Dr. Anthony Komaroff, Harvard Medical School | In Association with Harvard Health Publications
DEAR DOCTOR K:
I’m 58 and have a bad hip. Should I get a hip replacement now or wait until it’s absolutely necessary?
Many patients have asked me the same question over the years. I answer it somewhat differently today than I did 20 years ago, for two reasons. First, the technology of hip replacement has improved considerably. Second, 10 years ago I faced the same question myself: My right hip had been seriously damaged by arthritis and I was in pain. After putting it off for two years, I had the surgery. That changed my perspective.
Hip replacement is a surgical procedure in which damaged hip bone and cartilage are removed and replaced with artificial components. (See image below.) Hip replacement can greatly improve the function of your hip and substantially relieve pain.
But timing the surgery can be tricky. Artificial joints have a limited life span. With normal activity, most last 15 to 20 years. That’s why people under 60 are encouraged to delay the procedure if possible. The younger you are when you have a hip replacement, the more likely you will eventually need revision surgery to replace the implant.
On the other hand, it is possible to wait too long. Waiting until joint problems have severely limited your function may lessen pain relief and functional improvements from a hip replacement.
So when is it time for a joint replacement? First of all, X-rays should show advanced arthritis or other hip joint damage: Not all hip pain is caused by damage to the hip joint. Your age also is an important factor. But most important is the extent of your disability. I’d advise you to consider hip replacement if one or more of the following is true:
- You are unable to complete normal daily tasks without help.
- You have significant pain daily.
- Pain keeps you from walking or bending over.
- Pain doesn’t stop when you rest and keeps you awake at night.
- Non-surgical treatments, such as medicines and physical therapy, have not given you enough relief.
- Your doctor says less complicated surgical procedures are unlikely to help.
- You have trouble lifting your leg.
- You suffer severe side effects from the medications for your joint symptoms.
The bottom line: Taking into account the condition of your joints, your age and your overall health, you and your doctor need to strike a balance. Operate too soon, and you’ll increase your chance of revision surgery; wait too long, and you’ll subject yourself to additional months and years of pain.
In my case, I had been experiencing some hip pain for five years and quite bad pain for two years. Surgery immediately relieved the pain. Like most of my patients who have had hip replacements, I concluded I had waited too long.
Total hip replacement surgery
When rough and damaged cartilage prevents the bones of the hip from moving smoothly, an orthopedic surgeon can install an artificial joint with two parts. The head of the femur is replaced with an artificial ball with a long stem that fits down inside the femur bone. An artificial cup, called the acetabular cup, fits inside the hip socket. Cement may be applied depending on which type of artificial joint is used. The two pieces fit smoothly together to restore comfortable ball-in-socket movement.