Dr. Sebastian Rodriguez answers the most common questions about hip replacement surgery—from understanding when you need one to the anterior approach, implant types, and recovery expectations.
Anterior Hip & Robotic Knee Surgery
View ProfileFirst, you need to diagnose the problem correctly. A lot of people when they point to their hip, they often grab their butt or low back—and often that pain is actually low back pain. Hip pain typically manifests as groin pain.
A lot of athletes as they age think they've pulled a groin, and that can go on for several weeks or months. Even with treatment it doesn't seem to get better, then someone finally does an X-ray and says, "You don't have a pulled groin, you have hip arthritis."
Key symptoms include: groin tenderness, pain that radiates down to the knee, pain in the thigh and buttock (but not your low back), and limitation in mobility. People notice things like difficulty putting on shoes and socks, or sleeping in bed.
There's never a great time to have major surgery in your life. Everyone's busy—they have jobs, obligations, looking after grandkids. But I often tell patients: you'll know when you're ready.
Sometimes you start to feel symptoms but you're still managing day-to-day. Often people manage it with medication—some Tylenol, some Advil, maybe a prescription anti-inflammatory. When you start thinking about your hip more often than you're not, then you need to see somebody and discuss surgical options.
People think "I need an MRI," but actually the diagnosis for hip arthritis is mostly made on an X-ray. Two views of the X-ray in 10 seconds can tell me if you have hip arthritis and if you'd benefit from a hip replacement.
The degree of arthritis—terms like "severe" or "moderate" or "mild"—those are just subjective terms used to describe an X-ray. Once you have that condition, how it's impacting you is very personal and subjective.
For years we put a lot of emphasis on rehabilitation—what do you do after? It's only in the last decade we've really focused on prehabilitation. The fitter you are ahead of surgery, the easier your recovery will be.
Once you've traumatized the body with surgery, it's hard to recover muscle strength. So the more you can work on range of motion, mobility, and proprioception ahead of time, the faster you will recover.
Endurance training: Cardiovascular exercise for 20-30 minutes, three times a week. The three best non-impact options are:
Strength training: It doesn't have to be heavy weights—resistance can be bands, machines, or pulleys. If you've never exercised before, this should be done under the guidance of a trainer or physiotherapist.
The hip is the articulation between the femoral head and the acetabulum (your pelvic bone). We remove the femoral head and neck—the ball-type part of the femur—and put metal inside with a metal or ceramic head on top.
Then we put a metal cup into the pelvis (the acetabulum) with a plastic liner inside. So it's a ball and socket joint with:
The anterior approach is generally considered muscle-sparing—no muscles or tendons are detached from the bone and don't have to be reattached after. This means:
The lateral approach involves taking off your abductors and reattaching them—very safe in terms of dislocation, but can cause a permanent limp and weakness in some people, plus more painful recovery.
The incision needs to be big enough to safely do the surgery—classically 6 to 10 cm depending on the patient's size. For the anterior approach, there are two options:
Both work well with pluses and minuses to each, but underneath, the surgery is still the same.
We've gravitated toward more spinal anesthetics. With a spinal, you're frozen from the waist down and still spontaneously breathing—no breathing tubes in your mouth. It wears off after a couple hours.
Benefits include: no irritation to the throat, using less pain medication (it helps control pain after), and a smoother, faster recovery without the nausea and vomiting associated with general anesthesia.
It depends on the surgeon and complexity, but the actual procedure can be anywhere from 25-30 minutes to 45-50 minutes depending on how complex the case is.
Yes, we do bilateral hip replacements pretty often if people have symptoms and findings on both sides. If someone says "I can't even tell which one to do first, the right or the left," then we do both at the same time.
You have to be medically fit for it because it's a bit more stress on the body. We wouldn't do it preventatively on one side just because it "might bother you in the future."
There are a variety of different manufacturers, and every one will tell you theirs is a little better. The key thing is: let the surgeon decide what they're most comfortable using. You don't want to take a Ferrari driver and put him in a Porsche if he's never done that before.
Most components are equivalent—they've got very good track records over 10, 15, 20 years. If put in correctly, they should last 20 to 25 years.
Ceramic is a little bit smoother and will last a little bit longer. The original concern was a slight fracture risk in younger or heavier people, but that's been shown to not be as big a deal now. We use ceramic pretty liberally.
The downside: ceramic is more expensive, so in some public hospitals, they don't offer it as regularly.
We reserve cemented stems for people with osteoporosis or very weak bone—it gives instant fixation and adheres well to the bone. Some people with rheumatoid arthritis or other diseases might need a cemented stem to reinforce their bones even if they're young.
Press-fit stems require you to be careful with elderly patients because there's more stress on the bone. The decision is based on bone quality and patient comorbidities, not purely age.
Tech is coming to medicine like we've never seen before. We've been using computer navigation for all our hip replacements for several years. Now we're using robotics and robotic navigation to guide how we mill the bone and control leg length, offset, and component positioning.
The next 10 years will see a boom of tech, hopefully with integrated AI that evaluates what we're doing and the outcomes—and more virtual-type tools that are less invasive than big bulky robots.
The good news with hip replacement, especially with the anterior approach, is patients actually have very little pain. People are typically surprised—they wake up and might have a little discomfort initially, but that sharp gnawing pain in the groin is gone literally instantly.
Our studies show 80-90% of people don't even touch narcotics after surgery. You can manage pain with anti-inflammatories, Tylenol, and some nerve pain medication. Most people aren't using Tylenol 3s or Percocets after surgery.
Most of our patients go home the same day. With good anesthesia, surgical techniques, and patient prep, most people are able to go home same-day.
The caveat: if you're traveling from out of town, it might be safer to spend one night in the facility or hospital. But shortly after that, you'll be mobile with physiotherapy and then can go back to the hotel or home.
We typically start people off with a walker for balance—you can put your full weight on a hip replacement after surgery, but if you're feeling woozy with medications or tired, it's nice to have balance.
A lot of people ask about "hip precautions" because their grandmother had them. Nowadays, especially with the anterior approach, we don't have hip precautions anymore.
We caution people to be careful and not do extremes of range of motion to start. But those classic restrictions—needing a raised toilet seat, grab bars, couldn't bend or sit in a sofa—those are really historical in nature.
For the first 10-14 days, home exercises from the physiotherapist (booklets or apps) are more than enough—simple things like getting your leg bending, hip moving, and walking on your hip.
Real strength training doesn't start till 4-6 weeks after things have healed. Before that, physiotherapy exercises are really for mobility and keeping things moving.
Infection: Anytime you make an incision, skin bacteria could get inside. Most infections are superficial skin infections treatable with oral antibiotics if caught quickly. A deep infection may require another surgery to wash out or exchange components.
Dislocation: With anterior hip replacement, dislocation rates are exceedingly low—probably less than 1 in 200. But your hip can still pop out of socket if you're not careful.
Periprosthetic fracture: We're milling bones and hammering things in. If you've watched surgery on YouTube, you see we're a bunch of dudes with hammers! We do this carefully, incrementally, but the bone can still break—requiring a different implant or modifying weight-bearing after.
If there's skin glue and an occlusive dressing, leave it for 14 days. Once it comes off, you can shower, pat your incision dry, and put a little Polysporin or ointment on it.
If you have stitches or staples, those come out in 10-14 days. Some people are fearful of showering, but the best thing you can do is keep the whole area clean—shower with warm water and soap.
Book a consultation with Dr. Rodriguez or one of our specialized hip surgeons. Virtual appointments available across Canada.