What is an outcome for a bone-on-bone hip joint that gives no pain?

That’s a great question! My wife had a similar situation - pain was infrequent and she could exercise vigorously, no problem.
I’ve only heard anecdotally from others that either their father or grandfather “waited too long” and the operation became more complicated and the recovery longer.
In my wife’s case, only after surgery at HSS in NYC did she realize that she had been walking around with one leg shorter than the other.
Phil

I had a left hip replacement about five years ago when I was 76. I had a right knee replacement eleven months ago when I was 80.

Both were done after I had pain. I have concluded, after reading many studies, that most of the folks who are dissatisfied with a hip or knee replacement are those who had minimal or no pain to start with. Their expectations are much higher than someone who just wants the constant pain to stop. I think that is why many surgeons won't do the procedure without the patient having severe pain because it is likely that the patient will have substantial pain during recovery from a TKR (although I did not).

Personally, I would not do the procedure if I were not in substantial pain. I have had spinal and lumbar stenosis for years but it was not symptomatic to the surprise of my Neurologist. At the beginning of 2025 it turned symptomatic with pain radiating down both legs. After some months a pain doctor gave me an epidural steroid shot and so far (16 months later) it is still working.

But I have the Director of Minimally Invasive Spinal Surgery at the Barrows Neurological Institute on call. We have a deal...when the steroid shots stop working I call him.

Incidentally, I don't fear surgery from a great surgeon (and I try to only pick great surgeons). What I fear at my age is general anesthesia. A hip replacement can and should be done with regional anesthesia. That would be my requirement.

Hi, Laughlin 1947,

I am almost in your identical situation. I had a Left THR in 2023 done by a premiere ortho surgeon, but I was left with femoral nerve pain (like fire ants under the skin), which has subsided (but still there) since then. At first, I was told it would "go away" in months (6, 9, 12, 18) but NOT. The ortho did a bikini incision, very neat and clean, but I never asked about what kind of incision and would never have asked for a bikini incision (haven't worn bikinis in decades).

So my right hip is, and has been, bone on bone beginning when my left hip was diagnosed, but the left never hurt. The orthopedic surgeon on the left said I had 2 spurs and that's what caused my pain. My right may sometime "ping" if I rotate a certain way. So I avoid that movement. Otherwise, it does not debilitate me.

I will add I am not a "doctoring" person - for better or worse. Born and raised in coal mining territory in WV, we didn't have lots of medical resources, so we dealt with many situations and ultimately got better - unless it got worse and probably died. As we said in WV, sometimes you can swap the witch for the devil. At any rate, I do not plan to have the right hip operated on until that hip seriously affects my daily activities and quality of my life. Recuperating from the left was ok but I wasn't leaping tall buildings within a few months.

So bottom line, I believe in resorting to serious and invasive surgery like THR when it is absolutely necessary. I've been to my ortho and he agrees and has never said to do it earlier if I'm getting along fine. Of coure, it's everyone's choice and decision to make -- for better or worse. I am 79, in good health (except for normal aches and pains/like the tin man), but exercise, am active, still working part time. And you're right about the anesthesia. That could be the very worst. So many risks and only take them if no other choice. (Forgive typos)

@laughlin1947: I see you've posed some thoughtful questions here over time at Mayo Clinic Connect and have been engaged in several helpful dialogs about issues many of us can relate to as we age.

In regard to bone health, it can come as a shock to many to learn that signs of degeneration can show up on imaging as early as one's 20's. When I had been involved in reviewing disability claims as a nurse, I learned that up to 40% of people in that age category could show such changes in their spine, whether they were having pain or not. So as the years wear on, the wear and tear on on our bones and cartiledge does as well - to varying degrees. These degrees may impact our pain level and ability to function. In a few individuals, however, they have no such effect. In other words, the picture on the imaging (X-ray or MRI) is only a part of the story.

