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Deciding to have knee or hip replacement

Introduction

There are many factors that can help you decide to have knee or hip replacement surgery or not, such as reading about the operation and talking to others with knee or hip problems.

A key step is talking to your doctor about your quality of life and goals for surgery.

Surgery may or may not be the right choice for you. Only careful discussion and thought can help you make a decision.

Who benefits from knee or hip replacement surgery?

The most common reason to have a knee or hip replaced is to provide relief from severe arthritis pain that limits your activities. Your doctor may recommend replacement surgery when:

  • 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. They will wait until the problems are severe. Others will want to have joint replacement surgery in order to continue with sports and other activities they enjoy.

Knee or hip replacements are usually done in people who are 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 after surgery. Unfortunately, if a second joint replacement is needed in the future, it may not work as well as the first.

Is there any harm in waiting?

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

In most cases, delaying surgery should not make joint replacement less effective if you choose to have it in the future. In some cases, doctors may strongly recommend surgery if deformity or extreme wear and tear on the joint affects other parts of your body.

Also, if pain is preventing you from moving around well, the muscles around your joints may become weaker and your bones may become thinner. This may affect your recovery time if you have surgery at a later date.

Why 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:

  • Extreme obesity (weighing over 300 pounds)
  • Weak quadriceps -- the muscles in the front of your thighs -- that can make it very hard for you to walk and use your knee
  • Unhealthy skin around the joint
  • Previous infection of your knee or hip
  • Heart or lung problems, which make major surgery more risky
  • Other health conditions that may not allow you to recover well from joint replacement surgery

References

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

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

Updated: 5/15/2014

C. Benjamin Ma, MD, Assistant Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery, San Francisco, CA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.


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