Should You Have Hip Replacement Surgery? What You Need to Know to Make This Important Decision

Key points in making your decision
You may be considering hip replacement surgery if osteoarthritis causes severe hip pain and loss of function. The decision you and your doctor make depends on variables such as your age, health, and activity level, and the degree of pain and disability you are experiencing. Consider the following when making your decision.

• You can usually manage osteoarthritis pain with medication, exercise, physical therapy, and weight loss (if you are overweight). If these treatments do not relieve pain, other options include joint injections, arthroscopic surgery, and osteotomy. In the most severe cases, surgery to replace the joint is an option.
• Most people have joint replacement only when they can no longer control the pain in their hip with medication and other treatments and the pain is significantly interfering with their life.
• People who have had hip replacement surgery usually have much less pain than before the surgery, are able to resume daily activities, and have improved quality of life. A review of studies of people who have had their hips replaced reported that more than 70% have good to excellent function and relief of pain, extending at least 10 years after surgery.
• Most artificial hip joints will last for 10 to 20 years or longer without loosening, depending on how much stress you put on the joint, how much you weigh, and how well your new joint and bones mend.

What is osteoarthritis?
Osteoarthritis is a progressive condition of the cartilage in joints. The cartilage breaks down until the bones, which were once separated by cartilage, rub against each other, resulting in damage to the tissue and underlying bone. The symptoms of osteoarthritis include joint pain, stiffness after inactivity, and limited motion.

What surgeries may be considered to treat osteoarthritis?
Surgery is an option for people with severe osteoarthritis who do not get pain relief from medication, home treatment, or other methods and who have significant loss of cartilage. Surgery relieves severe, disabling pain and may restore joint function and mobility. Surgical choices include:

• Arthroscopy, which can provide temporary (and sometimes long-term) relief of symptoms of osteoarthritis. Arthroscopy can also fix a joint if it becomes “locked” or stuck due to loose cartilage or bone fragments.
• Osteotomy, used in cases of developmental hip deformity and in other cases of abnormality of the legs in active people younger than 60. Doctors use osteotomy to prevent development of severe hip arthritis.
• Hip replacement surgery, considered in cases of pain coupled with disability and deterioration of the hip that is visible on X-rays.
• Arthrodesis, surgery that joins (fuses) two bones in a diseased joint so that the joint can no longer move. It is rarely used in the hips because of eventual knee and back pain.
• Hip resurfacing surgery, which doctors use primarily for younger, more active people with pain and disability due to hip deterioration. No long-term results are available yet, but short-term results are positive up to about 8 years after surgery.

What happens in hip replacement surgery?
Total hip replacement surgery replaces the upper end of the thighbone (femur) with a metal ball and resurfaces the hip socket in the pelvic bone with a metal shell and plastic liner. Doctors can use cement to attach replacement joints to the bones.

What should I expect after hip replacement surgery?
Most people get out of bed with help on the day after surgery. You will immediately start physical therapy, which will require weeks of special exercises, and you may need crutches or a walker during this time. Total rehabilitation after surgery will take at least 6 months.

After rehabilitation, you will probably be able to do your daily activities more easily because the joint moves better and you will have less pain. It probably will be easier to climb stairs, walk without tiring, play golf, and resume other activities that you did before surgery.

Your information
Your choices are:

• Have hip replacement surgery.
• Continue to manage your joint pain and other symptoms with nonsurgical treatments, such as exercise, pain relievers, or joint injections, or, if appropriate, another type of surgery, such as arthroscopy.

The decision about whether to have hip replacement surgery takes into account your personal feelings and the medical facts.

For more information, including a chart on the pros and cons of having hip replacement surgery and a checklist to help you make your decision, visit our A-Z Health Library.