13 Things to Know Before Your Hip Replacement

Major surgery with a big impact

Could a 2-pound piece of titanium and ceramic change your life? Maybe, if a deteriorating hip joint -- or two -- is causing constant pain and threatening your ability to work, play and walk. While it's a major surgery with weeks of recovery, nearly 300,000 total hip replacements take place in the U.S. each year. If medical solutions aren't working, you may be wondering if an artificial hip could help.

When all else has failed

Anne Gittelson-Leck of Long Island is a repeat customer. She had her left hip replaced in February 2013 and came back for a matching right hip implant in June. Doctors determined that osteoarthritis (wear-and-tear arthritis) was causing her severe hip pain at a relatively young age. She tried physical therapy and other treatments before seeking evaluation for a possible hip replacement. "I wasn't really ready to hear that yet," she says, "but then the walking got more difficult." Now 50, she says she waited too long -- and that the results from her procedure are "amazing."

After conservative measures -- anti-inflammatory and pain medications, physical therapy, joint lubricants and cortisone shots -- are exhausted, it's time to talk about hip replacement, says Mathias Bostrom, the orthopedic surgeon at the Hospital for Special Surgery who operated on Gittelson-Leck.

Saying no to disability

Arthritis, trauma and degenerative disease can lead to excruciating hip problems. "Many of these patients can't sleep through the night," says Joshua Jacobs, a professor and chairman of orthopedic surgery at Rush University Medical Center in Chicago. "They're unable to walk more than a few blocks." As disease, pain and disability progress to the point where people can no longer perform activities of daily life, he says, "that's when hip replacement should be carefully considered and discussed."

"Osteoarthritis is the most common reason people have hip replacements, but there are others," says Jacobs, immediate past president of the American Academy of Orthopaedic Surgeons. Inflammatory arthritis, like rheumatoid arthritis, can also wreak havoc on the joints. So can osteonecrosis -- death of the bone cells -- from decreased blood flow. Developmental dysplasia (instability) of the hip in childhood may lead to surgery as an adult. And a broken hip from trauma could require a partial or complete replacement.

Not just for seniors

Many people think of hip replacement as a procedure for seniors. And it's true that fragility fractures from osteoporosis are more likely to occur in older adults, Jacobs says, or hip replacements coming from wear-and-tear arthritis. But people can have osteonecrosis in their 20s and 30s, and "folks with inflammatory arthritis, like rheumatoid arthritis, may also be young," he says. People who grew up with hip dysplasia, especially women, may need the procedure at younger ages, he says, but it's extremely rare for a teen or preteen to receive a joint replacement.

So people may not be too young for hip replacement -- or too old. "I do a fair number of 90-year-olds every year," Bostrom says, and his oldest hip replacement patient was over 100.

Choosing your surgeon

When planning for hip replacement, "the top two things you pick are the hospital and the surgeon," Bostrom says. Patients sometimes latch on to a particular buzzword, he notes: "They go, 'Well, I want X, Y and Z -- you know, an anterior approach and metal-on-metal; I want minimally invasive; and I want this and that.'" That's all fine, he adds, but what you really want is a surgeon who's done plenty of procedures. You want a specialist in hip and knee replacements rather than a generalist. "Especially if you're in a metropolitan area where there's a lot of expertise," he says. "A lot of this is just pure common sense."

Gittelson-Leck says it was important to do preliminary research: looking at how many procedures surgeons had performed and for how long, and finding out which surgical approach they preferred.

Pick a tried-and-true device

There's a wide range of prostheses (artificial joints) available to surgeons, made up of combinations of materials including metals such as titanium or chrome, ceramic and plastic. "The majority have a track record that would suggest very long survivorships and a high rate of success," Jacobs says. Rather than recommending one particular material or device, he says, he suggests picking one with a proven track record.

Bostrom tells his patients that new is not always better. For instance, "metal-on-metal total hips didn't turn out so well," he says. "They developed a tremendous amount of metal debris, which was a disaster."

Incision decision

When it comes to incisions, the newer option is the anterior (frontal) hip approach, "but there's been no definitive studies showing that it's better," Bostrom says. Although supporters say recovery is quicker and there's less muscle damage with the anterior approach, he says "it also has its own set of complications." Such choices are driven by the market rather than evidence, says Bostrom, who uses a posterior-lateral (to the side and rear of the hip) approach in his own operating room.

