Hip Replacement

Before you consider surgery

Doctor looking at a hip x-ray image.

There are several ways you can resume an active lifestyle with significant pain relief before you consider having surgery.  This first section will discuss:

Discuss each nonsurgical option with your primary care doctor to determine which are best for your specific needs.

What is Arthritis?

Did you know there are over 100 different types of arthritis? Arthritis is an inflammation of the joints that can take several forms:  

Arthritis can also be caused by prior injury, especially breaks in the bones of a joint, or could have developed based on how the joints formed during childhood.  

Symptoms of arthritis can include:

Medical drawing depicting the normal hip joint vs an arthritic hip joint. The arthritic hip joint is rough and has ragged edges where the normal joint is smooth.

What is Osteoarthritis?

Osteoarthritis is an inflammation of the joint, commonly the hip or knee joint.

Diagnosis is made by your physician based on a physical examination and x-rays. The doctor is looking for:

Medical drawing depicting a healthy knee joint vs a knee joint afflicted with osteoarthritis

What should I do before I consider surgery?

Explore nonsurgical ways to reduce your pain.

The pain of osteoarthritis can be dramatically decreased in several ways before you decide to have joint replacement surgery. The following pages will explain each nonsurgical option in more detail.

Weight Loss

Weight loss can be extremely helpful in decreasing the pain of arthritis.

What is your Body Mass Index?

Many physicians recommend avoiding joint replacement surgery if your Body Mass Index (BMI) is greater than 40. Folks with a BMI over 40 have a significant risk for increased complications after surgery including: 

You can determine your BMI using the BMI calculator provided. 

Strengthening Exercises

A light stretching and strengthening program can often be of benefit.

These exercises are typically recommended by a physical therapist for hip and knee pain. Performing these exercises can help strengthen the muscles and maintain range of motion which can help relieve pain and improve joint function. 

NOTE: Reference to the "operated leg" refers to the joint that is causing you discomfort.

Click each image for a video demonstration of the exercise.

Adaptive Equipment

If you could benefit from the use of adaptive equipment, your doctor can recommend you meet with an occupational therapist. 

Adaptive equipment:

A reacher: a straight rod with a grabbing device on one end, and a handle you squeeze to operate at the other end.  A sock aid: a curved piece of plastic with a rope tied to each side.

Gait aids

Image of a walker, a pair of crutches, and a wooden cane.

Gait aids may help patients feel more stable and help prevent falls. Using gait aids could both relieve pain while walking and also help you get up and down from a chair or out of bed.

Types of gait aids:

If you feel you would benefit from a gait aid, speak with your doctor.  Your doctor may write you a prescription for a cane or walker and consultation with a physical therapist.  


Red pills scattered on a surface.

There are a number of medications that can help with the pain of osteoarthritis.

Discuss the risk and benefits of each with your doctor to determine which one is best for you.




Your doctor may recommend injections directly into the aching joint. The purpose of the injections is to reduce the irritation caused by bone rubbing on bone. Injections are more typically done for patients with knee arthritis and only infrequently for patients with hip arthritis.

Corticosteroid Injections:

Hyaluronan Injections:

When should I consider having surgery?

First, have a discussion with your doctor.  The decision to have surgery is typically made based on the answers to the following questions: 

Our recommendations:

Once you have chosen surgery

Image of medical professionals in an operating room.

Also called arthroplasty, joint replacement surgery is performed to relieve pain and restore range of motion by realigning or reconstructing a joint.  After all nonsurgical treatment options have been exhausted, joint replacement surgery may be right for you.  Discuss your options with your doctor.  

If you and your doctor choose joint replacement surgery, review this section to learn: 

How should I prepare for surgery?

Once you’ve made the decision to proceed with surgery there is still much to do.

The following pages will review each item on the pre-operative checklist in more detail. 

Medical clearance

Your surgeon will let you know if you need a medical clearance from your family doctor and/or specialist.

Doctor's hands holding a pen and a clipboard with patient's hands clasped together across from the doctor.

Schedule other exams and procedures

Schedule a dental exam within 6 months prior to joint replacement surgery.

Schedule any invasive procedures at least two weeks prior to joint replacement surgery.

