Should I have hip replacement surgery?

Introduction

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This information will help you understand your choices, whether you share in the decision-making process or rely on your doctor's recommendation.

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.¹ 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.²
• 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.

Medical Information

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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:^{1 3}

• 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.⁴

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.

If you need more information, see the topic Osteoarthritis.

Your Information

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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.

Deciding about hip replacement surgery

Reasons to have hip replacement surgery

Reasons not to have hip replacement surgery

Your hip pain and loss of function have become severe. Medications and other treatments no longer relieve your pain. You want to resume activities such as golfing, riding a bike, walking, swimming, and hiking. Are there other reasons you might want to have hip replacement surgery?

Nonsurgical management may relieve your symptoms. Nonsurgical options include: Weight loss. Activity modification. Education about osteoarthritis. Medications, such as acetaminophen. Use of a cane or crutches. Rehabilitation after hip replacement surgery takes 6 months of physical therapy and sometimes will require great changes in how you sit, walk, and conduct your daily activities. You have a medical condition that might mean you would not tolerate anesthesia and surgery well. You may need another replacement in 10 to 20 years because of loosening of the artificial hip joint, the most common problem that occurs with hip replacement surgery. Are there other reasons you might not want to have hip replacement surgery?

These personal stories may help you make your decision.

Wise Health Decision

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Use this worksheet to help you make your decision. After completing it, you should have a better idea of how you feel about hip replacement surgery. Discuss the worksheet with your doctor.

Circle the answer that best applies to you.

1. Medications are controlling my symptoms.	Yes	No	Unsure
2. My quality of life is poor with my current treatment.	Yes	No	Unsure
3. I am afraid the osteoarthritis in my hip will just continue to get worse if I don't have surgery.	Yes	No	Unsure
4. I have to severely limit my activities because of my hip(s).	Yes	No	Unsure
5. I have more bad days than good.	Yes	No	Unsure
6. I am anxious to be able to resume my regular activities.	Yes	No	Unsure
7. My general health is good.	Yes	No	Unsure
8. I think I have the energy to go through a lengthy rehabilitation procedure.	Yes	No	Unsure
9. I am worried about needing another replacement surgery in later years.	Yes	No	Unsure

Use the following space to list any other important concerns you have about this decision.

What is your overall impression?

Your answers in the above worksheet are meant to give you a general idea of where you stand on this decision. You may have one overriding reason to have or not have hip replacement surgery.

Check the box below that represents your overall impression about your decision.

Leaning toward having hip replacement surgery

Leaning toward NOT having hip replacement surgery

Return to the topic: .

• Osteoarthritis
• Paget's Disease of Bone

References

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Citations

1. Sledge CB (2005). Principles of reconstructive surgery for arthritis: The hip. In ED Harris Jr et al., eds., Kelley's Textbook of Rheumatology, 7th ed., vol. 2, pp. 1876–1888. Philadelphia: Elsevier Saunders.

2. Scott D, et al. (2004). Osteoarthritis. Clinical Evidence (11): 1560–1588.

3. Nelson CL, Stolarski EJ (2005). Correction of arthritic deformities of the hip. In WJ Koopman, LW Moreland, eds., Arthritis and Allied Conditions: A Textbook of Rheumatology, 15th ed., vol. 1, pp. 1049–1065. Phildelphia: Lippincott Williams and Wilkins.

4. Daniel J, et al. (2004). Metal-on-metal resurfacing of the hip in patients under the age of 55 years with osteoarthritis. Journal of Bone and Joint Surgery, 86-B(2): 177–183.

Credits

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Author	Robin Parks, MS
Editor	Kathleen M. Ariss, MS
Associate Editor	Pat Truman, MATC
Primary Medical Reviewer	E. Gregory Thompson, MD - Internal Medicine
Specialist Medical Reviewer	Stanford M. Shoor, MD - Rheumatology
Last Updated	April 20, 2007