Arthritis: Should I Have Hip Replacement Surgery?

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Arthritis: Should I Have Hip Replacement Surgery?

1

Get the
Facts

2

Compare
Options

3

Your
Feelings

4

Your
Decision

5

Quiz
Yourself

6

Your Summary

Get the facts

Your options

Have hip replacement surgery.
Don't have your hip replaced. Continue to manage your joint pain and other symptoms with other treatments.

This decision tool is for people considering hip replacement surgery. If you are considering other types of surgery for your arthritis, talk to your doctor.

Key points to remember

Most people can manage osteoarthritis pain with medicine, exercise, physiotherapy, and weight loss (if they are overweight). If these things don't work, then surgery to replace the hip is an option.
Arthritis may get worse over time. But it may stay the same or even get better.
Most people have hip replacement only when they can no longer control pain with medicine and other treatments and when the pain prevents them from doing daily activities.
People who have this surgery usually have much less pain than before. And they can usually return to activities they enjoy.
Most artificial hip joints last for about 15 years. But this can depend on how much stress you put on the joint and how well your new joint and bones mend.
If you wait so long to have a hip replacement that you have already lost much of your strength, endurance, and ability to be active, then after the surgery you might have a harder time returning to your normal activities.

FAQs

What is osteoarthritis?

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.

What is hip replacement surgery?

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 about 15 years. But this can depend on how much stress you put on the joint and how well your new joint and bones mend.

What treatments other than surgery are available?

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 non-steroidal 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.
Physiotherapy. 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.
Natural health products, 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.

What should you expect after surgery?

Most people get out of bed with help on the day of surgery. You will start physiotherapy 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.

What are the risks of total hip replacement 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.

What do numbers tell us about the benefits and risks of hip replacement?

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 2}

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 6} If you are older or have other health problems, your risk may be higher.^{footnote 5}^{footnote 4, footnote 7}

Why might your doctor recommend hip replacement?

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.

Compare your options

Compare


What is usually involved?
What are the benefits?
What are the risks and side effects?

Have hip replacement surgery Have hip replacement surgery

You will have spinal or general anesthesia. You may be able to get out of bed with help on the day of surgery or the next day. Most people will have a short hospital stay or go home the day of surgery.
You will need several weeks of physiotherapy, including exercises you can do at home.
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.

You will likely have less pain, be able to do your daily activities, and have a better quality of life.^{footnote 1}

You may need another replacement in about 15 years.
All surgery has risks, such as bleeding, infection, heart attack, and risks from anesthesia. Other risks of hip replacement surgery include blood clots and problems with wound healing.
Your age and your health can also affect your risk.

Don't have your hip replaced Don't have your hip replaced

You try medicines, steroid shots, home treatment, or other methods to relieve pain.
You can decide to have the surgery later if the pain gets worse and medicines don't help.

You avoid the risks and side effects of surgery.
You avoid several months of physiotherapy and rehabilitation.

Medicines can cause side effects such as upset stomach, stomach bleeding, heartburn, and skin rashes.
You may not be able to relieve your pain enough with medicines or home treatment to do your daily activities.
If you decide to have surgery later, and if your limited activity has already caused you to lose strength, flexibility, balance, or endurance, it may be harder to return to your normal activities.

Personal stories about hip replacement surgery for osteoarthritis

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

I've always been active. I worked on the farm and also worked nights at the hospital for over 30 years. The pain in my hips has gotten so bad that it's really hard for me to work, take care of the garden, or go for walks with my grandkids. I've seen people in the hospital with hip replacements, and I know what to expect. It's not going to be easy, but I'm determined to get back to doing the things I enjoy—with less pain.

Carrie, age 66

I never pictured myself as the type who would use a cane. But it helps a lot. I know that surgery is an option, but I don't know who would take care of my sister at home while I was recovering in the hospital. And I don't want to spend any time in a rehabilitation centre. So I'll get by with my cane and my pain relievers as long as I can.

Elliot, age 73

I don't remember when I had a good night's sleep. My hip hurts when I walk, sit, or lie down. My doctor and I have talked about replacing my hip, and I know I may have to do that one day if things get worse, which my doctor says may or may not happen. I want surgery to be the last resort because the new hip could wear out before I die. For now, my doctor and I are going to try some different pain pills.

Gardner, age 54

I thought I'd fixed the dysplasia problems in my hip when I had an osteotomy about 10 years ago. But my osteoarthritis seems to be getting worse. I've decided to go ahead with hip replacement surgery. My husband and I have been planning a special anniversary, and I want to get the surgery and rehab done so that I can really enjoy it.

Carma, age 68

What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to have hip replacement surgery

Reasons not to have hip replacement surgery

I'm in too much pain to do my daily activities.

I'm able to manage my pain and do my daily activities.

More important

Equally important

More important

I think I can complete a long rehabilitation program.

I don't think I can go through a long rehabilitation.

More important

Equally important

More important

If I need another hip replacement in about 15 years, I'll be glad to get it.

I'm worried about needing another hip replacement later.

More important

Equally important

More important

I'll do whatever it takes to feel better, including surgery.

I don't want to have surgery for any reason.

