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Arthritis: Should I Have Hip Replacement Surgery?
You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.
Arthritis: Should I Have Hip Replacement Surgery?
Get the facts
Your options
- Have hip replacement surgery.
- Don't have your hip replaced. Continue to manage your joint pain and other symptoms with other treatments.
Key points to remember
- Most people can manage osteoarthritis pain with medicine, exercise, physical therapy, and weight loss (if they are overweight). If these treatments do not help your pain, you may try joint injections, arthroscopic surgery, or osteotomy. If these things don't work, then surgery to replace the hip is an option.
- Most people have hip replacement only when they can no longer control pain with medicine and other treatments and when the pain prevents them from doing daily activities.
- People who have had hip replacement usually:1
- Have much less pain than before surgery.
- Are able to return to their daily activities.
- Have a better quality of life.
- Most artificial hip joints will last for 10 to 20 years or longer without loosening. But this can depend 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 disease that affects the cartilage in joints. The cartilage breaks down until the bones, which were once kept apart by cartilage, rub against each other. This causes damage to tissue and bone. The symptoms of osteoarthritis include joint pain, stiffness after sitting or lying down, and not being able to move freely.
What surgeries are used 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 lost a large amount of cartilage. Surgery relieves severe pain and may improve how well the joint works and moves.
Types of surgery include:
- Arthroscopy. This can provide short-term (and sometimes long-term) pain relief. Arthroscopy can also fix a joint if it becomes "locked" or stuck because of loose cartilage or bone fragments.
- Osteotomy. Doctors use osteotomy to prevent severe hip arthritis in active people younger than 60.
- Hip replacement surgery. This is done when there is pain and disability along with damage of the hip that can be seen on X-rays.
- Arthrodesis. This surgery joins two bones in a diseased joint so that the joint can no longer move. It is rarely used.
- Hip resurfacing surgery. This is used mainly for younger, more active people who have pain and disability from hip problems. It's not known how well this works long-term. And the risk of needing the surgery redone are a little higher than with a standard hip replacement.2 But the results are positive for up to about 8 years in people who have had the surgery.3
What happens in hip replacement surgery?
Hip replacement surgery replaces the upper end of the thighbone (femur) with a metal ball, and it resurfaces the hip socket in the pelvic bone with a metal shell and liner made of ceramic, plastic, or metal. Doctors can use cement to attach replacement joints to the bone.
What should you expect after surgery?
Most people get out of bed with help on the day after surgery. You will start physical therapy right away. You will do special exercises and may need crutches for several weeks. Total rehabilitation after surgery can take at least 6 months.
After you have recovered, you will probably be able to do your daily activities more easily and with less pain. You may find it easier to climb stairs, walk without getting tired, play golf, and do other activities that you did before surgery.
Why might your doctor recommend hip replacement?
Your doctor might recommend hip replacement if:
- You have very bad pain, and other treatments have not helped.
- You have lost a large amount of cartilage.
Compare your options
Compare
What is usually involved? |
| |
What are the benefits? |
| |
What are the risks and side effects? |
|
- You will have local or general anesthesia. You may be able to get out of bed with help on the day after surgery. Most people go home within a few days to a week.
- You will start physical therapy right away and may continue for 6 months or more. You may need to use a walker or crutches for several weeks.
- You will likely have less pain, be able to do your daily activities, and have a better quality of life.1
- You may need another replacement in 10 to 20 years.
- All surgery has risks, such as bleeding, infection, and risks from anesthesia. Other risks of hip replacement surgery include blood clots and problems with wound healing.
- Your age and your health can also affect your risk.
- You try medicines, steroid shots, home treatment, or other methods to relieve pain.
- You can decide to have the surgery later if the pain gets worse and medicines don't help.
- You avoid the cost and risks of surgery.
- You avoid 6 months of physical therapy and rehabilitation.
- Medicines can cause side effects such as upset stomach, stomach bleeding, heartburn, and skin rashes.
- You may not be able to relieve your pain enough with medicines or home treatment to do your daily activities.
Personal stories
Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.
Personal stories about hip replacement surgery for osteoarthritis
These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.
I've always been active and always on my feet. I worked on the farm and also worked nights at the local hospital for over 30 years. The pain in my hips has gotten so bad that it's really hard for me to work, take care of my vegetable garden, or go for walks with my grandkids. I've seen people in the hospital with hip replacements, and I know what to expect. It's not going to be easy, but I'm determined to get back to doing the things I enjoy-with less pain.
Carrie, age 66
I never pictured myself as the type who would use a cane to get around. But it helps a lot to take the strain off my bad hip. I know that surgery to replace the hip is an option, but I take care of my invalid sister at home, and there wouldn't be anyone to take care of her while I was in the hospital and recovering. And I don't want to spend any time in a rehabilitation centre. So I'll manage with my cane and my pain relievers as long as I can.
Elliot, age 73
I don't remember when I had a good night's sleep. My hip hurts when I walk, sit, or lie down. My doctor and I have talked about replacing my hip, and I know I may have to face that one day. I want that to be my last resort, though, because I know that an artificial hip will wear out in 10 or 20 years and I'd just need another surgery. For now, my doctor and I are going to try some other things. I'm going to lay off golf for a while, and I'm going to try non-steroidal anti-inflammatory medicines.
