Hip Arthroplasty

Aetna covers FDA‑approved total hip arthroplasty (metal‑on‑metal, metal‑on‑plastic, ceramic‑on‑plastic, or ceramic‑on‑ceramic) for adults with advanced hip joint disease—pain and functional disability limiting ADLs from OA/RA/avascular necrosis/post‑traumatic arthritis, limited ROM/antalgic gait with pain on exam, radiographic AVN stage III collapse or Tonnis grade 2–3 disease—and requires documented failure of conservative therapy (12 or 24 weeks depending on age/BMI) with at least half of therapy being formal in‑person physical therapy in the past year. THA is excluded (not medically necessary) for active joint infection or systemic bacteremia, active skin infection or open wound at the surgical site (except recurrent cutaneous staph), allergy to implant components (e.g., cobalt, chromium, alumina), paraplegia/quadriplegia, or permanent irreversible muscle weakness preventing ambulation.

"Progressive or substantial periprosthetic bone loss confirmed by imaging;"