A comprehensive pillar for patients considering total hip arthroplasty
30 de minute, evaluare clinică, plan personalizat.
Short answer: Hip replacement is a surgery in which the damaged hip joint (femoral head and acetabulum) is replaced with an artificial implant. It is called total hip arthroplasty (THA). The most common reason for needing a replacement is hip osteoarthritis — the wear and tear of the hip cartilage. The surgery lasts 60–90 minutes, hospital stay is 4–6 days, and full recovery takes between 4 and 6 months. It has one of the best success rates in orthopedic surgery — over 90% of patients report significant improvement at 10 years post-op (Swedish Hip Arthroplasty Register, 2022 report).
The hip is a ball-and-socket joint. The 'ball' is the femoral head — the upper part of the femur. The 'socket' is the acetabulum — a hollow in the pelvic bone that houses the ball. Between the two, there is articular cartilage that allows for smooth, painless movement.
When this cartilage wears down — a process called hip osteoarthritis — the ball and socket rub directly bone-on-bone. This causes pain, stinging, and limited movement.
Hip osteoarthritis can be: <strong>primary (idiopathic)</strong> — age-related wear, the most common type, after age 60; <strong>secondary</strong> — occurs as a result of other conditions (insufficiently treated hip dysplasia, trauma, avascular necrosis of the femoral head, sequelae of rheumatological diseases); <strong>post-traumatic</strong> — after previous fractures or dislocations.
Besides primary hip osteoarthritis, hip replacement is also performed for: avascular necrosis of the femoral head (the femoral head loses its blood supply); adult hip dysplasia (a developmental anomaly); femoral neck fracture in elderly patients; severe rheumatological diseases (rheumatoid arthritis, ankylosing spondylitis); failure of previous interventions.
Hip osteoarthritis does not appear suddenly. It develops insidiously, over months or years.
Pain in the hip or groin area (less commonly on the side); pain occurs with prolonged exertion; it subsides with rest and anti-inflammatory drugs; slightly limited mobility — putting on socks on the affected side becomes difficult. <strong>Attention:</strong> sometimes the first pain appears in the corresponding knee (referred pain) — patients see an orthopedic surgeon for their knee and discover they have hip osteoarthritis.
Pain occurs with normal walking, after the first 100–500 m; initial night pain; visible limp; morning hip stiffness (10–30 min to 'warm up'); inability to cut your own toenails on the affected side; limited or painful sex for partners.
Continuous pain, including at rest and at night; walking limited to 50–100 m; affected limb becomes shorter (1–2 cm); calf and gluteal muscles begin to atrophy; quality of life profoundly affected — reactive depression, social isolation; anti-inflammatory drugs no longer work or cause gastric side effects.
Just like with the knee, we don't jump straight to surgery. There is a whole arsenal of conservative treatments that we exhaust first:
Weight loss if you are overweight — every extra kilogram loads the hip (1 kg of body weight = ~4 kg of pressure per joint, Messier SP et al., JAMA 2013); adapted physical activity (swimming, cycling) — no high-impact sports; avoiding prolonged standing.
Nonsteroidal anti-inflammatory drugs (NSAIDs) episodically, not chronically; paracetamol; stronger analgesics for painful episodes. Caution: prolonged use of NSAIDs damages the stomach and kidneys.
Strengthening of the gluteal and abductor muscles; stretching; hydrokinesiotherapy. Recommended with a competent physiotherapist — not 'at home from a YouTube video'.
With hyaluronic acid (effect lasts 6-12 months, medium efficacy for the hip); with PRP (platelet-rich plasma); with an anti-inflammatory steroid (rapid but short-lived effect; not to be repeated often — it damages the cartilage). → Details about PRP and hyaluronic acid injections
Corrective osteotomies for young patients with dysplasia; hip arthroscopy for labral tears or femoroacetabular impingement.
We evaluate most of these options during the consultation, depending on your stage and individual characteristics.
Chronic pain (over 6 months) that significantly affects quality of life; insufficient response to conservative treatment; radiological images of advanced hip osteoarthritis (Tönnis II-III or Kellgren IV); significant functional loss; a patient with comorbidities compatible with surgery.
Moderate hip osteoarthritis with pain controlled by medication; patient under 50 years old (we try the full conservative arsenal + possible osteotomies); BMI > 35 — we operate only after weight loss; decompensated diabetes, active infections.
Already visible limb shortening; established muscle atrophy; pathognomonic gait (Trendelenburg); compensation in the spine or other hip; progressive avascular necrosis (especially in young patients).
