg 2000; 8:66.
  23. Robinson CM, Christie J, Malcolm-Smith N. Nonsteroidal antiinflammatory drugs, perioperative blood loss, and transfusion requirements in elective hip arthroplasty. J Arthroplasty 1993; 8:607.
  24. Connelly CS, Panush RS. Should nonsteroidal anti-inflammatory drugs be stopped before elective surgery? Arch Intern Med 1991; 151:1963.
  25. Stoner SC, Lea JW, Dubisar BM, Farrar C. Possible international normalized ratio elevation associated with celecoxib and warfarin in an elderly psychiatric patient. J Am Geriatr Soc 2003; 51:728.
  26. Stading JA, Skrabal MZ, Faulkner MA. Seven cases of interaction between warfarin and cyclooxygenase-2 inhibitors. Am J Health Syst Pharm 2001; 58:2076.
  27. Mersfelder TL, Stewart LR. Warfarin and celecoxib interaction. Ann Pharmacother 2000; 34:325.
  28. Schwartz JI, Bugianesi KJ, Ebel DL, et al. The effect of rofecoxib on the pharmacodynamics and pharmcokinetics of warfarin. Clin Pharmacol Ther 2000; 68:626.
  29. Lindenauer PK, Pekow P, Wang K, et al. Lipid-lowering therapy and in-hospital mortality following major noncardiac surgery. JAMA 2004; 291:2092.
  30. Perhala RS, Wilke WS, Clough JD, Segal AM. Local infectious complications following large joint replacement in rheumatoid arthritis patients treated with methotrexate versus those not treated with methotrexate. Arthritis Rheum 1991; 34:146.
  31. Carpenter MT, West SG, Vogelgesang SA, Casey Jones DE. Postoperative joint infections in rheumatoid arthritis patients on methotrexate therapy. Orthopedics 1996; 19:207.
  32. Grennan DM, Gray J, Loudon J, Fear S. Methotrexate and early postoperative complications in patients with rheumatoid arthritis undergoing elective orthopaedic surgery. Ann Rheum Dis 2001; 60:214.
  33. Sanders DP, McKinney FW, Harris WH. Clinical evaluation and cost effectiveness of preoperative laboratory assessment on patients undergoing total hip arthroplasty. Orthopedics 1989; 12:1449.
  34. Simank HG, Brocai DR, Brill C, Lukoschek M. Comparison of results of core decompression and intertrochanteric osteotomy for nontraumatic osteonecrosis of the femoral head using Cox regression and survivorship analysis. J Arthroplasty 2001; 16:790.
  35. Millis MB, Murphy SB, Poss R. Osteotomies about the hip for the prevention and treatment of osteoarthrosis. Instr Course Lect 1996; 45:209.
  36. Ganz R, Gill TJ, Gautier E, et al. Surgical dislocation of the adult hip a technique with full access to the femoral head and acetabulum without the risk of avascular necrosis. J Bone Joint Surg Br 2001; 83:1119.
  37. McCarthy JC. Hip Arthroscopy: Applications and Technique. J Am Acad Orthop Surg 1995; 3:115.
  38. Callaghan JJ, Brand RA, Pedersen DR. Hip arthrodesis. A long-term follow-up. J Bone Joint Surg Am 1985; 67:1328.
  39. Sponseller PD, McBeath AA, Perpich M. Hip arthrodesis in young patients. A long-term follow-up study. J Bone Joint Surg Am 1984; 66:853.
  40. Crawford R, Ranawat CS, Rothman RH. Metal on metal: is it worth the risk? J Arthroplasty 2010; 25:1.
  41. Corten K, MacDonald SJ. Hip resurfacing data from national joint registries: what do they tell us? What do they not tell us? Clin Orthop Relat Res 2010; 468:351.
  42. Shimmin A, Beaulé PE, Campbell P. Metal-on-metal hip resurfacing arthroplasty. J Bone Joint Surg Am 2008; 90:637.
  43. Kelley TC, Tucker KK, Adams MJ, Dalury DF. Use of tranexamic acid results in decreased blood loss and decreased transfusions in patients undergoing staged bilateral total knee arthroplasty. Transfusion 2014; 54:26.
  44. Oremus K, Sostaric S, Trkulja V, Haspl M. Influence of tranexamic acid on postoperative autologous blood retransfusion in primary total hip and knee arthroplasty: a randomized controlled trial. Transfusion 2014; 54:31.
  45. Poeran J, Rasul R, Suzuki S, et al. Tranexamic acid use and postoperative outcomes in patients undergoing total hip or knee arthroplasty in the United States: retrospective analysis of effectiveness and safety. BMJ 2014; 349:g4829.
