From the Guidelines
Surgical intervention for hip arthritis is recommended when conservative treatments fail to provide adequate pain relief and functional improvement, with total hip arthroplasty being the most common procedure, as supported by the most recent and highest quality study 1.
Indications for Surgical Intervention
The decision to proceed with surgical intervention for hip arthritis should be based on the following indicators:
- Moderate to severe pain that persists despite conservative management
- Significant functional limitations
- Radiographic evidence of advanced arthritis with joint space narrowing, bone spurs, or deformity
Pre-Surgical Considerations
Before undergoing surgery, patients should be medically stable enough to tolerate the procedure, and the timing of surgery should be individualized based on symptom severity, functional limitations, and the patient's overall health status.
Surgical Procedure
Total hip arthroplasty involves removing damaged bone and cartilage and replacing them with prosthetic components, and is considered a clinically effective intervention for the management of osteoarthritis, as noted in 1.
Post-Surgical Pain Management
The analgesic regimen for total hip arthroplasty should include pre-operative or intra-operative paracetamol and cyclo-oxygenase-2-selective inhibitors or non-steroidal anti-inflammatory drugs, continued postoperatively with opioids used as rescue analgesics, as recommended in 1.
Key Considerations
- Age alone is not a contraindication for surgical intervention, but patients should be medically stable enough to tolerate surgery
- Delaying necessary surgery can lead to muscle atrophy, deconditioning, and potentially more difficult recovery, while performing surgery too early may expose patients to unnecessary surgical risks, as discussed in 1 and 1.
From the Research
Guidelines for Surgical Intervention
The decision to undergo surgical intervention for hip arthritis depends on various factors, including the severity of symptoms, patient's overall health, and the presence of any underlying conditions.
- Total hip arthroplasty (THA) is a common surgical procedure for hip arthritis, which involves replacing the damaged joint with an artificial one 2, 3.
- The procedure has been shown to be effective in reducing pain and improving function in patients with severe hip osteoarthritis, with significant improvements in patient-reported hip pain and function at 6 months after surgery 3.
- However, the decision to undergo THA should be made on a case-by-case basis, taking into account the patient's individual needs and circumstances.
Conservative Treatment Options
Before considering surgical intervention, conservative treatment options should be explored.
- Conservative treatment, such as modifications in activities of daily living and physical therapy, can be effective in managing mild femoroacetabular impingement and improving symptoms 4.
- Resistance training has also been shown to be a viable alternative to THA for some patients with severe hip osteoarthritis, although the effectiveness of this approach may vary depending on the individual patient 3.
Considerations for Surgical Intervention
When considering surgical intervention, several factors should be taken into account.
- The patient's bone quality is an important consideration, as osteoporosis can increase the risk of perioperative fracture, periprosthetic fracture, and late aseptic loosening 5.
- The type of implant used can also affect the outcome of the procedure, with conservative hip implants potentially offering an additional option for younger patients with arthritis 6.
- The surgeon's experience and expertise are also crucial factors in determining the success of the procedure 2.