Be prepared for months of recovery. You’ll need help.
Hip replacement operations are so common now that you may assume you’ll need one eventually, especially if you have some hip pain from arthritis. So why not do it sooner rather than later?
The truth: arthritis doesn’t always get worse over time and can even get better. Medicine, exercise, physical therapy, and losing weight can all help.
Consider a hip replacement procedure if your pain is interfering with your daily life, even after you try every recommended remedy. There are also circumstances when you should be especially cautious and perhaps get a second opinion — or resolve a problem before undergoing surgery.
You suspect you have an infection. Any infection, including periodontal disease, could spread to the joint and make things worse, and you might even need another operation. You’ll usually be given an antibiotic before the surgery, but thoroughly investigate any ongoing symptoms beforehand.
You have heart disease or another major ailment. The risk of a heart attack increases 25 times in the two weeks after a hip (or knee) replacement operation. Any condition that could complicate your surgery should give you pause. Be sure all your doctors know about any blood clotting problems, diabetes, and lung disease.
For every 100 people who undergo hip replacement, one will have a heart attack and one will have a blood clot in their lung within three months, studies indicate. Those aren’t forbidding risks, but they go up if you’re especially vulnerable.
You only have pain at rest. Hip replacements are best for pain that shows up when you’re moving. It may not be clear exactly why you have pain, so think about other factors, such as lack of sleep.
You get dizzy spells and fall. This problem has been linked to worse outcomes after hip replacement.
You are obese. If a surgeon refuses you solely because of your weight, get another opinion. But it’s important to understand the issue and weigh the pros and cons. Obese people are more likely to suffer hip (and knee) pain because the joints carry a bigger burden and are more prone to arthritis. But being very heavy is a risk factor in hip replacement surgery, particularly if you’re in the heaviest category. Obese women especially face higher chances of developing an infection from surgery and the new hip may become dislocated in both men and women. The obese are also at greater risk of a post-surgical heart attack, some research shows.
For all these reasons, doctors may urge you to lose weight before they’ll operate. However, how quickly you lose and how you do it may be important. A 2015 research review suggests that losing more than 5 percent of your body weight in the year before the surgery could actually increase your chances of a deep infection, and that weight loss doesn’t consistently protect you from more minor infections.
Other studies point out that obese people benefit from hip replacements and argue that the benefits generally far outweigh the risk.
You’re not prepared for the recovery. Full recovery takes months, and you’ll need help for at least for a few weeks, either from family or in a rehab center. You’ll need to work closely with a physical therapist as well. Are you committed to using your new hip? Many people don’t increase their physical activity or lose weight after the procedure, even though they now have the opportunity to be more active and improve their overall health.
Why should you get surgery?
If your hip pain is making you inactive, your health will suffer. Most people are happy with their new hip: Out of every 10 people, nine report that all or almost all of their pain is gone within two years. Your new hip could serve you well for more than a decade.
Among people in their nineties, hip replacement may have advantages over other kinds of repair after a fall. A broken hip usually needs the help of a rod and some type of plate or screw to heal, and recover takes time. Your best off if you can move sooner. If a new hip is put in, you may be able to walk the day after surgery — much more quickly than with other options. You may not be a good candidate if you have limited mobility for other reasons, dementia, or heart disease, but each situation is unique. Talk to your doctor.
When making your final decision, try to avoid a surgery date on Thursday or Friday, when research suggests it may be less successful.
March 31, 2020
Christopher Nystuen, MD, MBA