When is the right time to have a hip replacement?

Philip Stott

Hip replacements have been routinely carried out for more than 40 years and have given hundreds of thousands of people a new lease of life, says Philip Stott, who became a hip surgeon because he was so impressed by the improvement in quality of life following hip replacement surgery.

I often get asked when a person with osteoarthritis of their hip should ideally undergo hip replacement surgery. Is it when they first start getting pain? Or is it when they are so crippled with pain that they have exhausted every other painkilling method?

There’s no simple answer - what is correct for one patient may not be correct for the next. Arthritis is a degenerative condition, which tends to get worse with time. Some people deteriorate quickly, whereas others have a much slower, more stable course.

As the hip deteriorates, it usually gets more painful and restrictive. Patients don’t like using an arthritic hip, and so muscles waste away. The hip becomes stiffer. The spine and knee have to more of the work, often leading to problems in these joints too.

Hip replacement surgery can only replace the joint itself, but cannot give you new muscles. If your muscles are in excellent condition before the operation, you can expect a good outcome from a hip replacement. Conversely, if you are severely disabled by your arthritic hip, then a hip replacement may only get you out of most of your pain, but you may still walk with a limp and have a stiff hip. This is due to the muscles around the hip being weak and stiff. This may improve over time with exercise.

Total hip replacements have improved over the last 40 years. I remember being told that the first hip would last about 10 years, the second seven, the third five and so on. A modern hip replacement should have a much longer life span. The artificial joint that I use has studies showing 100% survival of the joint after 25 years of implantation and 80% survival at 40 years. The surgery has improved too, so that nowadays muscles are not cut like they used to be and patients are usually in hospital for less than five days.

Hip replacements are more common than you might think - last year some 80,000 people in England and Wales had hip procedures. I have replaced hips in people of all ages – from teenagers to someone over a hundred years old. Patients are generally in hospital for less than five days and can usually return to work after a few weeks and sporting activities soon after.

If you are troubled by painful arthritic hips, your GP will refer you to an orthopaedic surgeon who will advise you on the best treatment for your particular condition. The doctors will make sure that you are fully informed and involved in deciding how and where you are treated, so don’t be afraid to ask if you are unsure about anything.