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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?
Get the facts
- Have hip replacement surgery.
- Don't have your hip replaced. Continue to manage your joint pain and other symptoms with other treatments.
Key points to remember
- Most people can manage osteoarthritis pain with medicine, exercise, physical therapy, and weight loss (if they are overweight). If these treatments do not help your pain, you may try joint injections, arthroscopic surgery, or osteotomy. If these things don't work, then surgery to replace the hip is an option.
- 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 had hip replacement usually:1
- Have much less pain than before surgery.
- Are able to return to their daily activities.
- Have a better quality of life.
- Most artificial hip joints will last for 10 to 20 years or longer without loosening. But this can depend on how much stress you put on the joint, how much you weigh, and how well your new joint and bones mend.
Osteoarthritis is a disease that affects the cartilage in joints. The cartilage breaks down until the bones, which were once kept apart by cartilage, rub against each other. This causes damage to tissue and bone. The symptoms of osteoarthritis include joint pain, stiffness after sitting or lying down, and not being able to move freely.
Surgery is an option for people with severe osteoarthritis who do not get pain relief from medicine, home treatment, or other methods and who have lost a large amount of cartilage. Surgery relieves severe pain and may improve how well the joint works and moves.
Types of surgery include:
- Arthroscopy. This can provide short-term (and sometimes long-term) pain relief. Arthroscopy can also fix a joint if it becomes "locked" or stuck because of loose cartilage or bone fragments.
- Osteotomy. Doctors use osteotomy to prevent severe hip arthritis in active people younger than 60.
- Hip replacement surgery. This is done when there is pain and disability along with damage of the hip that can be seen on X-rays.
- Arthrodesis. This surgery joins two bones in a diseased joint so that the joint can no longer move. It is rarely used.
- Hip resurfacing surgery. This is used mainly for younger, more active people who have pain and disability from hip problems. It's not known how well this works long-term. And the risk of needing the surgery redone are a little higher than with a standard hip replacement.2 But the results are positive for up to about 8 years in people who have had the surgery.3
Hip replacement surgery replaces the upper end of the thighbone (femur) with a metal ball, and it resurfaces the hip socket in the pelvic bone with a metal shell and liner made of ceramic, plastic, or metal. Doctors can use cement to attach replacement joints to the bone.
Most people get out of bed with help on the day after surgery. You will start physical therapy right away. You will do special exercises and may need crutches for several weeks. Total rehabilitation after surgery can take at least 6 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, play golf, and do other activities that you did before surgery.
|Outcomes after surgery||Number of people|
|Overall satisfaction 1 year after surgery||93 out of 100 (930 out of 1,000)|
|Need for repeat surgery within 15 years||21 out of 100 (210 out of 1,000)|
|Serious joint infection within 4 years after surgery||Less than 1 out of 100 (7 to 8 out of 1,000)|
|Death within 1 to 3 months after surgery||Less than 1 out of 100 (1 to 8 out of 1,000)|
*Based on the best available evidence (evidence quality: high to borderline)
Satisfaction with surgery
The evidence about hip replacement surgery suggests that most people are happy with the results. The quality of this evidence is borderline.
Take a group of 100 people who have the surgery. One year later, 93 people out of 100 will be satisfied with the results. This means that 7 out of 100 will not be satisfied.
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. The quality of the evidence about this is high.
Take a group of 100 people who have the surgery. Within 15 years after the surgery, 21 out of 100 will need to have the hip replaced again. This means that 79 out of 100 will not need to repeat the surgery within the first 15 years.
Problems after surgery
The evidence suggests that, like most surgeries, hip replacement may have some risks. The quality of the evidence about risks is moderate.
Take a group of 1,000 people who have the surgery. Problems that can occur include:
- Serious joint infection. Within 4 years after surgery, 7 to 8 out of 1,000 people (or less than 1 out of 100) may get a serious infection in the joint. This means that 992 to 993 people out of 1,000 will not get an infection.
- Death, which may or may not be caused by the surgery itself. Within 1 to 3 months of surgery, 1 to 8 out of 1,000 people (or less than 1 out of 100) may die. This means that 992 to 999 people out of 1,000 who had the surgery will not die within 1 to 3 months.
Understanding the evidence
Some evidence is better than other evidence. Evidence comes from studies that look at how well treatments and tests work and how safe they are. For many reasons, some studies are more reliable than others. The better the evidence is—the higher its quality—the more we can trust it.
Another thing to understand is that the evidence can't predict what's going to happen in your case. When evidence tells us that 2 out of 100 people who have a certain test or treatment may have a certain result and that 98 out of 100 may not, there's no way to know if you will be one of the 2 or one of the 98.
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.
Compare your options
What is usually involved?
What are the benefits?
What are the risks and side effects?
- You will have local or general anesthesia. You may be able to get out of bed with help on the day after surgery. Most people go home within a few days to a week.
- You will start physical therapy right away and may continue for 6 months or more. You may need to use a walker or crutches for several weeks.
