Your loved one may need hip arthroplasty (replacement) if their hip causes great pain and limits their daily life. Examples may be if your loved one's hip is hurting so bad they can't sleep. It's hard for them to bathe, clean, make it to the mailbox, or shop at the grocery. If they have a damaging and deteriorating condition in their hip that has become debilitating and less invasive methods (medications, walking aids, physical therapy, etc.) are not successful, there's a good chance they need a hip replacement.
Symptoms of a bad hip
The following symptoms may indicate that hip arthroplasty (replacement) is needed and may be resolved by having a hip replacement (the list is not exhaustive).
Pain in the anterior (front) hip or groin
Pain that has not gotten better with other treatments (physical therapy, medications, walking aids)
Pain with activity, though also when at rest
Pain that gets worse when putting weight on the affected side, even with a cane or walker
Persistent pain, worsening pain, or new compounding pain, despite medication
Stiffness/tightness of the hip that limits the range of motion or mobility
Limits the ability to walk up or down stairs
Loss of motion, especially the ability to rotate the hip
Pain or loss of function limits or prohibits performing normal activities, such as bathing, preparing meals, doing household chores, and walking
Continuously disrupted sleep
Difficulty putting on shoes and socks
Difficulty rising from a seated position
Medical indications for hip arthroplasty (replacement)
Total hip arthroplasty (THA, or total hip replacement) is usually performed on adults after other therapies like weight loss, walking aids, medications, and physical therapy have failed to provide relief and restore function. A hip replacement may be needed because of:
Osteoarthritis - commonly known as wear-and-tear arthritis, osteoarthritis damages the slick cartilage that covers the ends of bones and helps joints move smoothly
Inflammatory arthritis (rheumatoid arthritis, psoriatic arthritis) - caused by an overactive immune system, inflammatory arthritis erodes cartilage and occasionally underlying bone, resulting in damaged and deformed joints
Injuries, like a hip fracture or dislocation from a fall
Degenerative disease
Developmental hip dysplasia
An injury that didn’t heal right
Osteonecrosis (avascular necrosis) - when there isn't enough blood supply to the ball portion of the hip joint, such as might result from a dislocation or fracture, the bone collapses and deforms
Tumor in the hip joint
Childhood (congenital) hip disorders
Because all surgeries have risks, and prostheses can fail as time goes by, the surgeon may recommend delaying a hip replacement until more severe symptoms are present.
Contraindications - Who shouldn't have hip surgery
Talk to your loved one's healthcare providers about issues that may disqualify them from having hip arthroplasty (replacement). Hip replacement surgery isn’t for everyone. Even if someone is in pain and can’t move their hip as well as expected, they aren’t automatically considered for a hip replacement. Your loved one might be ineligible if they have:
Severe medical problems such as end-stage heart, lung, liver, or kidney disease, anemia, recent heart attack, unstable angina, advanced osteoporosis, and others
An active infection
Irreversible or permanent muscle weakness, with or without nerve involvement
Paraplegia or quadriplegia
Severe morbid obesity (more than 100 pounds over ideal weight or BMI over 40)*
*This is determined solely by the orthopedic surgeon and may not be a contraindication to hip replacement surgery.
Making the decision
The decision to have total hip arthroplasty (replacement surgery) should be a cooperative one between you, your loved one, their primary care doctor, and the orthopedic surgeon. The primary care doctor will refer your loved one to an orthopedic surgeon for a thorough evaluation to determine if they might benefit from this surgery.
The orthopedic surgeon will review the results of the evaluation and discuss whether total hip replacement is the best method to relieve pain and improve function. Other treatment options — including medications, injections, physical therapy, walking aids, weight loss, or other types of surgery — may also be considered and discussed.
The orthopedic surgeon will explain the potential risks and complications of total hip replacement, including those related to the surgery itself and those that can occur over time after surgery.
Realistic expectations
An important factor in deciding whether to have total hip arthroplasty (replacement) is understanding what the procedure can and cannot do.
Most people who have total hip replacement surgery experience a dramatic reduction of hip pain and a significant improvement in the ability to perform daily activities. Often they can even go back to an active lifestyle and the recreational things they enjoy. But total hip replacement does not give someone the ability to do more than they could before developing arthritis. A hip replacement doesn't give the person a bionic hip with enhanced performance.
With normal use and activity, every hip replacement implant begins to wear in its plastic spacer. Chronic illness, excessive activity, or increased weight may accelerate wear and even cause the hip replacement to loosen and become painful. Therefore, most surgeons advise against high-impact activities such as running, jogging, jumping, or other high-impact sports (for the remainder of the person's life).
Realistic activities following total hip replacement include unlimited walking, swimming, golf, driving, light hiking, biking, ballroom-style dancing, and other low-impact sports and activities.
With appropriate activity modification, hip replacements can last for many years and restore quality of life.
