The Hip Joint

If you Need an Artificial Hip

Questions and Answers

Some patients first inquire about hip replacement when they have little hip disease. Others postpone their inquiries until the disease is very severe. Everyone has their own threshold for pain and tolerance levels for instability and stiffness. Here are some questions that often arise and their answers.

Q. Who should seriously consider hip replacement and when?

A. People whose pain and/or disability are sufficient to justify major elective surgery.

  • When quality of life and/or independence decrease due to pain and mobility problems. For some, pain regularly disturbs sleep. Others are no longer able to dance, play golf, and shop by themselves.
  • when non-operative measures can no longer remedy their hip problems. That is, when analgesics are ineffective for relieving pain and walking is too difficult with a stick, crutch, or other walking aid.

Who Should Probably Not Consider Hip Replacement?

A. Hip replacement is not recommended for everyone. Some people have health problems that increase the risk of complications and jeopardize the chance for a successful surgical result.

Certain people may be better off avoiding this surgery

  • if having an operation or anaesthesia is too risky; for example, due to advanced heart, kidney, liver and/or blood diseases such as anemia. One's physical condition must be good enough to tolerate an operation with significant blood loss (e.g. 1-1.5 liter).

  • if bone quality is not strong enough to support an implanted prosthesis. This could be due to osteoporosis, a poor blood supply, bone cancer, bone infection, or previous hip operations. Each time a hip is replaced less bone is available to support a new prosthesis.

  • if a condition such as mental illness, Alzheimer's disease, substance misuse (e.g. drugs, alcohol) impairs the ability or willingness to cooperate, both during the initial healing period and in the long term.

  • If an existing physical condition would excessively stress a well-implanted prosthesis. Examples of this are muscle diseases and skeletal deformity.

  • If an active infection is present in bone or in any other part of the body.

However, each case is different. If in doubt, check with your doctor or surgeon.

How Realistic Are Your Expected Benefits from a Hip Replacement?

If you decide to have a hip replacement, you as the patient and your surgeon are likely to have different expectations of your surgical outcome. Here are some typical expectations:--

You will hope for 100% relief from pain.

Although this sometimes happens, your surgeon will expect your pain to decrease by 80-95%.

You will hope that the length of your legs will be equal.

Your surgeon will try to make them equal in length but this is not always feasible.

You will hope to regain a normal walking pattern.

This may be possible. However, most surgeons will consider the operation successful if you can walk without much pain and only a trace of limp.

You will hope to once again be able to sink into low lounges and deep chairs and be able to bend fully forwards in order to rise out of them.

Your surgeon may advise you against this and tell you to avoid bending more than 90° at the waist.

You will hope to recover the ability to turn your leg fully in any direction.

Your surgeon will advise you to permanently avoid turning your leg inward as this can dislocate your artificial hip prosthesis.

You will hope that your new hip will last forever.

Your surgeon will hope that your hip will last ten years or longer.

If you are in a younger age group, perhaps having had your hip joint damaged in a motor vehicle accident, you may hope to return to full sport activity (tennis, squash, skiing).

Your surgeon will discourage this except for certain kinds of activity. Running and jumping have to be avoided because these movements put unnecessary wear on the prosthesis, can increase the possibility of dislocation, and may fracture or otherwise damage the remaining bone.