When you mentioned that an orthopedic doctor had called you with a great deal of concern about getting a hip replacement soon after you had inquired, I wonder if this had been based on that inquiry and the review of your films. Perhaps the doctor had been under the impression you had asked because you were having accompanying pain and loss of function typically seen with that type of picture. Perhaps upon review of a detailed history in which you denied any associated issues, the orthopedist was able to take the whole picture into account, that being: there is no need for surgical intervention even with bone-on-bone arthritis without any significant complaints of pain that impact daily function. Although we often hear that surgeries like total hip replacements have become routine (I know, I just had one on Friday but I definitely did have increasing pain and mobility issues!) it's important to remember that surgery carries the risk of infection, blood clots or other complications. As long as the joint is functioning well, which it may continue to do indefinitely, there is no medical indication to operate and consider such potential.

However, should you begin to experience discomfort that leads to pain in the groin particularly that radiates outward or down the leg to the thigh/knee, you notice difficult putting on shoes/socks, lowering to/rising from a chair, ascending/descending stairs, ambulating distances that had not been a problem before or stiffness in the area, definitely report this to your medical provider for a full evaluation so the pain generator can be more fully evaluated and the proper treatment advised.

Please see the section in this accompanying guide on "hip replacement may be an option" and let me know if this information has helped as I hope it has!

@heavyphil Thank you for your comments and description of your family's trials and tribulations. For me, it seemed so odd that once I got face-to-face with the head of the Hoag Orthopedic Hospital and worked the conversation around quickly to my degraded hip joint, that the head surgeon blew me off so quickly, without explaining, as to the fact he would do nothing. So, on one hand I had an orthopedic doctor (now retired) who called me (unexpectedly), being alarmed at the condition of my pain-free hip, versus on the other hand having a head surgeon who simply couldn't be bothered with my case and degrading joints. (This ramble is just me being bewildered).
I'm also concerned about something even moreso than my hip, as I have a badly messed up back (2 sets of vertebrae are bone-on-bone, with 23 degree spinal scoliosis, and the rest of my vertebrae with bulging discs up to 6 mm of bulge) due to a fall off a ladder in 2023. I went to a highly regarded back surgeon who offered no compromise treatment other than back surgery with metal rods and the like. Nothing in between. Over the past many months with my back, I have gone from multiple lower back epidural injections (none better than 3 weeks of pain relief) to radio frequency ablations that have worked wonderfully. But I am so puzzled that no orthopedic doctor has taken extra minutes to discuss my options. That's some of the value of this Mayo Clinic blog - to discuss options.

@mackad2024 Thanks for your personal insights and experiences. I have enjoyed the Mayo Clinic blog immensely, primarily due to others who explain treatment options and their good/bad outcomes. Over these past few years, it seems to me that surgeons want (eagerly) to operate and not offer other treatment options. One personal example I have is that, in April 2025, I had arthroscopic surgery on my left knee due to sharp pain and some slightly rough cartilage. The surgeon did me no favors when he cut part of a torn meniscus that was keeping that joint from being bone on bone. Once he cut the meniscus edge off, the joint did of course become bone on bone, and it looked like I was destined for a TKR. I'm sure that was the objective the surgeon had. TKRs lead to much better paydays. I've been very reluctant to get a TKR due my age of 78years and not being a fan of PT. So, long story short, I went thru multiple epidurals and after having read articles online, I saw where hyaluronic acid injections were often successful. I tried three of those (low viscosity) and they were not successful. Then I saw where there is a version of high viscosity HLA (aka Durolane) that has been successful. I asked my knee ortho doctor why she hadn't offered that option and said it wasn't covered by Medicare. I said I didn't care, and I would pay the $450 out of pocket. Later I asked them to apply to Medicare to get it paid by the program and that effort was successful. I later went on to ask her if she knew about HLA oral capsules (a note from the Mayo Clinic patient blog) and she said she never heard of them. Not a believer! Well, that was several months ago and I'm still doing well with my knee pain. My difficulty is with walking with arthritic knees that ache a bit (I'm a tin man like you), so I'm relearning the finer points of easy walking (doing one hour each AM). I've also become a real fan of radio frequency ablation that is working well after 2 months, and I'm hopeful it will be as long as 6 months of relief.

@laughlin1947: Adding the link to guide here: https://www.mayoclinic.org/tests-procedures/hip-replacement/about/pac-20385042