Think “hip replacement” and you may picture poor, frail Grandma, who slipped, fell and broke her hip. You may not picture your neighbor or co-worker (or yourself!), hale and hearty; ready for another decade or two of an active life.
But think again.
"I am definitely replacing the hip joints of active, younger people,” says Christopher Chen, MD, an orthopedic surgeon with Alta Bates Summit Medical CenterOpens new window in Berkeley. “Just five years ago, the majority of patients were 60-65. Now I'm noticing an increasing number of patients in their 50s who need hip replacement – and even some in their mid 40s.”
We’re living longer. And we’ve probably been far more physically active than our parents or grandparents ever imagined – and moving through middle age, we’re just not ready to stop. But the joints do wear out, just like the tires on your car. And when a hip starts to cause pain, it can severely impact every aspect of life.
Not all hip pain actually represents a problem with the hip joint – see companion article “Oh, My Aching Hip,” to learn other reasons for pain in this area. But if the discomfort has been identified as deterioration in the hip joint itself, there are options for reducing pain and keeping you on your feet.
“A patient with a problem hip has several options,” notes Denise Romero, MD, an orthopedic surgeon with Sutter East Bay Medical Foundation and Alta Bates Summit Medical Center in the Berkeley area. “Treatment really depends on the exact diagnosis, combined with the patient’s needs and goals. Do you want to keep playing tennis, or just keep up with your grandkids?”
The simplest treatments may involve weight loss, modifying activities to put less strain on the joints, or injections that reduce inflammation and relieve pain.
When those are not enough, surgical techniques can repair the areas causing pain or loss of movement.
Younger people with hip impingement – bone catching on bone in the rotating portion of the hip joint - may benefit from arthroscopic surgery to “smooth out” these rough edges. There are also soft tissue injuries about the hip that can be treated arthroscopically that were previously unrecognized and went untreated in active patients with hip pain. “This is a surgery usually performed on an active person in their 20s to 40s,” notes Dr. Romero. “It can give them greater mobility and perhaps forestall the development of arthritis later in life.”
For older patients whose hips are wearing out, actual replacement of the bony joint is the cure. Because even these replacement joints have a limited lifespan – at least a decade, but probably less than 20 years – “the thinking used to be: wait before you replace the joint,” says Dr. Romero. “But that thinking has changed. Patients want to enjoy their 50s, 60s and 70s without pain, so they opt for a replacement sooner. Yes, they may need a revision surgery later in life, but they have gained years of pain-free movement while they are still very active.”
Hip replacement is a major surgery and patients should be aware that there will be some downtime as they recover. “But that doesn’t mean staying in bed,” notes Dr. Romero. “Patients are up and walking while still in the hospital, and out of the hospital in 3-5 days.” However, full recovery may take another few months.
“Patients are delighted to be pain-free,” says Dr. Chen. “They often tell me ‘I wish I had done this sooner! I can’t believe what a difference it has made.’”
The new hip must be respected, and a return to heavy-impact sports is not recommended. But the new hip should allow most daily activities and a range of physical movement - including swimming, hiking and cycling – that don’t involve heavy impact on the joint.
Both doctors are clear that hip replacement is a great option – for the right patient. The patients’ level of pain, goals for their own activity level, and plans for the recovery period should all be considered. “Only the patient can decide when the time is right,” says Dr. Romero.
There are different techniques for performing the surgery, including a newer anterior approach that doesn’t involve cutting through major muscles to reach the joint. This technique is not available in every community, so learning about the surgical options is part of making an informed decision, as is choosing a hospital or facility that has a good track record in joint replacement surgeries.