Flu or pneumonia vaccines 


Attend pre-operative appointments

Plan on spending most of the day at Milton S. Hershey Medical Center for your pre-operative appointments.

The following occurs during the pre-surgical visit with your surgeon or physician assistant:

The following occurs during the pre-surgical visit with anesthesia team:

Attend Joint Replacement Education Class

You will also attend a pre-operative Joint Replacement class.

Start Pre-operative Exercises

You may be given a prescription for a physical therapy evaluation before surgery. The physical therapist will teach you exercises you can do at home to begin strengthening your legs. 

NOTE: Reference to the "operated leg" refers to the joint that is causing you discomfort.

Click each image for a video demonstration of the exercise.

Arrange for care and transportation

Young woman smiling, standing behind a car door while smiling parents are at their doorstep.

Arrange for transportation:  

Make arrangements for someone to stay with you for a few days after your surgery:

Prepare your home for recovery

Prior to surgery it is recommended that you make the following preparations:

man in bathroom with walker, grab bars and shower chair available

Schedule physical therapy

Make arrangements for your physical therapy needs. Hip replacement patients will receive a home exercise program and walking instructions for after discharge.

Patient on physical therapy table about to begin exercises.

Pick up medications

You'll want to have your medications on hand before having surgery:

White pill bottle on a pharmacy counter

Meet the surgical team

Member - American Association of Hip and Knee Surgeons logo

You're in good hands.

All of our board-certified surgeons have completed orthopaedic subspecialty fellowships in the area of joint arthroplasty. 

We work as a team.

An integrated, multidisciplinary approach combines a team of dedicated physicians, physician assistants, orthopaedic nurses, anesthesia teams, and physical and occupational therapists dedicated to providing our patients with the highest quality care. 

You can view our list of providers and learn more about each one on the Penn State Health Bone and Joint Institute webpage.    

What happens during surgery?

The following video was produced by the National Health Service in the United Kingdom.  It does an excellent job explaining how the joint works, how osteoarthritis affects the joints, and what happens during hip replacement surgery.  

Note: The hip replacement video references the use of acrylic cement to keep the prosthesis in place. At Penn State, and in the U.S., most hip replacements are performed using the bone ingrowth method, though both approaches can work very well.

Total Hip Replacement:

How will the pain be controlled?

IV drip in an operating room

Pain control is one of the most important considerations for our patients around the time of surgery. We will do everything that we can to help manage your pain in an acceptable manner. Patients who are on regular narcotic pain medications prior to surgery have a much more difficult time managing their pain after surgery.

We use a multi-modal approach to pain management.

You will be asked frequently during your hospital stay what your pain level is as a way of monitoring the effectiveness of the pain control.

Can I go home the same day as surgery?

Some patients may be eligible for an outpatient hip replacement. This means that the patient would be able to go home on the same day as their replacement surgery. Patients who are considering this should be in excellent health with good strength. 

For certain patients in good health, who have a strong support system at home, outpatient hip replacement may be an excellent choice.

What should I bring to the hospital?

Bring the following with you: 

Do not bring:

The day before surgery

Nurse smiling on the phone at a hospital reception area.

The day before surgery, an admissions nurse will call and tell you:

Evening before surgery:

It is important to prepare your skin before surgery to reduce the risk of infection at the surgical site.  Your surgical team has chosen disposable cloths, or wipes, moistened with a special rinse-free antiseptic solution.  Follow the pre-operative skin preparation process outlined on the following page.  

Pre-operative skin preparation

Important Notes:  

Prepare your skin the evening before surgery:

How to prep:

  1. Shower or bathe at least 2 hours before using the disposable cloths
  2. Use all six of the disposable cloths to prep your entire body. Wipe down your body like you would with a washcloth
    1. One wipe is for your neck, chest, and abdomen
    2. One wipe is for your arms
    3. One wipe is for each leg
    4. One wipe is for your back
    5. One is for the surgical area - wipe your surgical site last, moving back and forth for about 3 minutes making sure to wet the entire area
  3. Allow the area to air dry for 1 minute. Do NOT rinse off (unless you develop a skin irritation from the medication in the wipes)  
  4. Do not apply any powders, creams, deodorant, creams, or lotions
  5. Put on clean clothing
Prep the skin as follows: 1. Wipe the neck, chest, and abdomen. 2. Wipe the arms. 3. One leg. 4. The other leg. 5. Your back. 6. The surgical site (do this site last)

The morning of your surgery, you'll perform this process again:

What can I expect during the hospital stay?

