A posterior hip replacement is a total hip replacement done from the back of the hip and it’s the most common approach surgeons use.
It’s popular because it gives a clear view of the thigh bone and avoids cutting the muscles on the side of the hip (the “abductors”). These are muscles that you rely on to walk without limping. The surgery itself is the same as any hip replacement: the worn ball at the top of the thigh bone and the worn socket are replaced with smooth artificial parts so the joint can move comfortably again.
This page explains why this approach is so widely used, what the surgery involves, and what recovery looks like.
What condition does this treat:
Like any hip replacement, this treats a hip joint damaged badly enough to interfere with daily life. The most common issue is arthritis. When the smooth cushioning inside the joint wears away, the bones rub together and ordinary movements like walking, sitting, or driving become painful.
The surgery removes the damaged parts and replaces them with artificial ones that recreate how a healthy hip moves.
When should you consider surgery:
Surgery is generally considered when hip pain is seriously affecting your life and non-surgical treatments haven’t given enough relief.
The “back” (posterior) approach in particular is the workhorse method most surgeons use. However, the choice of approach depends on several things: any previous incisions, the type of implant being used, your risk of dislocation, body weight, the shape of your hip, and what technique your surgeon is most experienced with.
Your surgeon will recommend the approach that fits your situation best.
What happens during surgery:
You’ll usually be fully asleep under general anesthesia or numbed from the waist down instead. You’ll be positioned on your side with the hip being operated on facing up.
The surgeon makes a curved incision at the back of the hip and carefully works through the tissue to reach the joint — taking special care to protect the sciatic nerve, a major nerve that runs down the leg.
Then they:
- Cut and remove the worn ball at the top of the thigh bone.
- Clear away any bone spurs and smooth out the socket so the new cup can grip firmly.
- Fit a cup into the socket (press-fit, sometimes with small screws) and add a smooth plastic liner.
- Shape the hollow space inside the thigh bone with sizing tools, then test fit with trial parts to check stability, movement, and leg length.
- Once the fit is right, place the final stem into the thigh bone and attach a new metal or ceramic ball.
- Fit the ball into the socket, repair the muscles and tissue that were moved aside, and close the incision in layers.
X-ray showing total hip replacement
What does recovery look like:
You’ll be given medication to prevent blood clots, such as a blood thinner like aspirin. Most people can stand and walk with help the day after surgery.
By three to four weeks, the majority are walking without a walker or other aids. As with any hip replacement, physical therapy plays a big role in rebuilding strength and movement, and your surgeon will guide your timeline based on how you’re healing.
Most patients are comfortable around 6 weeks. You can start driving around 6 weeks. Many patients return to sedentary desk work around 4 weeks post operatively. Manual labor job may required up to 12 weeks before you are strong enough to return to work.
What are the major risks and complications:
Serious complications are uncommon, but they’re discussed thoroughly with every patient. They include:
- Blood clots in the leg, which can be dangerous if one travels to the lungs.
- Infection, at the wound or deeper around the implant.
- Bleeding during or after surgery.
- Heart problems, such as a heart attack, as with any major surgery.
- Hardware problems, like the implant loosening or failing over time.
- A small difference in leg length after surgery.
Your surgeon will go over how these apply to your case.
What if you don’t have surgery:
Surgery isn’t required, and many people manage hip arthritis for a long time with medication, physical therapy, and injections. These are all reasonable first steps. But arthritis doesn’t heal on its own, so the joint generally keeps wearing down.
For many people the pain and stiffness slowly worsen and everyday activities get harder over time. Non-surgical care eases symptoms but doesn’t fix the underlying damage.
It’s also worth remembering that “posterior” is just how the surgeon reaches the hip, not a separate decision about whether to have a replacement if you do choose surgery, your surgeon will pick the approach that’s safest for you.
When to proceed is a decision to make together based on how much your hip is affecting your daily life.
How Medicare Covers Posterior Hip Replacement
If you have Medicare, your healthcare provider may bill for CPT Code 27130 — this refers to a surgical procedure where the damaged hip joint is removed and replaced with an artificial implant through an incision made at the back (posterior) of the hip.
“What Will It Cost You?”
If you don’t have secondary insurance, here’s what you can expect:
Estimated Out-of-Pocket Cost for Posterior Hip Replacement (27130): $303.45
“For example, hypothetical patient, Mary, needed a posterior hip replacement after years of painful arthritis. Her surgery included 1 procedure: replacement of her hip joint with an artificial implant through a posterior approach (27130). Thanks to Medicare, her total out-of-pocket cost was about $303.45. Her secondary insurance then covered it completely!”
Do you have more questions?
What are the benefits of posterior hip replacement?
Posterior hip replacement offers advantages such as excellent exposure of the hip joint, familiar surgical technique for many orthopedic surgeons, and good long-term outcomes in terms of pain relief and improved function.
What are the potential risks or complications associated with posterior hip replacement?
