From the Guidelines
Surgery for hip disease should be considered when conservative treatments fail to provide adequate pain relief or functional improvement, and the patient has radiographically moderate-to-severe osteoarthritis or advanced symptomatic osteonecrosis with secondary arthritis, as recommended by the 2023 American College of Rheumatology and American Association of Hip and Knee Surgeons clinical practice guideline 1.
Key Considerations
- Patients should first try non-surgical approaches including physical therapy, weight loss if appropriate, activity modification, assistive devices like canes, and medications such as NSAIDs or acetaminophen.
- The decision to proceed with surgery should be made through a shared decision-making process with the physician, considering the unique risks and benefits for the individual patient.
- In patients who are indicated for total joint arthroplasty (TJA) and for whom nonoperative therapy has been ineffective, proceeding directly to surgery without delay is conditionally recommended over delaying arthroplasty for a trial of physical therapy or other nonoperative treatments 1.
Special Considerations
- In patients with obesity, delaying surgery to meet a rigid weight or body mass index threshold is not recommended, but patients should be educated on the increased risk of medical and surgical complications due to their obesity 1.
- In patients with diabetes mellitus, delaying surgery to improve glycemic control is conditionally recommended 1.
- In patients with nicotine dependence, delaying TJA to achieve nicotine cessation or decreased use of nicotine products is conditionally recommended 1.
Timing of Surgery
- The timing of surgery depends on individual factors including age, activity level, overall health, and disease severity.
- Hip replacement surgery has a high success rate, with most modern prostheses lasting 15-20 years or longer.
- Delaying necessary surgery can lead to muscle atrophy, gait abnormalities, and compensatory issues in other joints, so patients shouldn't wait until they're completely disabled before considering surgical options.
From the Research
Considerations for Surgery
When considering surgery for a patient with hip disease, several factors should be taken into account.
- The patient's overall health and medical history
- The severity of the hip disease and the impact it has on daily life
- The effectiveness of non-surgical treatments, such as physical therapy, medication, and lifestyle modifications
Non-Surgical Treatment Options
Non-surgical treatment options, such as intra-articular injections, may be considered before surgery.
- Intra-articular injections of corticosteroids, hyaluronic acid, and platelet-rich plasma (PRP) have been shown to provide relief for patients with hip osteoarthritis 2, 3, 4
- PRP injections have been found to provide pain relief and functional improvement for up to six months in patients with mild to moderate hip osteoarthritis 3, 4
Surgical Considerations
Surgery may be considered when non-surgical treatments have failed to provide adequate relief and the patient's quality of life is significantly impacted.
- Total joint replacement (TJR) surgery may be an option for patients with severe hip osteoarthritis 5
- Multimodal pain management strategies, including pharmacologic and non-pharmacologic interventions, can help manage pain before and after TJR surgery 5
Patient-Specific Factors
Patient-specific factors, such as age, disease severity, and overall health, should be considered when deciding on the best course of treatment.