More important

Equally important

More important

My other important reasons:

More important

Equally important

More important

Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Having surgery

NOT having surgery

Leaning toward

Undecided

Leaning toward

Your Summary

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

Your decision

Next steps

Which way you're leaning

How sure you are

Your comments

Your knowledge of the facts

Key concepts that you understood

Key concepts that may need review

Getting ready to act

Patient choices

What matters to you

Print Summary

Credits and References

Credits

Author	Healthwise Staff
Primary Medical Reviewer	Anne C. Poinier MD - Internal Medicine
Primary Medical Reviewer	Kathleen Romito MD - Family Medicine
Primary Medical Reviewer	Martin J. Gabica MD - Family Medicine
Primary Medical Reviewer	Adam Husney MD - Family Medicine
Primary Medical Reviewer	E. Gregory Thompson MD - Internal Medicine
Primary Medical Reviewer	Jeffrey N. Katz MD, MPH - Rheumatology
Primary Medical Reviewer	Heather Quinn MD - Family Medicine

References

Citations

Lozada CJ (2013). Treatment of osteoarthritis. In GS Firestein et al., eds., Kelley's Textbook of Rheumatology 9th ed., vol. 2, pp. 1646–1659. Philadelphia: Saunders.
Beswick AD, et al. (2012). What proportion of patients report long-term pain after total hip or knee replacement for osteoarthritis? A systematic review of prospective studies in unselected patients. BMJ Open, 2(1). DOI: 10.1136/bmjopen-2011-000435. Accessed April 24, 2016.
Evans JT, et al. (2019). 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. Lancet, 393(10172): 647–654. DOI: 10.1016/S0140-6736(18)31665-9. Accessed September 15, 2020.
Phillips CB, et al. (2003). Incidence rates of dislocation, pulmonary embolism, and deep infection during the first six months after elective total hip replacement. The Journal of Bone and Joint Surgery. American Volume, 85-A(1): 20–26. http://jbjs.org/content/85/1/20.long. Accessed May 25, 2016.
Singh JA, et al. (2011). Cardiac and thromboembolic complications and mortality in patients undergoing total hip and total knee arthroplasty. Annals of the Rheumatic Diseases, 70(12): 2082–2088. DOI: 10.1136/ard.2010.148726. Accessed May 25, 2016.
Middleton A, et al. (2017). Outcomes over 90-day episodes of care in Medicare fee-for-service beneficiaries receiving joint arthroplasty. Journal of Arthroplasty, 32(9): 2639–2647.e1. DOI: 10.1016/j.arth.2017.03.040. Accessed February 18, 2021.
Cram P, et al. (2011). Clinical characteristics and outcomes of Medicare patients undergoing total hip arthroplasty, 1991-2008, JAMA. 305(15): 1560-1567. Accessed March 17, 2017.

Arthritis: Should I Have Hip Replacement Surgery?

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

Get the facts
Compare your options
What matters most to you?
Where are you leaning now?
What else do you need to make your decision?

1. Get the Facts

Your options

Have hip replacement surgery.
Don't have your hip replaced. Continue to manage your joint pain and other symptoms with other treatments.

This decision tool is for people considering hip replacement surgery. If you are considering other types of surgery for your arthritis, talk to your doctor.

Key points to remember

Most people can manage osteoarthritis pain with medicine, exercise, physiotherapy, and weight loss (if they are overweight). If these things don't work, then surgery to replace the hip is an option.
Arthritis may get worse over time. But it may stay the same or even get better.
Most people have hip replacement only when they can no longer control pain with medicine and other treatments and when the pain prevents them from doing daily activities.
People who have this surgery usually have much less pain than before. And they can usually return to activities they enjoy.
Most artificial hip joints last for about 15 years. But this can depend on how much stress you put on the joint and how well your new joint and bones mend.
If you wait so long to have a hip replacement that you have already lost much of your strength, endurance, and ability to be active, then after the surgery you might have a harder time returning to your normal activities.

FAQs

What is osteoarthritis?

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.

What is hip replacement surgery?

Most artificial hip joints last for about 15 years. But this can depend on how much stress you put on the joint and how well your new joint and bones mend.

What treatments other than surgery are available?

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 non-steroidal 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.
Physiotherapy. 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.
Natural health products, 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.

What should you expect after surgery?

What are the risks of total hip replacement 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.

What do numbers tell us about the benefits and risks of hip replacement?

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.²

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.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.⁶ If you are older or have other health problems, your risk may be higher.⁵^{4, 7}

Why might your doctor recommend hip replacement?

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.

