Do I Need a Hip Replacement? Signs It Is Time

What decides whether I need a hip replacement?

The deciding factor is how much the hip limits your life. The American Academy of Orthopaedic Surgeons states that recommendations for surgery are based on a patient's pain and disability, not age. Most people who have the operation are between 50 and 80, but it has been done successfully at nearly every age.

Hip replacement is an elective operation for most people with arthritis. That means you and your surgeon decide together when the benefits of surgery outweigh living with the hip as it is. No X-ray, number or deadline should make that choice for you.

What are the signs it may be time?

OrthoInfo and MedlinePlus describe a similar set of signs. The more of these that fit you, the more reasonable it is to talk about surgery.

• Hip pain limits everyday activities such as walking, bending, bathing, shopping or household chores.
• Pain continues while resting, during the day or at night, or keeps you from sleeping through the night.
• Stiffness limits your ability to move or lift the leg, such as getting into a car or putting on socks.
• You need a cane or walker to get around because of the hip.
• Physical therapy, activity changes, medicine and injections no longer give enough relief.
• You are giving up things that matter to you, such as travel, golf or time on the floor with grandkids.

Does bone on bone mean I need surgery right away?

Not necessarily. Bone on bone describes an X-ray where the cartilage space has worn away. It confirms advanced arthritis, yet people with similar X-rays can feel very different. Research on hip and spine pain has found that X-ray signs of hip arthritis, even severe ones, do not consistently match how much the hip hurts.

Some people with a dramatic X-ray walk comfortably and choose to wait. Others with moderate changes have constant pain and decide surgery is worth it. Both can be right. The X-ray tells us the condition of the joint, and your symptoms tell us whether it is time.

The reverse also happens. Some people have real hip joint pain while their X-ray shows only mild changes, and in those cases an MRI or a diagnostic injection can help explain the gap. The safest way to make this decision is to treat the person, using the images as one piece of the evidence.

What should I try before a hip replacement?

Most people benefit from a fair trial of non-surgical care, and many get years of comfortable use from it. OrthoInfo lists switching to lower-impact activity, weight loss, targeted exercise, walking aids, pain relievers and cortisone injections as the first steps for hip arthritis.

Injections deserve a special note. MedlinePlus explains that a hip joint injection can relieve pain for weeks or months in some people, and it can also confirm that the joint is the true source of pain. That second role matters. MedlinePlus notes that if the shot does not relieve pain, the hip joint may not be the source, and that deserves a closer look before any surgery.

There are exceptions where waiting does not help. When arthritis is advanced, pain is constant and you have already tried these steps without success, more months of the same may only add to muscle loss and stiffness. A frank conversation about that point is part of a good evaluation.

Should I get a second opinion?

It is reasonable to get one, especially if you were told you need a new hip after a brief visit or a single X-ray. A second opinion should confirm that the pain is coming from the hip and not the lower back, a tendon or the knee. Back problems in particular can mimic hip pain and can still hurt after a hip is replaced.

It should also review whether a less invasive option fits, and explain the choices if surgery is the right answer, such as the surgical approach, outpatient versus hospital stay, and whether hip resurfacing or a hip-preserving procedure makes sense for a younger, active patient.

Our Saturday Hip Pain Clinic welcomes second opinions. Bring your X-rays and MRI, a list of what you have tried, and your questions.

What does a hip replacement involve?

In a total hip replacement, the worn ball and socket are replaced with metal, ceramic and plastic parts. OrthoInfo describes the operation as usually taking 1 to 2 hours, with some patients admitted overnight and others going home the same day.

Risks are real but uncommon. According to OrthoInfo, serious complications such as joint infection occur in less than 2 percent of patients, and blood clots, dislocation and implant wear are discussed before surgery. OrthoInfo notes most people can resume normal light daily activities within 3 to 6 weeks, and improvement continues for months after that.

How do I decide when the time is right?

Ask yourself a few honest questions. Is the hip keeping you from activities you value? Are you sleeping poorly because of it? Have you given non-surgical care a fair try? Are you healthy enough for surgery, or are there steps such as weight loss or blood sugar control to work on first?

It also helps to picture the next year. If the hip stays the way it is now, what will you give up? If surgery goes well, what would you get back? Writing down two or three specific goals, such as walking a round of golf, traveling without dreading the airport or sleeping through the night, makes the conversation with your surgeon far more useful.

If the answers lean toward yes, it is a good time to sit down with a hip specialist. If they lean toward no, you can keep managing the hip and revisit the question later. Our team is glad to help with either path, and new patients are usually seen within the week.

Questions patients ask