Primary Total Hip Arthroplasty

Indications

• End stage hip arthritis failing non-operative care
• Displaced femoral neck fractures in active independent patients
• Avascular necrosis with collapse
• Displaced femoral neck fractures in active, independent patients

Position

• Lateral decubitus for posterior and lateral approaches
• Supine for the direct anterior approach
• Lateral decubitus for posterior and lateral approaches, supine for the direct anterior approach

Operative Steps

1. Template for cup size, stem size, offset and leg length
2. Posterior approach splitting gluteus maximus, releasing piriformis, short external rotators and capsule as a layer for repair
3. Neck cut at the templated level
4. Ream the acetabulum to the true floor
5. Cup at about 40 degrees inclination and 15 to 20 degrees anteversion (Lewinnek safe zone)
6. Broach the femur and trial
7. Check leg length, offset, combined anteversion and stability in flexion with internal rotation
8. Implant definitive components and repair capsule and rotators
9. Template preoperatively for size, offset and leg length

Postoperative Care

• Weight bear as tolerated
• VTE prophylaxis
• Hip precautions after a posterior approach
• Dislocation precautions depend on approach and surgeon preference
• Most patients walk with an aid on day 1

Complications

• Dislocation
• Leg length difference
• Periprosthetic fracture
• Infection
• Sciatic nerve palsy
• Aseptic loosening and wear
• Leg length discrepancy
• Aseptic loosening and wear in the long term

Related Pages

• Adult Hip Disorders
• Posterior Approach to Hip

Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.