Hip Surgery
Planning Out Your Procedure
What is Hip Surgery?
A hip replacement, also known as hip arthroplasty, is a surgical procedure designed to alleviate hip pain. During this procedure, artificial implants are inserted to replace the hip joint and take the place of natural tissue. The hip is a joint that is made up of a ball at the top of the femur, or thigh bone, and a socket located in the pelvis, also known as the hip bone. During surgery, either the ball or the hip socket might be replaced. The operation should reduce your pain levels enough that you can get back to your normal routine and exercise.
How Long Will My Hip Replacement Last?
The longevity of your new artificial hip depends on your age, the materials used, and your activity level. Below are some findings from previous years for patients who received a replacement with hip surgery:
- For standard metal-plastic hip replacements, in patients with an average age of 70, 95% last 10–15 years
- With these same implants, in patients aged 40–60, the implant’s survivorship drops to 70–80% over 8 years
- Metal hip surface replacement shows 96% survivorship at 7 years in patients aged 40–60
- Studies of ceramic-ceramic, metal-cross-linked polyethylene and small-bearing total hip replacements show approximately 95–98% survivability in young patients as well
Bone Health Expectancy for Hips
Those who are considered obese, which is a Body Mass Index of greater than 29, or who have low bone density have a higher risk of early femoral failure, which involves fractures and head collapse. Therefore, all patients have a DEXA scan and their vitamin D level checked before surgery to ensure the best possible outcome for their new hip.
Rods, screws, and other uncemented components are most commonly used to avoid any issue in the healing process as well as the usability of the joint for years to come. Vitamin D is added as needed, calcium is recommended, and special postoperative protocols are set up based on each patient’s lifestyle and routines.
Using these methods, the risk of early femoral failure has been reduced to below 0.1%. We are now also using these protocols for stem total hip replacements to lower our previous 1.5% rate of femoral fractures.

Does Insurance Pay for Hip Replacement Surgery?
A hip stem replacement (HSR) is simply one type of total hip replacement (THR) in hip surgery. There is no separate CPT code for HSR. When we bill insurance companies for the procedure, we use CPT code #27130, which is defined as replacing both surfaces of the hip joint. The cost to the insurance company when we perform HSR is the same as for traditional stemmed THR.
The implants we use are FDA-approved Biomet Recap Femoral and Biomet Magnum Acetabular Components. Using them in combination as a total metal-on-metal hip surface replacement in the United States constitutes an off-label use. This is perfectly legal and a commonly accepted practice in the United States.
The FDA can only prohibit the US promotion of these implants as total resurfacing combinations. These implants are promoted as total resurfacing devices worldwide. US-licensed physicians can use implants and drugs off-label. HSR has not been retrospectively denied, but we cannot guarantee your insurance company’s action.
Large Hospitals vs. Small Specialized Practices
Studies have shown that outcomes for joint replacement are better in high-volume centers but most high-volume centers are large hospitals, where sick people with resistant bacteria congregate. The outcome is more dependent on the surgeon than the hospital. A high-volume surgeon who performs hip surgery in a smaller hospital or outpatient setting is the best of both worlds.
Costs of Hip and Joint Replacement Surgery
Costs for joint replacement vary widely and are difficult to compare. Unfortunately, insurance companies have forced us into such complex contracts that quoting a price is almost impossible.
Here’s a rough estimate of the costs. An episode of care cost for joint replacement is the total amount paid to all providers for the service over 120 days (or 4 months).
- For Government plans, this is about $12,000
- For Blue Cross at Providence Hospital NE, this is $35,000
- For outpatient surgery at our hip surgery center, this is $28,000
- At the other two major hospital systems in our metro area, it is $45,000 at Palmetto Health and $65,000 at Lexington Medical (from the Blue Cross website)
- At some hospitals in this country, the cost is over $100,000. Depending on your insurance contract, you will pay some portion of this.
For more information, please contact us.
The physicians at Midlands Orthopaedics & Neurosurgery will ensure the most comprehensive approach to help find relief for you in the quickest way possible.
Wear and Tear Resistance
Modern thinner, more brittle plastics are wear-resistant, especially when used with ceramic heads, but active patients may break them. Avoid heavy labor and repetitive high-impact activities. Metal-metal bearings only wear excessively when implanted incorrectly. Titanium stems of total hip replacements are stronger than plastic liners but may fatigue after long-term extreme impact activities.
Metal-on-metal bearings mimic hip bearings biomechanically. Patient anatomy determines implant size. After 6 months, they are stable enough to move freely. Smaller plastic bearings biomechanically degrade. Thus, extreme flexion must be permanently restricted.
Total hip stems are stiffer than bone. This irritation causes thigh pain in 3–5% of total hip stem patients. It may limit patients’ impact activities.
Although cement is still commonly used to fix implants to the bone in Europe, in the US more than 95% of hip replacements are of the uncemented (bone-ingrowth) type. Cement is a weak link that breaks down over time. Uncemented fixation in the hip is the most recommended.
There is no difference visible in the gait of patients with resurfacing or total hip replacement. However, 4/5 laboratory gait studies show that gait is normal with resurfacing while it is not with total hip replacement. Two comparative survey studies have shown that a higher percentage of resurfacing patients can return to desired sporting activity than compared to total hip patients.