Risks and complications of posterior hip replacement may include infection, blood clots, dislocation of the prosthetic hip joint, nerve or blood vessel injury, leg length inequality, implant loosening, and the need for revision surgery.
How does the recovery process differ for posterior hip replacement compared to other approaches?
Recovery after posterior hip replacement may involve specific precautions to prevent hip dislocation, such as avoiding certain movements and positions during the initial healing phase. Physical therapy and rehabilitation are also essential components of the recovery process.
Are there any restrictions on physical activities or movements after posterior hip replacement surgery?
Patients may need to avoid certain movements and activities that place excessive stress on the hip joint, especially during the early stages of recovery. However, most individuals can gradually resume normal activities as tolerated with guidance from their healthcare provider.
What are the potential long-term outcomes of posterior hip replacement?
Long-term outcomes of posterior hip replacement surgery may include pain relief, improved hip function, increased mobility, and enhanced quality of life for many patients. However, individual results may vary depending on factors such as patient age, activity level, and overall health.
How does the risk of nerve injury differ between posterior hip replacement and other approaches?
Posterior hip replacement carries a risk of injury to the sciatic nerve, which runs close to the surgical site. However, advances in surgical technique and intraoperative monitoring have reduced the incidence of nerve injury in recent years.
How does the risk of blood loss differ between posterior hip replacement and other approaches?
Posterior hip replacement may be associated with a slightly higher risk of blood loss compared to anterior or lateral approaches due to the larger incision and potential disruption of more soft tissue structures. However, transfusion rates are typically low with modern surgical techniques and blood conservation strategies.
Can posterior hip replacement be performed in patients with pre-existing medical conditions?
Posterior hip replacement may be performed in patients with certain pre-existing medical conditions, depending on the severity and stability of the conditions and the overall surgical risk. However, careful pre-operative evaluation and optimization may be necessary to minimize the risk of complications.
How does the risk of implant loosening differ between posterior hip replacement and other approaches?
Posterior hip replacement may be associated with a slightly higher risk of implant loosening compared to anterior or lateral approaches, particularly in patients with poor bone quality or suboptimal implant positioning. However, advances in implant design and surgical technique have improved implant stability and longevity in recent years.
Are there any specific post-operative precautions or instructions for patients undergoing posterior hip replacement?
Yes, patients undergoing posterior hip replacement surgery may receive specific post-operative precautions to minimize the risk of hip dislocation, such as avoiding crossing the legs, bending the hip beyond a certain angle, or sitting on low chairs or sofas. Compliance with these precautions is essential for successful recovery.
How does the risk of leg length inequality differ between posterior hip replacement and other approaches?
Posterior hip replacement may be associated with a slightly higher risk of leg length inequality compared to other approaches, as precise restoration of leg length and alignment may be more challenging due to the posterior surgical approach. However, careful pre-operative planning and intraoperative techniques can help minimize this risk.
Can posterior hip replacement be performed using robotic-assisted techniques?
Yes, posterior hip replacement surgery can be performed using robotic-assisted techniques, which offer potential benefits such as improved accuracy in implant placement, enhanced surgical precision, and better patient outcomes. Robotic technology may be particularly useful in cases involving complex hip anatomy or revision surgery.
How does the risk of infection differ between posterior hip replacement and other approaches?
Posterior hip replacement carries a risk of surgical site infection similar to other surgical approaches, although infection rates are typically low with modern surgical techniques and perioperative antibiotic prophylaxis. However, patient-specific factors such as immunocompromised status or obesity may increase the risk of infection in some cases.
Can posterior hip replacement be performed in patients with previous hip surgeries or revisions?
Yes, posterior hip replacement surgery can be performed in patients with a history of previous hip surgeries or revisions, depending on the specific circumstances and the underlying hip pathology. However, careful pre-operative evaluation and surgical planning are essential to address any anatomical challenges or complications from prior surgeries.
How does the risk of perioperative complications differ between posterior hip replacement and other approaches?
Posterior hip replacement may be associated with a slightly higher risk of certain perioperative complications such as nerve injury, wound healing problems, and blood loss compared to other approaches. However, careful patient selection, meticulous surgical technique, and adherence to evidence-based practices can help minimize the risk of complications in all approaches.
Are there any specific intraoperative considerations or techniques used in posterior hip replacement surgery?
Yes, posterior hip replacement surgery requires careful soft tissue dissection and retraction to access the hip joint from the back. Intraoperative techniques such as capsular repair, femoral head osteotomy, and acetabular reaming may be used to optimize implant placement and stability.
Can posterior hip replacement be performed using tissue-sparing approaches such as muscle-sparing techniques?
Yes, posterior hip replacement surgery can be performed using tissue-sparing techniques, which aim to minimize soft tissue damage, reduce post-operative pain, and accelerate recovery. These techniques typically involve smaller incisions and less disruption to surrounding muscles and tendons.
