Arthritis: Should I Have Hip Replacement Surgery?

Osteoarthritis is a problem that affects all parts of the joint. For example, when cartilage breaks down, the bones start to rub against each other. This rubbing damages your tissues and bones.

The symptoms of osteoarthritis include joint pain, stiffness after you sit or lie down, and not being able to move freely.

Arthritis may get worse over time. But it may stay the same or even get better.

Hip replacement surgery replaces damaged parts of your hip joint with new metal, ceramic, or plastic parts. It can help with severe pain. It may also improve how well the joint works and moves. This type of surgery is an option for people with severe osteoarthritis who have lost a lot of cartilage and do not get pain relief from other treatments.

Most artificial hip joints last for at least 15 years. And more than half last for 25 years or more. But this can depend on how much stress you put on the joint and how well your new joint and bones mend.

There are many treatments for osteoarthritis. But what works for someone else may not help you. Work with your doctor to find what is best for you. Often a mix of things helps the most.

Treatments other than surgery include:

• Medicines. If your pain is mild, over-the-counter pain medicines may help. These include acetaminophen (for example, Tylenol) and nonsteroidal anti-inflammatory drugs, such as ibuprofen (for example, Advil, Motrin) or naproxen (for example, Aleve). But if these don't help your pain, you may need a stronger prescription medicine.
• Exercise. It can help keep your muscles strong and your joints moving well.
• Ice or heat. Heat may help you loosen up your joints before an activity. Ice is a good pain reliever after activity or exercise.
• Physical therapy. This includes specific exercises that can help you stretch and strengthen your muscles and reduce pain and stiffness.
• Walking aids. A cane, crutches, or a walker can help take some of the stress off of your hip and make it easier to get around.
• Losing weight, if you're overweight. Losing weight helps take some of the stress off of your joints.
• Steroid shots. If you have inflammation, steroid shots can help reduce pain for a while. The relief usually lasts weeks to months.

Some other things that you may try include:

• Acupuncture. It involves putting very tiny needles into your skin at certain places on your body to try to relieve pain. Some people find that acupuncture helps. But there is not a lot of medical research to support the use of acupuncture for hip arthritis.
• Dietary supplements, such as glucosamine and chondroitin, fish oil, or SAM-e. Some people feel that these supplements help. But medical research does not prove that they work. Talk to your doctor before you take these supplements.

Most people get out of bed with help on the day of surgery. You will start physical therapy right away. You will do special exercises and may need crutches for several weeks. It usually takes people 2 to 3 months to get back to doing their usual activities. But it may take a little longer than that for some people. A full recovery may take 6 to 12 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, and do other activities that you did before surgery.

All surgery has risks, such as complications from anesthesia. And after any major surgery, there is always a small chance of a blood clot or a heart attack.

With total hip replacement, there is also a small risk of infection or hip dislocation. And some people, over time, may have other problems. These include the feeling that one leg is longer than the other, loosening of the parts of your new joint, or sensitivity to metal. If you are allergic to certain metals, tell your doctor.

Pain relief with surgery

• The evidence about hip replacement surgery suggests that most people are happy with the results.
• Take a group of 100 people who have the surgery. Six months after hip replacement, about 90 out of 100 people have less pain and can do more activities than they could before surgery.^{footnote 1}

Need for repeat surgery

• Most artificial hips last for many years. But they can wear out or have other problems. Some people have to repeat the surgery to have the joint replaced again.
• Take a group of 100 people who have the surgery. Within 15 years after the surgery, 10 out of 100 will need to have the hip replaced again. More than half of hip replacements last for 25 years or more.^{footnote 3}

Problems after surgery

The evidence suggests that, like most surgeries, hip replacement may have some risks.

Take a group of 100 people who have the surgery. About 4 out of 100 people have a serious complication like a joint infection, a blood clot, or a heart attack within 3 months after surgery.^{footnote 5} If you are older or have other health problems, your risk may be higher. ^{footnote 7footnote 6, footnote 2}

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.
• Your hip pain is keeping you from being active enough to keep up your strength, flexibility, balance, or endurance.
• You don't have health problems that would make it dangerous to have surgery.