Surgery for Hip Osteoarthritis
Understanding risks, benefits and types of surgery for hip osteoarthritis
Surgery is suitable for ‘few‘ people with hip osteoarthritis. It is considered a last resort so it sits on top of the treatment pyramid. Surgery may be beneficial if you have extensively tried the other types of treatment in order first. There are different types of surgical approaches that are currently used to treat hip osteoarthritis. It’s really important to note that even if you receive surgery, you need to continue with your core (and potentially add-on) treatments such as exercise, education and weight management.
Listen to Orthopaedic Consultant, Mr Finbarr Condon talk to a patient about the suitability of a hip replacement surgery.
How do I know if I need surgery for hip osteoarthritis?
There is no standard answer to this question. The decision to have surgery is one that needs much thought and discussion between yourself and your surgeon. If you have not tried the core recommended treatments (bottom of the pyramid) yet then this is where you should start your journey. You may also want to consider others (e.g. spouse or friends and family) in your decision.
This tool is an online decision-making tool from the U.K. National Joint Registry that provides the benefits and risks of surgery based upon you. The questions asked may help you facilitate a discussion and decision with your surgeon.
Some of these considerations may include:
The severity of your pain
How your symptoms are impacting on your daily life
How your symptoms are impacting on your sleep
To what extent you have tried other treatments
Any risks associated with other health conditions
How prepared you are for the recovery period
Is it possible to avoid surgery for osteoarthritis?
It is possible to avoid surgery by using the core recommended treatment options. Many people believe that all people with osteoarthritis will eventually need surgery or a total joint replacement, but this is a myth!
About 1 out of every 10 choose to have hip replacement surgery in the first 10 years after they first see their healthcare professional.
About 9 out of every 10 don’t have surgery and can manage their osteoarthritis without it.
What are the surgical options available for osteoarthritis?
The most common surgery for people with hip osteoarthritis is a total joint replacement (also known as arthroplasty). In this surgery, they replace the surfaces of the ball and socket in the hip joint (the head of the femur and acetabulum of the pelvis). They are replaced by new joint surfaces made from metal and plastic.
Surgery can usually help with pain and basic mobility but the new joint might be less mobile than your original hip joint. Talk to your healthcare professional about realistic expectations of surgery before you decide to go ahead.
Want to know more about what to expect if you are thinking about surgery?
What can I expect if I decide to opt for surgery?
Before surgery and during surgery
Your surgery will work better if you can be active, stop smoking (if you smoke) and are a healthy weight before surgery. During surgery, you will usually have a general anaesthetic. The surgeon makes a cut on your hip, takes out the damaged joint and fits a new one. Surgery takes between 1 – 3 hours. You will be in hospital between 1 – 5 days.
You will be given blood thinning medicine to stop you getting a blood clot in the leg or lung. You will see a physiotherapist who will give you exercises to do when you get home. These are vital to your recovery.
Recovery from joint replacement surgery
How quickly you recover depends on your age, general health and fitness, and how well you stick to the recommended exercises and guidance after surgery. You should be able to stop using crutches or a frame about 6 weeks after surgery.
It may take up to 3 months for pain and swelling to settle down. For some people recovery can take many months, and some may need further support from a physiotherapist.
Driving – most people can drive again after about 6 weeks if they feel safe to do so.
Return to work – it depends on the kind of work you do. You can usually do office work after 6 weeks, but for a more physical job it will be longer.
Replacement joints don’t last forever. It is a very difficult surgery to redo a replacement joint (have a joint replaced for a second time). This is why your consultant will wait for your osteoarthritis to be severe before they offer a first replacement.
What are the expected outcomes after surgery for osteoarthritis?
Although most people benefit from this procedure, not all do. Surgery does not give everyone a better quality of life. From 7% and up to approximately 1 in 5 people (20%) are dissatisfied with their outcomes after a hip replacement. Research is still investigating why this is the case. It is important to have thoroughly researched the risks and benefits before deciding whether you want to undergo surgery.
Have a look at this tool again, which is an online decision-making tool from the UK. It provides you with the benefits and risks of surgery based upon you. The overall flow and questions asked might help inform your decision and facilitate a discussion with your surgeon.
