It’s time to consider a hip replacement when your hip is limiting your life and a proper go at exercise, weight management and pain relief hasn’t changed that. The deciding factor is how much the hip COSTS you, not how the X-ray looks or how old you are.
The usual signs: pain that stops you walking as far as you want, pain that wakes you at night, and a stiff hip that turns socks, shoes and getting into the car into a struggle.
There’s no prize for holding out as long as possible, and there’s little to gain from rushing in while the hip is still manageable. The decision is yours, made with your surgeon.
Signs it may be time
- Your world is shrinking: you turn down walks, trips or time with family because of your hip
- Night pain: the hip wakes you most nights, or you can’t get comfortable in bed
- Pain at rest: it aches while you sit, not only after you’ve been on your feet
- Everyday tasks are hard: socks, shoes, toenails, and getting in and out of the car or bath
- Painkillers aren’t enough: you need them most days and they barely take the edge off
- You’ve done the basics well: a structured exercise program for a few months, plus weight loss and pain relief where they fit, and the hip is still holding you back
Your X-ray vs how you feel
- The picture and the pain often don’t match. Some people with a badly worn-looking hip manage well. Others with moderate changes struggle every day
- Surgeons decide on pain and function. The American Academy of Orthopaedic Surgeons says there are no absolute age or weight limits for hip replacement, and that the recommendation rests on pain and disability, not age
- The X-ray still matters. It confirms that arthritis is the cause and helps plan the operation. Hip pain with a near-normal X-ray usually has another explanation. Early avascular necrosis, for example, may only show on an MRI
- Make sure it’s the joint. Arthritis usually hurts in the GROIN or front of the thigh, sometimes down to the knee. Pain on the outside of the hip, worse lying on that side, is more often a tendon problem. See gluteal tendinopathy
What to try first
- Exercise and education: a structured program that strengthens the buttock and thigh muscles is recommended at every stage of hip arthritis. It won’t wear the joint out faster. See hip arthritis: symptoms and treatment and hip arthritis exercises
- Weight loss, if you carry extra: less weight means less load through the hip with every step
- Pain relief: anti-inflammatory tablets can help in flares, if they’re safe for you. Ask your doctor
- A cane in the opposite hand: hold it on the side of your good hip to take load off the sore one
- Simple aids: a sock aid, a long-handled shoehorn and firmer, higher chairs make daily life easier while you decide
- A cortisone shot for a bad flare: relief is usually weeks rather than months. If surgery is likely, ask first, because many surgeons want a gap of a few months between an injection and the operation
- Give it a fair trial: a few months of doing these things properly. If nothing has changed, that’s useful information too
The X-ray shows the wear. Your life shows whether it’s time.
The risks of waiting too long
- Function tends to slip while you wait. Studies of people on waiting lists show walking, joint function and quality of life get steadily worse over months
- Muscles weaken. Limping and protecting the leg waste the hip and thigh muscles, and the hip gets stiffer
- Other parts of life suffer: sleep, mood, weight and general fitness all take a hit when you move less
- Most people still do well after a long wait. Some studies suggest a long delay may take a little off the final result. That’s why guidelines advise considering surgery before severe pain and disability have been going on for a long time
The risks of going too early
- Every operation has risks. Infection happens in around 1 in 100 people. Dislocation, blood clots, a leg that feels a little longer and a numb patch near the scar are the other main ones
- Most people are glad they had it, but at least 7 in 100 are not satisfied afterward. The less the hip bothered you beforehand, the less room there is to feel better
- A new hip wears over time. Roughly 9 in 10 are still working at 15 years. If you’re younger and very active, you’re more likely to need a redo operation at some point in your life
Questions to ask your surgeon
- What will I realistically be able to do afterward that I can’t do now?
- What is likely to happen if I wait another six to 12 months?
- Given my health, what are my own risks?
- Which approach do you use, and why? See anterior vs posterior hip replacement
For a fuller list, see questions to ask before orthopedic surgery. If you decide to go ahead, see how to prepare for hip replacement.
Get seen today if
- You fell and can’t put weight on the leg, or it looks shorter or turned out. It could be a fracture
- The hip is suddenly very painful, hot or swollen and you have a fever or feel unwell
- Your calf is swollen, warm or painful
Get it checked if
- Pain is getting quickly worse over weeks rather than months
- Pain keeps you awake most nights
- You have unexplained weight loss, night sweats or a history of cancer
- You’ve given exercise and the other basics a proper trial and nothing has changed
Don’t wait for a worse X-ray. Decide on what the hip is costing your life.