Admissions Department desk at the main entrance of the Penn State Health Milton S. Hershey Medical Center main hospital.

On the morning of surgery, report to the Admission Department at the main entrance of the hospital.

In the operating room:

Recovery room:

Orthopaedic unit:

Physical and Occupational Therapy

We try to provide most patients with physical therapy the afternoon of surgery. During these sessions, you will learn:

Occupational Therapy sessions will:

Image of person using walker to stand up from a seated position.

When can I go home?

Senior couple walking into their home, one of them is using a walker, the other is supporting them.

Most patients can expect to return to their own home after leaving the hospital, typically the day after surgery.

Recovery after surgery

After joint replacement surgery, there is still much work to be done.

Rehabilitation begins almost immediately after joint replacement surgery, and there are certain things you need to watch out for. This section will discuss:

When should I call the doctor?

90% or more of patients do well after their hip replacement, though some patients do have complications.  It’s better if you can return to the Milton S. Hershey Medical Center, however, if you experience chest pain or shortness of breath, go to the nearest hospital.

Penn State Health Milton S. Hershey Medical center emergency department entrance with two ambulances.

What are the risks?

As with any surgical procedure, there are risks. Let's review each potential complication in more detail.

Injuries to the large nerves or blood vessels around your hip:


Infection is one of the most severe complications after hip arthroplasty, though it is uncommon (it occurs approximately 0.5% to 1.5% of the time)

Blood clots:

Persistent pain:

Persistent pain is not common in hip arthroplasty patients, perhaps 5% or less of patients experience this.

Some patients will experience a leg length difference after a hip replacement:


2% to 3% of patients will continue to limp after hip arthroplasty.


Wear or loosening of the pieces over time

What are the dos and don'ts after a hip replacement?

You have an important role in caring for your “new” hip:

There are certain movements that place stress on your new hip and should be avoided until you are instructed to do otherwise by your doctor:

Post-operative Exercises

It is important that you do the exercises recommended by your physical therapist after your joint replacement.

Click each image for a video demonstration of the exercise.

Occupational Therapy

Patient getting out of the passenger side of a vehicle while stabilizing themselves with a walker.

An occupational therapist will recommend techniques to help you perform daily living tasks as you recover from surgery. Specific recommendations will vary depending on your individual living situation. Your therapy team will teach you safe procedures for common daily activities such as:

Decide what type of vehicle will be used for travel after your surgery. 

Things to consider: 

Special equipment may be recommended to assist you with your daily activities

You may be instructed to use a "reacher" for donning pants and shoes.  Your therapy team will demonstrate how to use each recommended device, as needed. One commonly used device is the ‘Sock Aid’  demonstrated here:

Your therapy team may recommend special equipment to assist you with
your daily activities such as the sock aid, demonstrated here.

(The following steps are demonstrated without narration.)

Step 1: Pull sock on to the sock aid with top of sock facing you. Pull until toe of sock is tight against sock aid. Do not pull sock beyond knots on the side.

Step 2: Use the ropes to lower sock aid to the floor in front of foot on operated leg. Put your foot into sock.

Step 3: Point your toes down towards the ground and pull up on the rope. The sock aid will be moving out of sock.

Step 4: Pull until sock aid is all the way pulled out of sock.

Life after replacement surgery

After surgery patients can walk, bike, swim, play golf, ski in moderation, play doubles tennis and perform other moderately strenuous activities. Remember, your hip replacement will not make you 18 again. You may still have some mild stiffness, decreased range of motion and limitations of your activity.

A grandparent and grandchild walking down a wooded path holding hands.

Thank you for visiting

Thank you for taking the time to review this resource!  If you have other questions or would like to discuss hip replacement further we would be happy to meet with you.

Best wishes from the Hip and Knee Arthroplasty Division at Penn State Health! 

Aerial photo of the Penn State Health Milton S. Hershey Medical Center.