During the consultation, we discuss your specific situation. There is no 'one-size-fits-all' protocol.
Cemented prosthesis: components are fixed with bone cement (polymethylmethacrylate); immediate, very stable fixation; recommended for patients over 70 or with osteoporosis; durability 15–20 years.
Uncemented prosthesis: components have a porous surface into which the bone grows over months; 'biological' fixation; recommended for active patients under 65–70 years old, with good bone quality; durability 20–25 years or more.
Hybrid prosthesis: one cemented component, one uncemented; a compromise between the two.
Bearing surface: metal-on-polyethylene (most common); ceramic-on-polyethylene (less wear); ceramic-on-ceramic (least wear; small risk of 'squeaking' noises; recommended for young patients); metal-on-metal (used less frequently now).
The decision is made individually. During the consultation, I will explain what I would specifically recommend for you and why.
Posterior approach (Kocher-Langenbeck): the most common (60–70% of cases); excellent visibility, standardized technique; slightly longer recovery, movement restrictions for 6 weeks.
Anterolateral approach (Watson-Jones): spares the gluteal muscles; slightly faster recovery.
Direct anterior approach (DAA / Smith-Petersen): spares everything, no muscle cutting; fastest recovery, minimal restrictions; technically demanding.
I use the approach that benefits you the most, depending on your case, bone quality, and goals.
The night before: hospital admission; fasting from midnight; a mild sedative for sleep.
The morning of the surgery: preparation (antiseptic shower, change of clothes, IV line); final conversation with me + the anesthesiologist; transfer to the operating room.
In the operating room: anesthesia (usually spinal + sedation; rarely general); positioning on the side or back, depending on the approach; disinfection and sterile draping; incision (10–15 cm); exposure of the joint, dislocation of the femoral head; precise cuts to prepare the surfaces; preparation of the acetabulum and insertion of the cup; cutting the femoral head and preparing the femoral canal; insertion of the femoral components and stability check; reduction of the joint, checking mobility and limb length; copious irrigation, layered suturing.
Total duration: 60–90 minutes for standard cases.
On the first post-op day: you get out of bed, take your first steps with a walker. This is crucial — early mobilization prevents thrombosis and stiffness.
Weeks 1–2: hospitalization for 4–6 days; walking with a walker under the supervision of a physiotherapist; regular dressing changes; anticoagulant to prevent thrombosis; strict movement restrictions (depending on the approach). Posterior: do not flex the hip over 90°, do not internally rotate, do not cross your legs. Anterior: fewer restrictions. Discharge when you can walk independently with a walker and pain is controlled orally.
Weeks 3–6: at home, physiotherapy 3–5×/week; transitioning from a walker to crutches; progressive mobility; movement restrictions still in place (especially for the posterior approach); resume driving: 6–8 weeks.
Weeks 6–12: transitioning to a cane, then walking without support; movement restrictions are relaxed after weeks 6–8; sedentary activities fully resumed; light sports (swimming, cycling) after weeks 8–10.
Months 3–6: complete independence; continue physiotherapy 1–2×/week for maintenance; 6-month evaluation — control X-ray + clinical exam.
Month 6+: maximum mobility (not identical to a natural hip, but very close); resumption of most activities. <strong>Allowed long-term:</strong> walking, swimming, cycling, golf, hiking, dancing, yoga, pilates. <strong>Not recommended:</strong> regular running, repetitive jumping, high-impact sports.
Every surgery has risks. Hiding them doesn't help you make an informed decision. Here are the real risks, with real incidences:
| Risk | Incidence | How We Prevent It |
|---|---|---|
| Infection | 1–1.5% | Prophylactic antibiotics, strict asepsis |
| Deep Vein Thrombosis (DVT) | 1–3% (with prophylaxis) | Anticoagulant for 4–6 weeks, mobilization |
| Pulmonary Embolism | under 1% | Same measures |
| Prosthesis Dislocation | 1–3% (more common in the first 3 months, posterior approach) | Adherence to movement restrictions |
| Limb Shortening/Lengthening | under 1 cm (usually imperceptible) | Pre-op planning, intra-op measurements |
| Sciatic Nerve Injury | under 0.5% | Careful technique |
| Prosthesis Wear/Loosening | Cumulative over time | Correct technique, normal weight |
| Need for Revision | ~3% at 10 years, ~10% at 20 years | Quality implant, follow-up |
Infection
Incidence: 1–1.5%
Prophylactic antibiotics, strict asepsis
Deep Vein Thrombosis (DVT)
Incidence: 1–3% (with prophylaxis)
Anticoagulant for 4–6 weeks, mobilization
Pulmonary Embolism
Incidence: under 1%
Same measures
Prosthesis Dislocation
Incidence: 1–3% (more common in the first 3 months, posterior approach)
Adherence to movement restrictions
Limb Shortening/Lengthening
Incidence: under 1 cm (usually imperceptible)
Pre-op planning, intra-op measurements
Sciatic Nerve Injury
Incidence: under 0.5%
Careful technique
Prosthesis Wear/Loosening
Incidence: Cumulative over time
Correct technique, normal weight
Need for Revision
Incidence: ~3% at 10 years, ~10% at 20 years
Quality implant, follow-up
The numbers are not meant to scare you, but to show you that the risks are small, but real. Data from the Swedish Hip Arthroplasty Register (2022 annual report) confirms success rates of over 90% at 10 years post-op, and pre-operative honesty is part of your informed decision.
