James B. Grimes, MD
mis med pro

Total Hip Replacement (THR)

Total Hip Replacement (THR) web based movie

Total hip replacement is a surgical procedure in which the damaged cartilage and bone is removed from the hip joint and replaced with artificial components. The hip joint is one of the body’s largest weight-bearing joints, located between the thigh bone (femur) and the pelvis (acetabulum). It is a ball and socket joint in which the head of the femur is the ball and the pelvic acetabulum forms the socket. The joint surface is covered by smooth articular cartilage, which acts as a cushion and enables smooth movements of the joint.

A number of diseases and conditions can cause damage to the articular cartilage. Total hip replacement surgery is an option to relieve severe arthritis pain that limits your daily activities.

Disease Overview

Arthritis is inflammation of the joints resulting in pain, swelling, and stiffness and limited movement. Hip arthritis is a common cause of chronic hip pain and disability. The three most common types of arthritis that affect the hip are:

  • Osteoarthritis: It is characterized by progressive wearing away of the cartilage of the joint. As the protective cartilage wears down, the bone ends rub against each other and cause pain in the hip.

  • Rheumatoid arthritis: This is an autoimmune disease in which the tissue lining the joint (synovium) becomes inflamed, resulting loss of cartilage causing pain and stiffness.

  • Traumatic arthritis: This is a type of arthritis resulting from a hip injury or fracture. Such injuries can damage the cartilage and cause hip pain and stiffness over a period of time.


The most common symptom of hip arthritis is joint pain and stiffness resulting in limited range of motion. Vigorous activity can increase the pain and stiffness that may cause limping while walking.


Diagnosis is made by evaluating the medical history, physical examination and X-rays.

Surgical Procedure

Surgery may be recommended, if conservative treatment options such as anti-inflammatory medications and physical therapy do not relieve the symptoms.

The surgery is performed under general or spinal anesthesia. During the procedure, an incision is made over the hip to expose the hip joint and the femoral head is removed from the acetabulum. The surface of the damaged or arthritic socket is prepared using a reamer. The acetabular component is inserted into the socket. The most common type of cup fixation is the press-fit between the acetabular component and the bone. Occasionally, acetabular fixation is supplemented with screws that go through the cup into the bone. On rare occasions the acetabular component is fixed in place with bone cement. A liner made of plastic, ceramic or metal is placed inside the acetabular component. The femur or thigh bone is then prepared by removing bone using special instruments to exactly fit the new metal femoral component. The femoral component is then inserted to the femur either by a press fit or using bone cement. Then the femoral head component made of metal or ceramic is placed on the femoral stem. X-rays are routinely taken during the procedure to check for position of the components and leg length. The muscles and tendons around the new joint are repaired, if necessary, and the incision is closed.

Post-operative care

After undergoing total hip replacement, you must take special care to prevent the new joint from dislocating and to ensure proper healing. Some of the common precautions to be taken include:

  • Avoid combined movement of bending your hip and turning your foot inwards

  • Keep a pillow between your legs while sleeping for 6 weeks

  • Avoid extreme positions of the hip

  • Avoid sitting on low chairs

  • Avoid bending down to pick up things, instead a grabber can be used to do so

  • Use an elevated toilet seat


As with any major surgical procedure, there are certain potential risks and complications involved with total hip replacement surgery. The possible complications after total hip replacement include:

  • Infection

  • Dislocation

  • Fracture of the femur or pelvis

  • Injury to nerves or blood vessels

  • Formation of blood clots in the leg veins

  • Leg length inequality

  • Hip prosthesis may wear out

  • Failure to relieve pain

  • Scar formation

  • Pressure sores

Total hip replacement is one of the most successful orthopaedic procedures performed for patients with hip arthritis. This procedure can relieve pain, restore function, improve your movements at work and play, and provide you with a better quality of life.


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