Not everyone with hip arthritis is a candidate for total hip replacement surgery. Below are lists of indications and contraindications for this surgery.

Indications for Total Hip Replacement Surgery

Patients eligible for this surgery have moderate to severe arthritis in the hip, including osteoarthritis, rheumatoid arthritis or post-traumatic arthritis, that causes pain and/or interferes with daily living. For example:

  • Walking, going up stairs, and bending to get in and out of chairs is difficult
  • Pain is moderate to severe even while resting, and may affect sleep
  • Joint degeneration has caused stiffness that affects the patient’s range of motion during normal activities; the patient may also have a limp
  • Symptoms are not adequately alleviated by non-surgical treatments, such as non-steroidal anti-inflammatory drugs (NSAIDs), physical therapy, steroid injections, or the use of a cane or walker
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About 90% of patients who undergo hip replacement have hip osteoarthritis.7 In addition to arthritis, some patients have hip replacement surgery to correct problems related to fractures (i.e. a "broken hip") or other medical conditions, such as osteonecrosis (bone death caused by inadequate blood supply).

Contraindications for Total Hip Replacement Surgery

Careful patient selection improves the odds of a successful surgery and lowers the risk of post-surgical complications.

Some people are ineligible for hip replacement surgery and others may be cautioned because they have a greater than average risk of post-surgical complications. Reasons for this include:

  • Infection. An existing infection is an absolute contraindication, and patients who are prone to infection may not be eligible for this surgery. Serious cases of post-surgical infection can cause a patient to be readmitted to the hospital, require prolonged courses of intravenous antibiotics, and in some cases require the removal of the artificial hip.
  • Nicotine. Smokers and other tobacco users face a higher rate of medical complications and a higher risk of needing follow-up surgery or revision hip replacement surgery. For example, a survey of more 500 people who underwent total knee replacement surgery found that smokers were about 10 times more likely to have had a revision surgery.8 To lower post-surgical risks, candidates for total hip replacement are encouraged to quit or cut back on tobacco use.
  • Osteoporosis. Severe osteoporosis can be a contraindication for surgery because bones may be too brittle to properly support and adhere to the new joint prostheses. Mild to moderate osteoporosis is not a contraindication for hip replacement surgery; however, it may affect how a surgeon plans for surgery. A surgeon may choose to use bone cement rather than a cementless adhesion to attach the new prostheses to the existing bone. A surgeon may want to take steps to improve bone density before hip replacement surgery. This treatment may continue after surgery to enhance the lifespan of the hip replacement.
  • Other factors. Patients may be ineligible for surgery if they are unable to follow through with pre- and post-surgical instructions. For example, people who suffer from dementia or alcoholism are more prone to dangerous falls and may not be able to reliably comply with the recommendations of their surgeons. Both of these factors may compromise the success of the procedure in the event that the implant does not adhere to bone, the bones around the implants break, or a dislocation occurs.

Age and Weight Requirements

People as young as 19 and as old as 90 can undergo hip replacement surgery (though younger patients must have reached their full adult size). While there is no upper age limit, patients who are older often have medical conditions such as Type II diabetes or heart disease that can increase the risk of post-operative medical complications.

There are no set weight limits regarding who can have hip replacement surgery; however, being overweight can decrease the lifespan of a joint implant. In addition, obese patients are more prone to medical complications, post-surgical infections, and wound healing complications. Though the infection risk for obese patients is still relatively low, overweight patients are encouraged to lose weight prior to surgery.

References:

  1. Pivec et al. Hip arthroplasty. Lancet. 2012 Sep 25. pii: S0140-6736(12)60607-2. doi: 10.1016/S0140-6736(12)60607-2.
  2. Kapadia BH, Johnson AJ, Naziri Q, Mont MA, Delanois RE, Bonutti PM. Increased Revision Rates After Total Knee Arthroplasty in Patients Who Smoke. J Arthroplasty. 2012 May 23. [Epub ahead of print] PubMed PMID: 22633104.
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