Hip replacement surgery is part of the National Endoprosthetics Program. Eligible patients benefit from a fully covered surgery.
The steps: referral from your family doctor; orthopedic consultation (free with CAS); investigations (X-ray, possibly MRI, blood tests); enrollment in the National Program — a waiting list of 3–9 months; the surgery — at hospitals with a contract; a free voucher for balneotherapy for recovery.
Advantages: short waiting time, choice of implant, private room.
Estimated costs (2026): consultation 200–400 lei; surgery + implant + hospitalization 22,000–40,000 lei (highly variable); hybrid (CAS coverage for the surgery + private payment for a separate room) — a frequently chosen solution.
At my office, the consultation costs 360 lei. An estimate for the surgery is provided after a complete clinical evaluation.
I am Dr. Alexandru Florian Grecu, senior consultant orthopedic surgeon, with clinical activity in Craiova. I work at MedLife Private Hospital Craiova (2A Științei St.) for private consultations and surgeries, and at Craiova County Clinical Emergency Hospital (1 Tabaci St.) for cases on the public CAS route through the National Endoprosthetics Program.
My main specializations are hip and knee arthroplasty, knee arthroscopy, and regenerative therapy with PRP and hyaluronic acid. In addition to my clinical work, I teach orthopedics at the University of Medicine and Pharmacy of Craiova, as a Senior Lecturer.
Orthopedics is a specialty where what matters is not just the day of the surgery, but what happens 5, 10, or 20 years later. I choose implants, techniques, and the timing of the intervention with this long-term perspective in mind. My patients are primarily people who want to regain their lost mobility — whether for work or to watch their grandchildren grow up.
For complete details about my professional background, see the About page.
Hip osteoarthritis doesn't mean you're "past it". Treatment, whether conservative or surgical, restores mobility and a normal life. The important step is to stop postponing the evaluation. During the consultation, we'll discuss exactly where you stand, what your alternatives are, and what each option would mean for you. Appointments: 0251 960 (MedLife) or +40 787 210 391 Consultations: with CAS or private (360 lei). Mon–Fri, 08:00–18:00.
Programări: 0251 960
30 de minute, evaluare clinică, plan personalizat.
I have created a dedicated brochure for patients preparing for hip replacement surgery. It contains everything you need — from hip anatomy to recovery exercises.
📄 Download brochure: Patient's Guide to Hip Replacement Surgery (PDF)The brochure supplements the information on this page with all the practical details you need. During the consultation, we will personalize the plan according to your situation.
Felson DT et al. — Weight loss reduces the risk of symptomatic knee osteoarthritis in women. Ann Intern Med. 1992;116(7):535-9.
For the rule 'losing 5 kg can reduce knee pain by 20-30%'.
Messier SP et al. — Effects of intensive diet and exercise on knee joint loads in adults with knee osteoarthritis. JAMA. 2013;310(11):1226-1235.
For the rule '1 kg of body weight = approximately 4 kg of pressure per knee with each step'.
Bourne RB et al. — Patient satisfaction after total knee arthroplasty: who is satisfied and who is not? Clin Orthop Relat Res. 2010;468(1):57-63.
For the >90% satisfaction rate after knee replacement.
Swedish Hip Arthroplasty Register — Annual Report 2022.
For the long-term success rate of hip replacement.
Allen KD, Golightly YM — Epidemiology of osteoarthritis: state of the evidence. Curr Opin Rheumatol. 2015;27(3):276-83.
For the prevalence of knee osteoarthritis and risk factors (3-4 times more common in women).