Hip Arthritis & Total Hip Replacement

What is hip arthritis?

The hip is a ball-and-socket joint. The ball is the top of the thigh bone (femur) and the socket is a cup in the pelvis. Both surfaces are lined with smooth cartilage that lets the joint glide. In arthritis, that lining thins and roughens until bone meets bone.

Most hip arthritis is osteoarthritis, the wear-and-tear kind. Others include arthritis after an old injury, inflammatory arthritis such as rheumatoid arthritis, and collapse of the ball from poor blood supply (avascular necrosis). Subtle shape differences you were born with can also wear the joint earlier than expected.

What does hip arthritis feel like?

Pain is usually felt in the groin or the front of the thigh, though it can also show up in the buttock or the knee. It tends to build slowly. Early on it flares after activity and settles with rest. Later it hurts with simple things: getting out of a car, putting on socks and shoes, climbing stairs, or walking even short distances.

Stiffness after sitting, a limp, and a catching or grinding feeling are common. Pain at night or at rest usually means the joint is well along.

What can I try before surgery?

Many people get a lot of mileage out of non-surgical care for a long time. A typical plan combines:

• Activity changes that spare the joint, such as swimming or cycling in place of running
• Weight loss when it applies, since every pound of body weight places several pounds of load across the hip
• Physical therapy to keep the hip moving and strengthen the muscles that support it
• A cane held in the opposite hand on bad days
• Anti-inflammatory medicine when it is safe for you
• An image-guided cortisone injection, which can calm a flare for weeks to months

None of these reverse the arthritis. They are about buying comfort and time. If they stop working, that is the cue to talk about surgery.

When does hip replacement make sense?

There is no X-ray score that tells you it is time. The decision is based on how much the hip limits your life. Dr. Stepanyan is more likely to recommend replacement when:

• Pain wakes you at night or hurts at rest
• You have trouble walking, climbing stairs or dressing
• Therapy, injections and medicine no longer help enough
• X-rays show advanced arthritis that matches your symptoms
• The pain keeps you from work, caregiving or activities that matter to you

Waiting does not make the surgery harder in most cases, so it is reasonable to take your time, but a stiff, weak hip can slow recovery. That is one reason not to wait until you can barely walk.

What happens in a hip replacement?

Dr. Stepanyan removes the damaged ball and cartilage and replaces them with a metal cup in the socket, a smooth liner, and a metal stem topped with a ceramic or metal ball in the thigh bone. The new surfaces glide smoothly again, and the pain from bone rubbing on bone goes away.

He performs minimally invasive, muscle-sparing hip replacement through the direct anterior approach, which reaches the joint from the front by working between muscles instead of cutting through them. Results depend a great deal on the surgeon's experience with the technique, which is why it is worth asking how many a surgeon does.

Surgery takes about an hour, usually under spinal anesthesia with sedation. Many patients go home the same day or after one night. Not every hip suits every approach, and Dr. Stepanyan will tell you honestly if a different route is safer for yours.

Robotic assistance. For appropriate patients, Dr. Stepanyan uses the MAKO robotic-arm system. A CT scan is turned into a 3D plan before surgery, and the robotic arm helps place the cup and set leg length to that plan. It does not operate on its own. The surgeon guides every step. Studies so far support more accurate implant placement, while evidence that it leads to better long-term results is still being gathered.

How long does a hip replacement last?

Longer than most people expect. A review pooling studies and national joint registries with at least 15 years of follow-up estimated that about 58% of hip replacements were still working at 25 years.¹ Many of the studies behind that number involved older implants, and modern designs are expected to perform at least as well, though no one can promise a particular result. Younger and very active patients put more years of wear on an implant, so revision later in life is possible.

What are the risks?

The main risks are infection, blood clots, dislocation, a difference in leg length, fracture of the bone during or after surgery, nerve irritation, and wear or loosening over the years. Most are uncommon, and your care team takes steps to lower each one, including antibiotics, blood thinners, careful positioning and early walking. Heart, lung and diabetes control before surgery matter, and Dr. Stepanyan will ask you to optimize them first.

Should I get a second opinion?

If you have been told you need a hip replacement and want to be sure, or if you were told you are too young, too heavy or too old, a second opinion is reasonable. Request a visit and bring your X-rays and any MRI.

Where can I see Dr. Stepanyan?

Dr. Stepanyan sees hip patients in Glendale, East LA and Santa Fe Springs. He operates at Adventist Health Glendale, Glendale Memorial Hospital, Adventist Health White Memorial and White Memorial Montebello, Providence Saint Joseph Medical Center and Avalon Surgery Center.

What does recovery look like?

These are typical stages after a hip replacement. Your own plan from Dr. Stepanyan and your therapist may differ.

1. Day of surgery

   Up and walking

   Most patients stand and walk with a walker within hours of surgery. Many go home the same day or the next morning with pain medicine, a blood-thinner plan and a home or outpatient therapy schedule.

2. Weeks 0–2

   Settle in

   Expect swelling, bruising and soreness. You walk several times a day with a walker or cane, ice and elevate, and do simple exercises. Most people can shower at home soon after surgery.

3. Weeks 2–6

   Build walking

   The walker usually gives way to a cane and then to walking unaided. Therapy focuses on gait, balance and strength. Many people return to desk work, and driving is typically allowed once you are off narcotic pain medicine and can react safely.

4. Weeks 6–12

   Return to life

   Most daily activity feels normal. Low-impact exercise such as walking, cycling, swimming and golf is usually resumed. Strength and endurance keep improving for several months more.

Most people feel substantially better by three months, and recovery continues for up to a year. Call the office promptly for fever, increasing redness or drainage at the incision, calf pain or swelling, or sudden inability to bear weight.

Sources

1. Evans JT, Evans JP, Walker RW, 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. Journal article