When it comes to incisions, Gittelson-Leck isn't thrilled with her 8-inch matching hip scars. But the left one is now faded ("just a thin pink line") and smooth, and she expects her right-hip scar will become less bumpy and noticeable.

One hip at a time

What if both hips are bad -- is it worth getting them replaced at the same time? Bostrom says he generally advises against a bilateral procedure, because the "medical risks of doing it are a little bit too high," with a much higher risk of blood clots. "Other medical complications -- cardiovascular, pulmonary -- are a little higher than they should be," he says. While he advises a double replacement in certain circumstances, he usually tells patients: "Get one done, get stronger, then get the other side done."

To prevent complications like blood clots, postoperative care includes getting patients up and moving as soon as possible and giving anti-clotting medications. Infection is possible soon after the procedure or months later, and some post-replacement patients take preventive antibiotics before dental work or certain surgical procedures.

Surgery or construction project?

Hip replacement surgery takes anywhere from one to three hours. The two-part prostheses is either attached to the bone with epoxy cement, or with mesh that bone can grow into. The surgeon uses a power saw, drill, reamer and rasps (filing tools) to cut through the original femoral head, ream out cartilage from the original hip socket and reshape the socket before inserting the new metal piece. Between her first and second replacement, Gittelson-Leck watched the procedure performed on YouTube, "where you can see it's a huge operation." Viewing the procedure online was a revelation, she says, especially the surgical-grade saws, chisels and drills.

Out of the OR

Hip replacement requires anesthesia, and patients spend an hour or more in the recovery room where surgery's done. But after that, the rest period is over. "As soon as I went into the regular room, they had me up and walking with the walker, just to move" and so they could examine her gait, Gittelson-Leck says. She experienced some swelling and used a pain-medicine pump for less than a day, soon ramped down to medicine by mouth. With both procedures, she left the hospital within a few days.

Immediate recovery posed some challenges. "I could get around; it was painful but bearable, but I couldn't do it without the extra equipment," she says. That included using a walker for the first two weeks, and a special toilet seat to keep from bending her hips past 90 degrees. After making it home from the hospital, driving a car or even being a passenger was temporarily off limits to avoid bumping. She needed pain medicine to get through the first couple nights, when it was uncomfortable to lie down.

Time for recovery

Most patients feel pretty good by about six to eight weeks after surgery, Bostrom says. Beforehand, he tells patients that even though hip replacements are common, "it's still a major operation. They're not going to be back to work the next week. They're going to have to restrict some of their activities for a period of time," up to three months or so.

Gittelson-Leck took six weeks off from work with her procedures. Now in her eighth week post-op, she says she's still in physical therapy, but "doing better than before" her hip replacement. "It's more of a healing pain, not a hurtful, stabbing pain." She says people considering hip replacement might find that "recovery is quicker, and not as painful as you would imagine."

No lifetime warranty

Hip replacements typically last about 15 to 20 years, research suggests. Jacobs hopes that as materials improve and with ongoing innovation -- like biologic hip replacements -- future joint replacements will last six or seven decades. But for now, he says, "I do counsel younger patients in their 30s and 40s that it's likely they will need further surgery somewhere down the line."

Ski, don't run

Eventually, both experts say, hip replacements can come to feel so natural that people may forget they even have them, but it's not really as if they're back in their 20s, active as ever. "This is not a joint designed to really go running on," Bostrom says. "It's primarily to get rid of pain, and improve people's quality of life. Not for them to go run marathons," although he'll tell some patients it's OK to ski.

Jacobs says lower-impact exercises such as swimming, water aerobics and cycling "are all great ways to stay in shape, to be active, to exercise, without putting the kind of impact loads on a joint that may lead to wear and tear over time -- and ultimately to the need for a new joint replacement."

Back in the saddle

Gittelson-Leck says she's happy to be able to bend again, to sit in butterfly pose with her soles together and her legs flopped open. It's not just about flexibility. Most patients recover from hip replacement, Jacobs says, not only with much better function but with a new lease on life. "Activities of daily living, working, playing with grandchildren -- all the things we take for granted," he says. "When you have a severely arthritic hip, [those activities are] hard to do and now it's restored." While each patient is different, he adds, and some continue to have hip symptoms, "typically they're far less than the symptoms that brought them into surgery in the first place."

Lisa Esposito is a Patient Advice reporter at U.S. News. You can follow her on Twitter, connect with her on LinkedIn or email her at lesposito@usnews.com.