Gardner, age 54
I thought I had fixed the dysplasia problems in my hip when I had an osteotomy some 10 years ago, but my osteoarthritis seems to be getting worse in that hip all the time. I have decided to go ahead with hip replacement surgery. My husband and I have been planning a walking trip in Ireland for years, and I'm going to get the surgery and rehabilitation done so that I can walk through that beautiful country without so much pain.
Carma, age 68
What matters most to you?
Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.
Reasons to have hip replacement surgery
Reasons not to have hip replacement surgery
I'm in too much pain to do my daily activities.
I'm able to manage my pain and do my daily activities.
I think I can complete a long rehabilitation program.
I don't think I can go through a long rehabilitation.
If I need another hip replacement in 10 to 20 years, I'll be glad to get it.
I'm worried about needing another hip replacement later.
I'll do whatever it takes to feel better, including surgery.
I don't want to have surgery for any reason.
My other important reasons:
My other important reasons:
Where are you leaning now?
Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.
Having surgery
NOT having surgery
What else do you need to make your decision?
Check the facts
Is hip replacement the only option for treating osteoarthritis?
- YesSorry, that's not right. Most people with hip pain can try other treatments like medicine and physical therapy before having hip replacement.
- NoYou're right. Most people with hip pain can try other treatments like medicine and physical therapy before having hip replacement.
- I'm not sureIt may help to go back and read "Key points to remember." Most people with hip pain can try other treatments like medicine and physical therapy before having hip replacement.
After surgery, will you be able to resume your daily activities?
- YesYou're right. People who have had hip replacement usually have much less pain than before surgery, are able to return to their daily activities, and have a better quality of life.
- NoSorry, that's not right. People who have had hip replacement usually have much less pain than before surgery, are able to return to their daily activities, and have a better quality of life.
- I'm not sureIt may help to go back and read "What should you expect after surgery?" People who have had hip replacement usually have less pain than before, are able to return to their daily activities, and have a better quality of life.
Do your age, health, and activity level matter when it comes to deciding about hip replacement surgery?
- YesYou're right. You and your doctor will decide about surgery based on your age, health, activity level, and how much pain and disability you have.
- NoSorry, that's not right. You and your doctor will decide about surgery based on your age, health, activity level, and how much pain and disability you have.
- I'm not sureIt may help to go back and read "Key points to remember." You and your doctor will decide about surgery based on your age, health, activity level, and how much pain and disability you have.
Decide what's next
Do you understand the options available to you?
Are you clear about which benefits and side effects matter most to you?
Do you have enough support and advice from others to make a choice?
Certainty
How sure do you feel right now about your decision?
Check what you need to do before you make this decision.
Use the following space to list questions, concerns, and next steps.
Your Summary
Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
Your decision
Next steps
Which way you're leaning
How sure you are
Your comments
Your knowledge of the facts
Key concepts that you understood
Key concepts that may need review
Getting ready to act
Patient choices
Credits and References
| Credits | Healthwise Staff |
|---|---|
| Primary Medical Reviewer | Anne C. Poinier, MD - Internal Medicine |
| Specialist Medical Reviewer | Stanford M. Shoor, MD - Rheumatology |
- 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.
- 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.
- 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.
Arthritis: Should I Have Hip Replacement Surgery?
- Get the facts
- Compare your options
- What matters most to you?
- Where are you leaning now?
- What else do you need to make your decision?
1. Get the facts
Your options
- Have hip replacement surgery.
- Don't have your hip replaced. Continue to manage your joint pain and other symptoms with other treatments.
Key points to remember
- Most people can manage osteoarthritis pain with medicine, exercise, physical therapy, and weight loss (if they are overweight). If these treatments do not help your pain, you may try joint injections, arthroscopic surgery, or osteotomy. If these things don't work, then surgery to replace the hip is an option.
- Most people have hip replacement only when they can no longer control pain with medicine and other treatments and when the pain prevents them from doing daily activities.
- People who have had hip replacement usually:1
- Have much less pain than before surgery.
- Are able to return to their daily activities.
- Have a better quality of life.
- Most artificial hip joints will last for 10 to 20 years or longer without loosening. But this can depend 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 disease that affects the cartilage in joints. The cartilage breaks down until the bones, which were once kept apart by cartilage, rub against each other. This causes damage to tissue and bone. The symptoms of osteoarthritis include joint pain, stiffness after sitting or lying down, and not being able to move freely.
What surgeries are used 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 lost a large amount of cartilage. Surgery relieves severe pain and may improve how well the joint works and moves.
Types of surgery include:
- Arthroscopy. This can provide short-term (and sometimes long-term) pain relief. Arthroscopy can also fix a joint if it becomes "locked" or stuck because of loose cartilage or bone fragments.
- Osteotomy. Doctors use osteotomy to prevent severe hip arthritis in active people younger than 60.
- Hip replacement surgery. This is done when there is pain and disability along with damage of the hip that can be seen on X-rays.
