Planning a Hip Replacement? 6 Things to Know
In the not-so-distant past, total hip replacement surgery was a major operation that involved large incisions, significant pain, and a long recovery. Today, minimally invasive surgical techniques, improved implants, and modern anesthesia have changed that experience. Many patients are walking within hours of surgery, and some return home the same day.
Hip replacement—also called total hip replacement or total hip arthroplasty—is now one of the most common and successful procedures for relieving hip pain caused by arthritis or other joint damage.
It’s also no longer limited to older adults. While the surgery was once most common among people in their 70s, many patients today undergo hip replacement in their late 40s, 50s, or early 60s, partly because modern implants can last 25 years or longer.
“The surgical instrumentation is better, the outcomes are better, and the implants are better, so that they last longer,” says Elie Mansour, MD, a Yale Medicine orthopaedic surgeon who specializes in knee and hip replacement and reconstruction. “We used to have patients wait until they were 65 to 75 to do the surgery because they could hold out until they absolutely needed it because the implants didn’t last as long, and they wanted to avoid a second surgery in the future. Now we are seeing most patients are in their mid-50s to mid-60s.”
How do you know if you need a hip replacement?
Doctors usually recommend hip replacement surgery only after nonsurgical treatments have not provided enough relief from the pain.
“Oftentimes, osteoarthritis is involved so we’d want to make sure the patient is on anti-inflammatories to address that, in addition to trying physical therapy, and potentially steroid injections into the hip joint,” Dr. Mansour says.
If those treatments no longer help, surgery may be considered—especially when pain and loss of function begin to affect daily life. “If the patient has done all of these things and is still feeling pain on a daily basis, especially at night with disturbed sleep, and if they have lost function that is affecting their daily activities, then surgery may be the best step,” he says.
Pain and function tend to go hand in hand.
“That’s because a painful hip will affect its function, and if your movement is limited, that can lead to more pain,” Dr. Mansour says.
By “function,” he explains, doctors are looking at your ability to engage in basic daily activities, such as walking through a grocery store, doing household chores, getting in and out of a car, and sleeping comfortably through the night.
“We’re not talking about someone who used to run 10 miles a day and now can only run seven,” he says. “We’re talking about difficulty with everyday activities. Total hip replacement can also be offered to more active and higher demand patients, however, expectations after must be reasonable.”
Do genetics play a role in needing a hip replacement?
Yes. Research suggests that genetics play a significant role in whether or not a person develops hip osteoarthritis, the most common reason people need a hip replacement.
Some studies estimate that about 60% of the risk of hip osteoarthritis may be inherited. People who have a parent or sibling who needed a hip replacement are more likely to need one themselves. In fact, siblings may be up to three times more likely to require the surgery.
While you cannot change your genetics, knowing your family history may help you focus on modifiable risk factors, such as maintaining a healthy weight. Being overweight or obese increases stress on the hip joint and raises the risk of developing severe arthritis.
In some cases, weight loss may also be necessary before surgery.
“Because there are BMI (body mass index) limits for the surgery, sometimes patients go on a GLP-1 weight-loss medication before the operation to become eligible,” Dr. Mansour says.
Should you do physical therapy before a hip replacement?
Many surgeons recommend physical therapy before surgery, sometimes called “prehabilitation” or “prehab.”
The goal is to strengthen the muscles around the hip joint before surgery, which can help patients recover mobility more quickly afterward.
“Sometimes patients are very deconditioned and we order physical therapy before the surgery just to make their muscles get stronger,” Dr. Mansour says. “Your recovery after surgery depends on how active you are before the surgery.”
However, prehab is not always possible. “Some patients are in too much pain and cannot do physical therapy before surgery, in which case we have to proceed without it,” he says.
What pain management options are used during hip replacement surgery?
Most patients receive regional anesthesia and a nerve block to control pain during and immediately after surgery.
A nerve block temporarily numbs the nerves around the hip, helping manage pain during the procedure and for six to seven hours afterward.
Patients may receive spinal anesthesia, which numbs the lower half of the body, or general anesthesia, where the patient is fully asleep.
The choice depends on patient preference, medical history, and anesthesia risk factors.
After surgery, most patients take opioid pain medication for a few days, then transition to non-opioid options, such as anti-inflammatory medications or acetaminophen.
Can you go home the same day after hip replacement surgery?
For many patients, same-day discharge is the goal after hip replacement surgery.
“We first make sure they have support at home, and if they do and they are ready, that is the preferred discharge,” Dr. Mansour says. “There is less risk of complications when patients recover at home compared to a short-term rehabilitation facility.”
However, some patients may still need a short stay in a rehabilitation facility—for example, if they live alone or do not have help with daily activities during the first days of recovery.
When patients undergo hip replacement at a Yale New Haven Hospital location, home-based recovery support is often available. Nurses typically visit patients at home during the first two weeks, and physical therapy can also begin at home.
“But we try to transition patients to outpatient physical therapy as soon as possible,” Dr. Mansour says. “There they have access to better equipment, and it helps them regain independence by getting dressed and leaving the house.”
Will you eventually need to have your other hip replaced?
People who develop osteoarthritis in one hip have a higher risk of developing arthritis in the other hip as well.
Research suggests that about 25% of patients have the other hip replaced within 10 years of their first surgery.
In the past, surgeons sometimes replaced both hips at the same time, but this approach is less common today. Recent studies show that simultaneous bilateral hip replacement can carry higher risks for some patients, Dr. Mansour says.
“However, there are also advantages, like less time off work, lower cost, and only doing anesthesia once,” he says. “Some surgeons still offer this if the patient is young and in good health.”
