Considering hip replacement surgery, but not sure when the time is right? Frank Frassica, M.D., chairman of the department of orthopedic surgery at Johns Hopkins, offers advice.
Q. When should a damaged hip be replaced?
A. I have been an orthopedic surgeon for 20 years, and in my experience, the people who are least satisfied with hip replacement surgery are those who had the surgery too early. They were unsuitable hip replacement candidates because their pain and debilitation levels were too low to justify surgery. After the hip replacement, they still have some pain from the surgery, which leaves them not only uncomfortable and unhappy, but also angry.
I regularly tell people to delay arthroplasty of the hip for as long as possible. How long is long? People who can walk one to two miles, but can’t walk five miles, are not good candidates for hip replacement. If you can still walk one to two miles, meet the demands of your job, go to the mall, and buy groceries, then it is too early to have hip replacement.
On the other side of the coin, if you cannot walk one to two miles, can’t shop or enjoy activities with your spouse and children as you used to, if physical therapy sessions have not helped, and if you have so much pain that you need a narcotic, then it’s probably time to have your hip replaced. When you’re ready to admit that the pain and disability are disrupting your life, make an appointment to consult with an orthopedic surgeon.
Once the decision is made, you need to have realistic expectations. When physically active people tell me they want a hip replaced so they can go back to competitive tennis, or take up aggressive downhill skiing or jogging, I make it clear that there will be serious problems down the road. I can almost guarantee that if they try those activities with their new hips, the artificial joint will eventually loosen, wear out, or fracture.
Total hip replacement will provide complete or nearly complete pain relief to almost all patients. Moreover, those patients with stiff hips before hip replacement surgery should be able to return to nearly normal hip motion. However, there are still some unsolved problems in the total hip replacement procedure. For example, the materials we use for hip replacements don’t last forever, although depending on the patient’s age and activity level, a hip replacement can last for 15 to 20 years or even longer before it has to be revised (replaced).