- Arthrodesis. This surgery joins two bones in a diseased joint so that the joint can no longer move. It is rarely used.
- Hip resurfacing surgery. This is used mainly for younger, more active people who have pain and disability from hip problems. It's not known how well this works long-term. And the risk of needing the surgery redone are a little higher than with a standard hip replacement.2 But the results are positive for up to about 8 years in people who have had the surgery.3
What happens in hip replacement surgery?
Hip replacement surgery replaces the upper end of the thighbone (femur) with a metal ball, and it resurfaces the hip socket in the pelvic bone with a metal shell and liner made of ceramic, plastic, or metal. Doctors can use cement to attach replacement joints to the bone.
What should you expect after surgery?
Most people get out of bed with help on the day after surgery. You will start physical therapy right away. You will do special exercises and may need crutches for several weeks. Total rehabilitation after surgery can take at least 6 months.
After you have recovered, you will probably be able to do your daily activities more easily and with less pain. You may find it easier to climb stairs, walk without getting tired, play golf, and do other activities that you did before surgery.
Why might your doctor recommend hip replacement?
Your doctor might recommend hip replacement if:
- You have very bad pain, and other treatments have not helped.
- You have lost a large amount of cartilage.
2. Compare your options
| Have hip replacement surgery | Don't have your hip replaced | |
|---|---|---|
| What is usually involved? |
|
|
| What are the benefits? |
|
|
| What are the risks and side effects? |
|
|
Personal stories
Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.
Personal stories about hip replacement surgery for osteoarthritis
These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.
"I've always been active and always on my feet. I worked on the farm and also worked nights at the local hospital for over 30 years. The pain in my hips has gotten so bad that it's really hard for me to work, take care of my vegetable garden, or go for walks with my grandkids. I've seen people in the hospital with hip replacements, and I know what to expect. It's not going to be easy, but I'm determined to get back to doing the things I enjoy-with less pain."
— Carrie, age 66
"I never pictured myself as the type who would use a cane to get around. But it helps a lot to take the strain off my bad hip. I know that surgery to replace the hip is an option, but I take care of my invalid sister at home, and there wouldn't be anyone to take care of her while I was in the hospital and recovering. And I don't want to spend any time in a rehabilitation centre. So I'll manage with my cane and my pain relievers as long as I can."
— Elliot, age 73
"I don't remember when I had a good night's sleep. My hip hurts when I walk, sit, or lie down. My doctor and I have talked about replacing my hip, and I know I may have to face that one day. I want that to be my last resort, though, because I know that an artificial hip will wear out in 10 or 20 years and I'd just need another surgery. For now, my doctor and I are going to try some other things. I'm going to lay off golf for a while, and I'm going to try non-steroidal anti-inflammatory medicines."
— Gardner, age 54
"I thought I had fixed the dysplasia problems in my hip when I had an osteotomy some 10 years ago, but my osteoarthritis seems to be getting worse in that hip all the time. I have decided to go ahead with hip replacement surgery. My husband and I have been planning a walking trip in Ireland for years, and I'm going to get the surgery and rehabilitation done so that I can walk through that beautiful country without so much pain."
— Carma, age 68
3. What matters most to you?
Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.
Reasons to have hip replacement surgery
Reasons not to have hip replacement surgery
I'm in too much pain to do my daily activities.
I'm able to manage my pain and do my daily activities.
I think I can complete a long rehabilitation program.
I don't think I can go through a long rehabilitation.
If I need another hip replacement in 10 to 20 years, I'll be glad to get it.
I'm worried about needing another hip replacement later.
I'll do whatever it takes to feel better, including surgery.
I don't want to have surgery for any reason.
My other important reasons:
My other important reasons:
4. Where are you leaning now?
Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.
Having surgery
NOT having surgery
5. What else do you need to make your decision?
Check the facts
1. Is hip replacement the only option for treating osteoarthritis?
- Yes
- No
- I'm not sure
2. After surgery, will you be able to resume your daily activities?
- Yes
- No
- I'm not sure
3. Do your age, health, and activity level matter when it comes to deciding about hip replacement surgery?
- Yes
- No
- I'm not sure
Decide what's next
1. Do you understand the options available to you?
2. Are you clear about which benefits and side effects matter most to you?
3. Do you have enough support and advice from others to make a choice?
Certainty
1. How sure do you feel right now about your decision?
2. Check what you need to do before you make this decision.
- I'm ready to take action.
- I want to discuss the options with others.
- I want to learn more about my options.
3. Use the following space to list questions, concerns, and next steps.
| By | Healthwise Staff |
|---|---|
| Primary Medical Reviewer | Anne C. Poinier, MD - Internal Medicine |
| Specialist Medical Reviewer | Stanford M. Shoor, MD - Rheumatology |
- 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.
- 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.
- 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.
Note: The "printer friendly" document will not contain all the information available in the online document some Information (e.g. cross-references to other topics, definitions or medical illustrations) is only available in the online version.
Last Revised: August 21, 2012
Author: Healthwise Staff
Medical Review: Anne C. Poinier, MD - Internal Medicine & Stanford M. Shoor, MD - Rheumatology
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