Hip Replacement Surgery: When to proceed

@pjjr My hip replacement choice was obvious - at 54 I could no longer mount a bicycle or go up steep stairs - had immediate replacement of both joints, six weeks apart. The process was not without some bumps in the road due to later-recalled components, but twenty years later, I am still glad I had them done - my quality of life has been great.

But with other ortho surgeries, hand and shoulder, I waited until my pain was every day or function was impaired. My hand surgeon was insistent that one not wait "too long" as too severe damage limits surgical options and can slow healing or prevent full recovery. This happened to two friends, who ended up with more drastic surgeries and less use of the affected hands/wrists.

Another thing to consider - over the past 20 years I have had ay least 10 orthopedic surgeries, and the older I get, the longer it takes to recover, and the harder I have to work at my physical therapy. We are "watching" my knee carefully now to decide exactly what the sweet spot is for a replacement.

Has the doctor indicated why your hip "screams THR" - it is possible that damage is becoming severe enough to risk a failure/fall/fracture - that is a scenario to be avoided if at all possible.

@sueinmn. Thanking you for taking the time to answer me. Doctor said my X-rays are bone on bone on my right hip, but he doesn’t only go by X-rays. I get minor twinges and pain in my knee when I lift something really heavy or as I stated prior putting on my socks. There is also an osteoporosis diagnosis looming over my head. I don’t want to go too soon or wait too long if it’s inevitable. Thank you.
.

@jakedduck1 there are always some risks, true - but not if you aren't a 'risk' itself. I was healthy, younger than the average person... but, I'm not going to lie - it did cause me a lot of pain.... But, I do my exercises that the PT recommended and this helps. I force myself to get outside and walk - and that helps, but it's hot in AZ. Our winter lasted 48hours. Shop around for doctors, if that would give you any assurance. My sister had the robotic one done- and was up and literally w/o pain in a week... I'm jealous!!

@pjjr My 69 yr old wife had your exact situation but even more so: elliptical machine 6 days/wk- zero pain!
Had an issue which seemed like sciatica/piriformis; consulted chiropractor who did range of motion tests and literally said “Well, it’s definitely NOT your hip!” Gave her exercises which did not help.
I finally convinced her to see an orthopedist ‘just because’….
He took an XRay, declared ‘bone on bone, you need a new hip, call me when you can’t stand the pain anymore’ and walked out…we were stunned and in disbelief.
Got a second consult at HSS and orthopedist said the same thing, but since there was no pain from the hip itself, maybe it was referred pain and suggested a steroid shot into the capsule…useless.
But the doc said waiting would have NO bearing on the outcome and even if she postponed surgery by a few years it would not impact the chance for success.
But not being a procrastinator, she went ahead and had the hip replaced since she knew it was inevitable. She’s almost 5 months out and that pain she had is gone; she does, however, have some twinges here and there from the surgery itself and it may take a full year until all that is completely resolved.
FYI - this is NOT an atraumatic surgery and muscle/tissue manipulation is anything but ‘delicate’, even by our HSS surgeon who used the STAR approach and did the entire procedure virtually on his laptop before picking up a scalpel. Best,
Phil

@heavyphil Thanks, I am not concerned with the surgery, coming off a lobectomy in January 2025 and displaced fracture of the clavicle in October 2025. I understand the not being the procrastinator part totally.(had the lung surgery 1 week after the thoracic surgeon said it had to come out. He told me to please let him know when I was ready.) So far one year later all is good. It’s am I going to be able to do what I do now, versus removing the discomfort that I have.

@sue2020
This is absolutely great advice!

I had a left hip replacement three years ago and a right knee five months ago. Both were pain free. I attribute that success as follows: 5% for my research into surgeons and techniques; 90% for the incredible skill and experience of my surgeon; and 5% for luck (good in my case).

I believe that the most important decision one can make once one decides that a TKR is needed is surgeon selection. Hip/knee replacement surgeons are no different from other professionals. There are some extraordinary ones, some really good ones, some pretty bad ones some who should have their license revoked with most somewhere in the middle.

As patients we can't really control the luck portion (I was a 77 YO male at the beginning of all this joint replacement stuff) but we can maximize our chances of a great recovery by picking a surgeon at the extraordinary end of the spectrum. My magician says he has three criteria for a replacement surgeon: extensive experience doing the exact same procedure; great hands; a great mind. If you can have all three, you are well on your way.

@pjjr If the doctor says the "xrays scream THR" that doesn't sound right! You may need a second opinion from a different orthopedic cliniic, even your primary doctor!
Depending on your risk factors and chronic diseases, it may be appropriate to use a prescription or OTC pain med on days you walk. Suggest to figure out, possibly with a Registered Dietitian and/or exercise specialist, what your goals are and lifestyle plan to achieve health goals. You mentioned 2-3 miles a day (or walking 4 times a week?), why 2-3 miles and what speed and target heart rate?
Difficult to say with limited information, but it sounds as though you may be doing OK, without using medication on occasion, and THR is not a consideration anytime in the next few years- if ever. The part about pain putting on socks is puzzling, not sure if that's your hip, perhaps try a sock assistive device- search your favorite retailer for "hip kit" - a hip kit might assist putting on socks and picking objects off the floor.
Best wishes

I am scheduled for THR in 2 weeks using anterior approach. I have bone on bone left hip & unable to bend, tie shoes or put on socks without sock aide. I’ve seen 2 surgeons & both agree I need the surgery. I am 65 & 8 months post lumbar fusion L4-5 and starting to feeling pretty good with just completing back PT. Hip pain causing sleep issues & weakness is affecting my gait. My PT agrees with surgeons. I’m unable to walk any real distance & continue to use a cane for extra support. I’m having second thoughts on having another surgery but I want to get back to walking again. Im hoping for the best.

@lopezaa25 sounds as though you are going ahead with surgery. You mentioned fusion in your low back; I believe the fusion is considered to possibly increase dislocation risk after surgery, suggest to discuss with the surgeon and determine if the surgery or THR hardware will be different because of the history of fusion. Best wishes

@tallbackhip I was told there is a slight possibility of dislocation since the fusion was done before the hip, which of course concerns me. I will ask about the different hardware though. I checked in with my spine surgeon as well. It’s been a hard decision but I am moving forward hoping to relieve the pain and finally get back to some real walking again. Wish me luck!