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decision pointShould I have hip replacement surgery?

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 things 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 medicine, 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 medicine 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
  • 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 medicine, 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.2 One large study suggests that hip resurfacing results are good. But the risk of needing the surgery redone are a little higher than with a standard hip replacement.3

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 (rehab) after surgery will take at least 6 months.

After rehab, 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 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.
  • Medicines and other treatments no longer relieve your pain.
  • You want to resume activities such as golfing, riding a bike, walking, swimming, or 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.
    • Medicines, such as acetaminophen.
    • Use of a cane or crutches.
  • Rehab 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.

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. Medicines 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 rehab 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

         

Citations

  1. Lozada CJ (2009). Management of osteoarthritis. In GS Firestein et al., eds., Kelley's Textbook of Rheumatology, 8th ed., vol. 2, pp. 1563–1577. Philadelphia: Saunders Elsevier.

  2. 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.

  3. Sibanda N, et al. (2008). Revision rates after primary hip and knee replacement in England between 2003 and 2006. Public Library of Science Medicine, 5(9): 1398–1408.

Author Shannon Erstad, MBA/MPH
Editor Kathleen M. Ariss, MS
Associate Editor Pat Truman, MATC
Primary Medical Reviewer Anne C. Poinier, MD - Internal Medicine
Specialist Medical Reviewer Richa Dhawan, MD - Rheumatology
Last Updated April 17, 2009

WebMD Medical Reference from Healthwise

Last Updated: April 17, 2009
This information is not intended to replace the advice of a doctor. Healthwise disclaims any liability for the decisions you make based on this information.

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