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Deciding to have knee or hip replacement

Introduction

Careful discussion and thought can help you make a decision about whether or not to have knee or hip replacement surgery. Surgery may or may not be the right choice for you. A key step is to talk to your doctor about your quality of life and your goals for possibly having surgery. You may also read about the operation you're considering and talk to others with knee or hip problems.

Who benefits from knee or hip replacement surgery?

The most common reason to have knee or hip replacement surgery is severe arthritis pain that limits your activities. Your doctor may recommend replacement surgery if:

  • Pain prevents you from sleeping or doing normal activities
  • You cannot move around by yourself and have to use a cane or walker
  • Your pain has not improved with other treatment
  • You understand the surgery and recovery involved

Some people are more willing to accept the limits knee or hip pain places on them, and wait until the problem is severe. Others will want to have joint replacement surgery in order to continue with sports and other casual activities.

Most knee or hip replacements are done in people who are age 60 and older. However, many people who have this surgery are younger. When a knee or hip replacement is done, the new joint may wear out over time. This is more likely to occur in people with more active lifestyles or in those who will likely live longer. If a second joint replacement is needed in the future, it may not work as well as the first one.

Is there any harm in waiting?

For the most part, knee and hip replacement are elective procedures. This means these surgeriesĀ are done to provide relief for your pain, not for any other medical reason.

Delaying surgery should not make joint replacementĀ less effective if you choose to have it in the future. However, if pain is preventing you from moving around well, your muscles around your joint may become weaker and your bones thinner. This may affect your recovery time once you do have replacement surgery.

You may not be able to have replacement surgery.

Your doctor may recommend against knee or hip replacement surgery if you have any of the following issues:

  • You are very obese (weighing over 300 pounds).
  • Your quadriceps, the muscles in the front of your thigh, are very weak. Weak quadriceps could make it very hard for you to walk and use your knee.
  • You have unhealthy skin around your knee.
  • You've had an infection of your knee before.
  • You have a history of heart or lung problems, which can make major surgery more risky.
  • You have any other health conditions that may not allow you to recover well from joint replacement surgery.

References

Mihalk WM. Arthroplasty of the knee. In: Canale ST, Beaty JH, eds. Campbell's Operative Orthopaedics. 12th ed. Philadelphia, PA: Mosby Elsevier; 2012:chap 7.

Harkess JW, Crockarell JR. . Arthroplasty of the hip In: Canale ST, Beaty JH, eds. Campbell's Operative Orthopaedics. 12th ed. Philadelphia, PA: Mosby Elsevier; 2012:chap 3.

Updated: 8/12/2013

C. Benjamin Ma, MD, Assistant Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.


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