2. Compare your options

	Have hip replacement surgery	Don't have your hip replaced
What is usually involved?	You will have spinal or general anesthesia. You may be able to get out of bed with help on the day of surgery or the next day. Most people will have a short hospital stay or go home the day of surgery. You will need several weeks of physiotherapy, including exercises you can do at home. 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.	You try medicines, steroid shots, home treatment, or other methods to relieve pain. You can decide to have the surgery later if the pain gets worse and medicines don't help.
What are the benefits?	You will likely have less pain, be able to do your daily activities, and have a better quality of life.¹	You avoid the risks and side effects of surgery. You avoid several months of physiotherapy and rehabilitation.
What are the risks and side effects?	You may need another replacement in about 15 years. All surgery has risks, such as bleeding, infection, heart attack, and risks from anesthesia. Other risks of hip replacement surgery include blood clots and problems with wound healing. Your age and your health can also affect your risk.	Medicines can cause side effects such as upset stomach, stomach bleeding, heartburn, and skin rashes. You may not be able to relieve your pain enough with medicines or home treatment to do your daily activities. If you decide to have surgery later, and if your limited activity has already caused you to lose strength, flexibility, balance, or endurance, it may be harder to return to your normal activities.

Personal stories

Personal stories about hip replacement surgery for osteoarthritis

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

"I've always been active. I worked on the farm and also worked nights at the hospital for over 30 years. The pain in my hips has gotten so bad that it's really hard for me to work, take care of the garden, or go for walks with my grandkids. I've seen people in the hospital with hip replacements, and I know what to expect. It's not going to be easy, but I'm determined to get back to doing the things I enjoy—with less pain."

— Carrie, age 66

"I never pictured myself as the type who would use a cane. But it helps a lot. I know that surgery is an option, but I don't know who would take care of my sister at home while I was recovering in the hospital. And I don't want to spend any time in a rehabilitation centre. So I'll get by with my cane and my pain relievers as long as I can."

— Elliot, age 73

"I don't remember when I had a good night's sleep. My hip hurts when I walk, sit, or lie down. My doctor and I have talked about replacing my hip, and I know I may have to do that one day if things get worse, which my doctor says may or may not happen. I want surgery to be the last resort because the new hip could wear out before I die. For now, my doctor and I are going to try some different pain pills."

— Gardner, age 54

"I thought I'd fixed the dysplasia problems in my hip when I had an osteotomy about 10 years ago. But my osteoarthritis seems to be getting worse. I've decided to go ahead with hip replacement surgery. My husband and I have been planning a special anniversary, and I want to get the surgery and rehab done so that I can really enjoy it."

— Carma, age 68

3. What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to have hip replacement surgery

Reasons not to have hip replacement surgery

I'm in too much pain to do my daily activities.

I'm able to manage my pain and do my daily activities.

More important

Equally important

More important

I think I can complete a long rehabilitation program.

I don't think I can go through a long rehabilitation.

More important

Equally important

More important

If I need another hip replacement in about 15 years, I'll be glad to get it.

I'm worried about needing another hip replacement later.

More important

Equally important

More important

I'll do whatever it takes to feel better, including surgery.

I don't want to have surgery for any reason.

More important

Equally important

More important

My other important reasons:

More important

Equally important

More important

4. Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Having surgery

NOT having surgery

Leaning toward

Undecided

Leaning toward

Credits

By	Healthwise Staff
Primary Medical Reviewer	Anne C. Poinier MD - Internal Medicine
Primary Medical Reviewer	Kathleen Romito MD - Family Medicine
Primary Medical Reviewer	Martin J. Gabica MD - Family Medicine
Primary Medical Reviewer	Adam Husney MD - Family Medicine
Primary Medical Reviewer	E. Gregory Thompson MD - Internal Medicine
Primary Medical Reviewer	Jeffrey N. Katz MD, MPH - Rheumatology
Primary Medical Reviewer	Heather Quinn MD - Family Medicine

References

Citations

Lozada CJ (2013). Treatment of osteoarthritis. In GS Firestein et al., eds., Kelley's Textbook of Rheumatology 9th ed., vol. 2, pp. 1646–1659. Philadelphia: Saunders.
Beswick AD, et al. (2012). What proportion of patients report long-term pain after total hip or knee replacement for osteoarthritis? A systematic review of prospective studies in unselected patients. BMJ Open, 2(1). DOI: 10.1136/bmjopen-2011-000435. Accessed April 24, 2016.
Evans JT, et al. (2019). 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. Lancet, 393(10172): 647–654. DOI: 10.1016/S0140-6736(18)31665-9. Accessed September 15, 2020.
Phillips CB, et al. (2003). Incidence rates of dislocation, pulmonary embolism, and deep infection during the first six months after elective total hip replacement. The Journal of Bone and Joint Surgery. American Volume, 85-A(1): 20–26. http://jbjs.org/content/85/1/20.long. Accessed May 25, 2016.
Singh JA, et al. (2011). Cardiac and thromboembolic complications and mortality in patients undergoing total hip and total knee arthroplasty. Annals of the Rheumatic Diseases, 70(12): 2082–2088. DOI: 10.1136/ard.2010.148726. Accessed May 25, 2016.
Middleton A, et al. (2017). Outcomes over 90-day episodes of care in Medicare fee-for-service beneficiaries receiving joint arthroplasty. Journal of Arthroplasty, 32(9): 2639–2647.e1. DOI: 10.1016/j.arth.2017.03.040. Accessed February 18, 2021.
Cram P, et al. (2011). Clinical characteristics and outcomes of Medicare patients undergoing total hip arthroplasty, 1991-2008, JAMA. 305(15): 1560-1567. Accessed March 17, 2017.

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