What are the risks of surgery for osteoarthritis?
Total joint replacement is a major surgery that cannot be undone and, as with all types of surgery, it has side effects. Therefore, it seems wise to have fully explored and tried all other treatment options first.
Serious adverse events include blood clots or deep vein thrombosis, infection in the wound or joint, damage to nerves or tissue and death. Other complications include stiffness, urinary tract infection, bleeding, implant problems and complications from anaesthesia. About 6% will experience a serious adverse event and about 5% will be re-admitted to hospital within 30 days so these risks should be considered carefully.
Listen to Orthopaedic Consultant, Mr Finbarr Condon talk potential complications of a hip replacement surgery.
Are exercise and other treatments needed after surgery?
YES!!!
It is essential that you undergo extensive rehabilitation after your hip surgery. This should be discussed in-depth with your physiotherapist or surgeon when deciding whether surgery is right for you.
What questions should I ask my orthopaedic surgeon/ consultant about my osteoarthritis?
If you have an appointment with an orthopaedic consultant, it can be helpful to be ready with some questions to get the most out of your appointment. Some examples are:
What are the benefits and the risks associated with surgery?
You may also wish to discuss the risks and benefits of prolonging a surgery or not getting the surgery.
What are the alternatives to surgery?
Have all other non-invasive or less invasive alternatives been adequately trialled?
Is it inevitable that I will eventually need surgery or is there anything I can do to prevent it?
How likely am I to have a complication from surgery?
If you have other factors or conditions that may increase surgical complications (for example older age, obesity or cardiac conditions), this should be included in the discussion.
If I undergo surgery, how long will the replacement last?
This also depends on individual factors and the materials used in the replacement.
How long will the recovery last?
How long will I be in hospital? What type of rehabilitation will I need to do and how will I be supported? When will I be able to drive? When will I be able to return to work / caring duties / activities and hobbies? What measures will need to be put in place at home so I can recover well.
How much improvement should I expect after surgery?
The consultant should be able to set your expectations for post-surgery. You should have an idea as to initial post-surgical pain and how much you will be able to do once you fully recover.
Go to the Tools & Resources section for more help on your journey where you can:
- Visit the Exercise Library,
- Find programmes on offer in your community
- Find a healthcare professional
- Find printable resources
- Or learn about another joint condition.
The information in this website page was informed by the following sources/references:
Scientific Publications
- Awad ME, Farley BJ, Mostafa G, Darwiche HF, Saleh KJ. The risk of hospital readmission, revision, and intra- and postoperative complications between direct anterior versus posterior approaches in primary total hip arthroplasty: a stratified meta-analysis and a probability based cost projection. HIP International. 2022;33(3):442-462. doi:10.1177/11207000211066454
- Heo SM, Harris I, Naylor J, Lewin AM. Complications to 6 months following total hip or knee arthroplasty: observations from an Australian clinical outcomes registry. BMC Musculoskelet Disord. 2020 Sep 10;21(1):602. doi: 10.1186/s12891-020-03612-8. PMID: 32912197; PMCID: PMC7488141.
- Ton J, Perry D, Thomas B, Allan GM, Lindblad AJ, McCormack J, Kolber MR, Garrison S, Moe S, Craig R, Dugré N, Chan K, Finley CR, Ting R, Korownyk CS. PEER umbrella systematic review of systematic reviews: Management of osteoarthritis in primary care. Can Fam Physician. 2020 Mar;66(3):e89-e98.
Patient Websites/Resources
- NHS Versus Arthritis. https://www.england.nhs.uk/wp-content/uploads/2022/07/Making-a-decision-about-hip-osteoarthritis.pdf
- National Joint Registry UK. https://jointcalc.shef.ac.uk/
- Hip Pain Help Website. Hip Pain Professionals (Dr Alison Grimaldi) https://hippainhelp.com/
Clinical Guidelines
- National Clinical Guideline Centre (UK). National Institute for Health and Clinical Excellence: Guidance. Osteoarthritis in over 16s: diagnosis and management. NICE guideline [NG226]. Published: 19 October 2022. https://www.nice.org.uk/guidance/ng226