What to weigh before hip replacement

What to check before waiting longer

Waiting may make sense while you sleep well and manage your usual daily tasks. Exercise or a cane may still be helping you move, even when some soreness remains. The X-ray and the ache don’t always match. That matters.

Choose a time to review the wait with your doctor, then notice whether walking, dressing, shopping, or getting into the car has become harder. If those tasks stay about the same, your present care may still be useful. You needn’t decide after one rough afternoon.

When to discuss surgery

Surgery is worth discussing when the exam and X-ray both show a badly worn joint. Growing rest soreness, lost sleep, or trouble dressing adds another reason. Your doctor also needs enough time to judge the exercise, medicine, or cane you tried. Then you can hear what a surgeon thinks.

Meeting a surgeon doesn’t commit you to an operation, and you can ask about likely relief, the risks, help you’ll need during recovery, and how long the new joint may last. The surgeon can explain whether waiting could cost you more sleep, movement, or independence. Money is a separate question, and it belongs in the talk too.

What to bring to the surgery visit

Bring a brief note about what the hip still allows and what has become harder. Include how long you used each exercise or medicine, along with any recent hip procedure. The surgeon needs those facts.

You may wish to ask which trouble the operation would address and what daily tasks may become easier. Ask what recovery requires at home. Your medicines, stairs, available help, and travel for later visits matter as well. It’s easier to choose when the answers are clear.

Sources

1. Pooled analysis of national joint registries (Australia and Finland, 215,676 hip replacements) put 25-year all-cause construct survival at 57.9% (95% CI 57.1-58.7); pooled case series gave 77.6% (95% CI 76.0-79.2). The authors conclude patients and surgeons can expect a hip replacement to last 25 years in around 58% of patients.

   Evans JT, et al. — How long does a hip replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up.. The Lancet, 2019. DOI: 10.1016/S0140-6736(18)31665-9.

2. A population-based analysis of 63,158 total hip replacements found 10-year implant survival of 95.6% and 20-year survival of 85.0%, but the LIFETIME risk of revision rose sharply with younger age at surgery - about 5% for those operated after 70, up to 35% (95% CI 30.9-39.1) for men in their early 50s, with a median time to revision of 4.4 years in those operated before 60.

   Bayliss LE, et al. — The effect of patient age at intervention on risk of implant revision after total replacement of the hip or knee: a population-based cohort study.. The Lancet, 2017. DOI: 10.1016/S0140-6736(17)30059-4.

3. A Lancet review characterises total hip replacement as one of the most effective operations in medicine - 'the operation of the century' - while noting that short-term objectives such as accelerated discharge must not compromise long-term implant performance, and that younger, more active patients now present with higher functional expectations.

   Learmonth ID, Young C, Rorabeck C — The operation of the century: total hip replacement.. The Lancet, 2007. DOI: 10.1016/S0140-6736(07)60457-7.

4. In a cohort of 2953 hips followed 11-28 years, radiographic hip OA raised the hazard of total hip replacement 13-fold (HR 13.2, 95% CI 8.1-21) - but more than four in five hips with radiographic hip OA had still NOT had a replacement 11-28 years later.

   Franklin J, et al. — Natural history of radiographic hip osteoarthritis: A retrospective cohort study with 11-28 years of followup.. Arthritis Care & Research, 2011. DOI: 10.1002/acr.20412.

5. UK FASHIoN, a 348-patient pragmatic multicentre RCT, found hip arthroscopy improved hip-related quality of life more than a personalised physiotherapist-led programme at 12 months (adjusted mean iHOT-33 difference 6.8, 95% CI 1.7-12.0; p=0.0093), just exceeding the 6.1-point minimum clinically important difference. Both groups improved substantially, and five of six serious adverse events in the surgical arm were treatment-related.

   Griffin DR, et al. — Hip arthroscopy versus best conservative care for the treatment of femoroacetabular impingement syndrome (UK FASHIoN): a multicentre randomised controlled trial.. The Lancet, 2018. DOI: 10.1016/S0140-6736(18)31202-9.

6. In a single-surgeon RCT of 90 patients OVER 40 with MRI-confirmed symptomatic labral tears and limited radiographic OA (Tonnis 0-2), arthroscopic labral repair plus physical therapy beat physical therapy alone at 12 months (iHOT-33 +12.11, P=.007; mHHS +6.99, P=.04). 63.6% of the physical-therapy-alone group crossed over to surgery, which both supports the result and limits it.

   Martin SD, et al. — Hip Arthroscopy Versus Physical Therapy for the Treatment of Symptomatic Acetabular Labral Tears in Patients Older Than 40 Years: A Randomized Controlled Trial.. American Journal of Sports Medicine, 2021. DOI: 10.1177/0363546521990789.

7. A meta-analysis of 28 studies covering 480,532 patients found a significant association between pre-operative intra-articular corticosteroid injection and periprosthetic joint infection after TOTAL HIP arthroplasty (OR 1.55, P=.001), with higher risk when the injection was given within 3 months of surgery (OR 1.20, P=.045). No such association was found for knee arthroplasty. Timing of a hip injection matters if replacement may follow.

   Albanese J, et al. — Infection Risk Increases After Total Hip Arthroplasty Within 3 Months Following Intra-Articular Corticosteroid Injection. A Meta-Analysis on Knee and Hip Arthroplasty.. Journal of Arthroplasty, 2023. DOI: 10.1016/j.arth.2022.12.038.