Most arthritic hip patients have no functional difference between resurfacing and total hip. Large metal-on-metal bearings in total hips and resurfacing provide superior stability with a small risk of adverse wear failure if the acetabular component is malpositioned. Resurfacing preserves bone, prevents thigh pain, and improves impact tolerance.
Infection
Postoperative infections are 1-2% nationwide and 0.1% is our infection rate. Even rare infections can be treated aggressively without implant loss.
Late hip infections from elsewhere are rare. There’s less than a 1% lifetime risk. Hip implant patients should treat any bacterial infection immediately but viruses are harmless. Betadine and Neosporin should be used to disinfect cuts.
Dental cleaning and procedures in contaminated areas require prophylactic antibiotics. Tell your dentist or doctor that you have a hip implant and request antibiotics. Pre-procedure doses are usually sufficient. One antibiotic dose is safe. This recommendation is controversial and unsupported by data. Late implant infection treatment is painful and costly.


Are you experiencing hip pain and discomfort?
Contact us to schedule an appointment to speak with one of our orthopedic doctors at one of our locations near you or give us a call at (803) 256-4107.
Frequently Asked Questions
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What is minimally invasive surgery?
Are metal ions only present for one year after surgery?
What is an FDA-approved implant?
What is a FDA procedure?
Why do total hip replacements dislocate?
Why are there so many restrictions with THR?
Can you lengthen my leg with a hip replacement?
What is the advantage of minimally invasive surgery?
What is the best bearing surface in hip replacement?
I believe metal on metal bearing is the best choice for hip replacement for the following two reasons:
- Extremely durable surface that is unlikely to ever wear out.
- Stability of the joint. Using a metal on metal bearing surface allows the manufacture of a large bearing hip joint that will not dislocate. Traditional hip replacements are not durable enough for many of today’s younger more active patients. Traditional metal on plastic bearing devices have been shown to have a failure rate of (30 % ) by seven years in this patient group. Recently several new bearing couples have been developed as more durable options:
- Crosslinked polyethylene – more durable than standard plastic but still not well tested. Previous modifications in plastics have been very unsuccessful.
- Ceramic on Ceramic – very durable bearing surface. Unlikely to ever wear out. However , manufacture of this brittle material is very tricky , occasionally resulting in failure by fracture of the ceramic parts while in use.
- Metal-on-Metal – very durable bearing surface. Unlikely to ever wear out. No possibility of cracking like ceramic. Although metal-on-metal and ceramics are equally durable bearing surfaces , a metal on metal bearing has one distinct advantage over all other bearing surfaces.
Large diameter joint replacements can be manufactured which allow the surgeons to reconstruct the hip in a mechanically sound fashion similar to a patient’s original hip and thus avoid dislocation after surgery. This is a major advantage that should not be underestimated. It is estimated that 5-7% of patients with total hip replacement will suffer dislocation over ten years. With large bearing joints the chance is less than 1 %. The improved stability makes it possible for us to offer patients a new hip without all of the traditional restrictions of total hip replacement. (Restrictions used to include no deep bending , crouching or crossing legs) , patients can now kayak , participate in dance , gymnastics , martial arts , etc. There is one potential problem with metal-on-metal bearings. Normal wear results in release of metal particles into the body. One problem with any artificial bearing surface is the wear regenerated by normal daily wear and tear. Large volumes of plastic generated by metal on plastic (traditional) replacements result in large amounts of bone destruction , (osteolysis) around implants and has been the major cause for failure in young patients. Both ceramic-on-ceramic and metal-on-metal devices generate about 99% less wear debris than traditional bearings and the debris generated seems to cause less irritation to the bone than plastic debris does. There has been some speculation of the potential for metal debris to cause cancer. However , with careful studies to date , no links have been demonstrated. My opinion is that the advantage of metal on metal bearings strongly outweighs the potential risks. Now we can return patients to normal function with almost no restrictions and expect their implants to last more than 10 years at very high activity levels. Most patients will never require another operation on their hip. If ceramic-on-ceramic or metal-on-crosslinked polyethylene bearings are used , wear is also not a problem , but significant restrictions remain. No running or jumping can be allowed due to the risk of fracture of the implant: no crossing of the legs or extreme bending can be allowed due to the risk of dislocation. I am surprised that any person would choose anything other than a large metal-on-metal bearing!
What complications can occur?
Why are most surgeons not performing hip surface replacement?
What surgeons perform hip surface replacement?
Is hip surface replacement experimental surgery?
How long is the recovery?
What is the advantage of a hip surface replacement?
There are pros and cons. The advantages include:
- Less bone is removed
- It is more durable than standard total hip replacement in young people (96% survivorship at 8 years in the English literature) ,
- Stability is better: a. no dislocation b. Minimal early postoperative hip precautions c. No hip precautions after 6 months
- No thigh pain ,
- Less risk of blood clots (3 in 700 in my experience , compared to 10% with total hip replacement) ,
- Less blood loss in surgery (transfusion is required in less than 1% in patients with a preoperative hemoglobin greater than 13; there is no need for autologous blood collection).
Recently large bearing metal-metal total hip replacements have become available as well (Biomet Magnum , released 12/2004 in the US market). We expect them to be just as durable and stable as hip surface replacement. The disadvantages of hip surface replacement include: % 1. 1% femoral neck fracture.% 2. 2% femoral head avascular necrosis. Both of these complications require revision of the femoral side to a large bearing implant that will mate with the acetabular component in place.
Do metal ions pose a health risk?
