More than 327,000 people have total hip replacement surgery in the United States each year,1,2 and the vast majority of those surgeries are done to relieve arthritis pain and increase hip function. During hip replacement surgery, the surgeon resurfaces the bones that form the ball-and-socket of the hip joint:

  • The femoral head is removed and replaced with a prosthetic ball. This ball is connected to a stem that is inserted into the marrow space of the upper thigh bone (femur).
  • The rounded socket of the pelvis is resurfaced and lined with a prosthetic cup.

When complete, the prosthetic femoral ball fits into the prosthetic hip socket to form a new hip joint.

Total hip replacement surgery, sometimes called total hip arthroplasty, is considered one of the most reliable surgeries ever developed. As many as 96% of patients who have had elective total hip replacement surgery say they would make the same choice again.3

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Total hip replacement is a major surgery. Recovery often requires several months of physical therapy. Many, but not all, surgeons recommend that their patients limit or avoid high-impact activities, such as running or jumping, which might damage or dislocate a new hip. For these reasons, a concerted effort to exhaust all non-surgical treatments, such as medication and joint-strengthening physical therapy, is recommended before considering total hip replacement surgery.

The Lifespan of a Total Hip Replacement

According to the American Academy of Orthopaedic Surgeons, hip replacements have an 80% chance of lasting at least 20 years.4 Patients can extend the life of their hip replacements by sticking to their physical therapy routines and avoiding high-impact activities.

Revision Total Hip Replacement

If the initial prostheses becomes loose, breaks, wears out, or repeatedly dislocates, then a second surgery called a revision total hip replacement is often recommended. Revision surgery is more technically challenging than an initial hip replacement, and patients are more prone to medical and/or surgical complications. A 2012 study5 of 1.7 million Medicare beneficiaries (65 years and up) shows complication rates are more than 3 times higher for revision hip replacement surgery compared to initial hip replacement surgery.

This difference may be in part because revision surgery patients are older and therefore more likely to have other conditions, such has heart disease and Type II diabetes, that put them at greater risk for a medical complication during or following the surgery (e.g. a heart attack, blood clot, or kidney damage). However, surgical complications, such as infection, nerve damage, and dislocation are also higher following revision surgery, due to progressive bone loss, scar tissue, and compromised muscle function and quality.

Deciding When to Have Total Hip Replacement

Some people with moderate to severe hip arthritis will postpone an initial hip replacement surgery for many years in hopes of avoiding an eventual revision surgery. This is a valid concern, however, there is evidence6 that post-surgery expectations are most likely to be met in hip replacement patients who—

  • are younger
  • have a lower body mass index (BMI of 35 or less)/ are not obese or significantly overweight
  • have better hip function and fewer symptoms before surgery
  • are employed

These factors indicate that patients may benefit from scheduling hip replacement surgery before hip arthritis pain becomes disabling and forces dramatic changes in daily routines.

People of all ages can benefit from hip replacement surgery. A patient should talk to his or her doctor about the best time to schedule hip replacement surgery.

References:

  1. Centers for Disease Control and Prevention. FastStats: Impatient Surgery. Accessed September 4, 2012. Page last updated May 16, 2012. http://www.cdc.gov
  2. Kim S. Changes in surgical loads and economic burden of hip and knee replacements in the US: 1997-2004. Arthritis Rheum. 2008 Apr 15;59(4):481-8. PubMed PMID: 18383407.
  3. See Full References
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