- You will likely have less pain, be able to do your daily activities, and have a better quality of life.1
- You may need another replacement in 10 to 20 years.
- All surgery has risks, such as bleeding, infection, 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.
- 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 cost and risks of surgery.
- You avoid 6 months of physical therapy 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.
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 and always on my feet. I worked on the farm and also worked nights at the local 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 my vegetable 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 to get around. But it helps a lot to take the strain off my bad hip. I know that surgery to replace the hip is an option, but I take care of my invalid sister at home, and there wouldn't be anyone to take care of her while I was in the hospital and recovering. And I don't want to spend any time in a rehabilitation center. So I'll manage 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 face that one day. I want that to be my last resort, though, because I know that an artificial hip will wear out in 10 or 20 years and I'd just need another surgery. For now, my doctor and I are going to try some other things. I'm going to lay off golf for a while, and I'm going to try non-steroidal anti-inflammatory medicines.
Gardner, age 54
I thought I had fixed the dysplasia problems in my hip when I had an osteotomy some 10 years ago, but my osteoarthritis seems to be getting worse in that hip all the time. I have decided to go ahead with hip replacement surgery. My husband and I have been planning a walking trip in Ireland for years, and I'm going to get the surgery and rehabilitation done so that I can walk through that beautiful country without so much pain.
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.
I think I can complete a long rehabilitation program.
I don't think I can go through a long rehabilitation.
If I need another hip replacement in 10 to 20 years, I'll be glad to get it.
I'm worried about needing another hip replacement later.
I'll do whatever it takes to feel better, including surgery.
I don't want to have surgery for any reason.
My other important reasons:
My other important reasons:
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.
NOT having surgery
What else do you need to make your decision?
Check the facts
Is hip replacement the only option for treating osteoarthritis?
- YesSorry, that's not right. Most people with hip pain can try other treatments like medicine and physical therapy before having hip replacement.
- NoYou're right. Most people with hip pain can try other treatments like medicine and physical therapy before having hip replacement.
- I'm not sureIt may help to go back and read "Get the Facts." Most people with hip pain can try other treatments like medicine and physical therapy before having hip replacement.
After surgery, will you be able to resume your daily activities?
- YesYou're right. People who have had hip replacement usually have much less pain than before surgery, are able to return to their daily activities, and have a better quality of life.
- NoSorry, that's not right. People who have had hip replacement usually have much less pain than before surgery, are able to return to their daily activities, and have a better quality of life.
- I'm not sureIt may help to go back and read "Get the Facts." People who have had hip replacement usually have less pain than before, are able to return to their daily activities, and have a better quality of life.
Do your age, health, and activity level matter when it comes to deciding about hip replacement surgery?
- YesYou're right. You and your doctor will decide about surgery based on your age, health, activity level, and how much pain and disability you have.
- NoSorry, that's not right. You and your doctor will decide about surgery based on your age, health, activity level, and how much pain and disability you have.
- I'm not sureIt may help to go back and read "Get the Facts." You and your doctor will decide about surgery based on your age, health, activity level, and how much pain and disability you have.
Decide what's next
Do you understand the options available to you?
Are you clear about which benefits and side effects matter most to you?
Do you have enough support and advice from others to make a choice?
How sure do you feel right now about your decision?
Use the following space to list questions, concerns, and next steps.
Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
|Primary Medical Reviewer||Anne C. Poinier, MD - Internal Medicine|
|Specialist Medical Reviewer||Stanford M. Shoor, MD - Rheumatology|
- Lozada CJ (2009). Management of osteoarthritis. In GS Firestein et al., eds., Kelley's Textbook of Rheumatology, 8th ed., vol. 2, pp. 1563–1577. Philadelphia: Saunders Elsevier.
- Sibanda N, et al. (2008). Revision rates after primary hip and knee replacement in England between 2003 and 2006. Public Library of Science Medicine, 5(9): 1398–1408.
- Daniel J, et al. (2004). Metal-on-metal resurfacing of the hip in patients under the age of 55 years with osteoarthritis. Journal of Bone and Joint Surgery, 86-B(2): 177–183.
- Vissers MM, et al. (2011). Recovery of physical functioning after total hip arthroplasty: Systematic review and meta-analysis of the literature. Physical Therapy, 91(5): 615–629.
- Ridgeway S, et al. (2005). Infection of the surgical site after arthroplasty of the hip. Journal of Bone and Joint Surgery, British volume, 87(6): 844–850.
- Centre of Excellence of Joint Replacements (2006). Norwegian Arthroplasty Register: Report 2006. Available online: http://nrlweb.ihelse.net.
- Salazar C, et al. (2011). Direct thrombin inhibitors versus vitamin K antagonists or low molecular weight heparins for prevention of venous thromboembolism following total hip or knee replacement. Cochrane Database of Systematic Reviews (3).
- Anakwe RE, et al. (2011). Predicting dissatisfaction after total hip arthroplasty: A study of 850 patients. Journal of Arthroplasty, 26(2): 209–213.