  46. Stowell CP, Chandler H, Jové M, et al. An open-label, randomized study to compare the safety and efficacy of perioperative epoetin alfa with preoperative autologous blood donation in total joint arthroplasty. Orthopedics 1999; 22:s105.
  47. Doodeman HJ, van Haelst IM, Egberts TC, et al. The effect of a preoperative erythropoietin protocol as part of a multifaceted blood management program in daily clinical practice (CME). Transfusion 2013; 53:1930.
  48. So-Osman C, Nelissen RG, Koopman-van Gemert AW, et al. Patient blood management in elective total hip- and knee-replacement surgery (Part 1): a randomized controlled trial on erythropoietin and blood salvage as transfusion alternatives using a restrictive transfusion policy in erythropoietin-eligible patients. Anesthesiology 2014; 120:839.
  49. Ranawat CS, Peters LE, Umlas ME. Fixation of the acetabular component. The case for cement. Clin Orthop Relat Res 1997; :207.
  50. McKellop H, Shen FW, DiMaio W, Lancaster JG. Wear of gamma-crosslinked polyethylene acetabular cups against roughened femoral balls. Clin Orthop Relat Res 1999; :73.
  51. McKellop H, Shen FW, Lu B, et al. Development of an extremely wear-resistant ultra high molecular weight polyethylene for total hip replacements. J Orthop Res 1999; 17:157.
  52. Joyce TJ. CORR Insights®: the John Charnley Award: highly crosslinked polyethylene in total hip arthroplasty decreases long-term wear: a double-blind randomized trial. Clin Orthop Relat Res 2015; 473:439.
  53. Rizzetti MC, Catalani S, Apostoli P, Padovani A. Cobalt toxicity after total hip replacement: a neglected adverse effect? Muscle Nerve 2011; 43:146.
  54. Mabilleau G, Kwon YM, Pandit H, et al. Metal-on-metal hip resurfacing arthroplasty: a review of periprosthetic biological reactions. Acta Orthop 2008; 79:734.
  55. Sedrakyan A, Normand SL, Dabic S, et al. Comparative assessment of implantable hip devices with different bearing surfaces: systematic appraisal of evidence. BMJ 2011; 343:d7434.
  56. Zijlstra WP, van Raay JJ, Bulstra SK, Deutman R. No superiority of cemented metal-on-metal over metal-on-polyethylene THA in a randomized controlled trial at 10-year follow-up. Orthopedics 2010; 33.
  57. Foster DE, Hunter JR. The direct lateral approach to the hip for arthroplasty. Advantages and complications. Orthopedics 1987; 10:274.
  58. Callaghan JJ, Dysart SH, Savory CG. The uncemented porous-coated anatomic total hip prosthesis. Two-year results of a prospective consecutive series. J Bone Joint Surg Am 1988; 70:337.
  59. Rodriguez JA, Deshmukh AJ, Rathod PA, et al. Does the direct anterior approach in THA offer faster rehabilitation and comparable safety to the posterior approach? Clin Orthop Relat Res 2014; 472:455.
  60. Sherry E, Egan M, Henderson A, Warnke PH. Minimally invasive techniques for total hip arthroplasty. J Bone Joint Surg Am 2002; 84-A:1481; author reply 1481.
  61. Wenz JF, Gurkan I, Jibodh SR. Mini-incision total hip arthroplasty: a comparative assessment of perioperative outcomes. Orthopedics 2002; 25:1031.
  62. Waldman BJ. Minimally invasive total hip replacement and perioperative management: early experience. J South Orthop Assoc 2002; 11:213.
  63. Wright JM, Crockett HC, Sculco TP. Mini-Incision for Total Hip Arthroplasty. Orthopedic Special Edition 2001; 7:18.
  64. Berger RA. Two-Incision Micromini Total Hip Replacement: When and When Not Indicated. Advances in Minimally Invasive Surgery of the Hip Symposium. Presented at: American Academy of Orthopaedic Surgeons 70th Annual Meeting. New Orleans; February 5, 2003.
  65. Wright JM, Crockett HC, Delgado S, et al. Mini-incision for total hip arthroplasty: a prospective, controlled investigation with 5-year follow-up evaluation. J Arthroplasty 2004; 19:538.
  66. Murphy SB, Gobezie R. Image-guided surgical navigation: Basic principles and applications to reconstructive surgery. Orthopaedic Journal at Harvard Medical School 2002; 4:68.
  67. Johnson RL, Kopp SL, Burkle CM, et al. Neuraxial vs general anaesthesia for total hip and total knee arthroplasty: a systematic review of comparative-effectiveness research. Br J Anaesth 2016; 116:163.
  68. Hartog YM, Mathijssen NM, Vehmeijer SB. Total hip arthroplasty in an outpatient setting in 27 selected patients. Acta Orthop 2015; 86:667.