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Jonathan Cluett, M.D.

Delaying Hip Replacement Not Helpful

By April 30, 2014

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A recent analysis found that delaying hip replacement was not a cost effective way to address the treatment of severe hip arthritis.

Hip arthritis may require you to have a hip replacement surgery, but often patients and doctors worry about doing this too soon.  The common thinking is that simple treatments should be exhausted, and patients should be older before hip replacement.

While this study is not the definitive answer, it does suggest that delaying surgery may not be necessary.  First, it may not save on cost.  Second, because of improvements in hip materials, the likelihood of needing revision hip replacement is very small.

Related: Hip Replacement in Young Patients | Hip Replacement Implant Options

Source: Early Hip Replacement Cost-Effective

Comments
February 12, 2013 at 10:26 am
(1) Jane Doe says:

Six weeks ago I had a hip replacement at the age of 53.

By the time I had my first hip x-ray in March 2010, I’d been limping and had pain for several years, and the x-ray showed bone-on-bone arthritis. The surgeon I spoke to estimated I’d need to have the surgery within 2-3 years, and he turned out to be right.

I feel strongly that the approach taken by many doctors–”you’re ready for your hip replacement when your pain is no longer being controlled by pain killers–is very misguided. Severe arthritis involves a lot of pain, suffering, and dysfunction, and I don’t see why someone my age, for example, should more or less destroy his life for several years in order to put the surgery off as long as possible. If he gains two extra years before doing the surgery and those years are filled with misery, what has he gained? Also, I am sure many people with severe arthritis become sedentary, lose muscle mass, and gain weight, all of which are clearly harmful to their overall health. There is also the damage that long-term use of pain killers can cause to the body.

Bottom line: I wonder how many of the surgeons who take the approach of waiting until the pain killers are no longer working have had severe arthritis themselves. My guess is very few of them.

February 13, 2013 at 12:32 am
(2) L.P. says:

I have been in severe pain for almost 2 years as I’m bone on bone. The last Ortho guy I saw a year ago said, You need a hip replacement. I said…..NOT in this lifetime!! I don’t LIKE surgery and am not good at it…or recovery. So, I went to an osteopath….today actually…. and she wants to do a cortizone injection into that bad hip….mainly to relieve this horrific pain as I can barely walk even with my cane which I’ve been using for almost 3 years now, and I don’t sleep….because of this pain.
I also have spinal stenosis and many other physical issues that are also causing pain….too numerous to mention. I do have Lyme Disease and Lymphedema which can create problems with surgery. I will eventually have to have my hip replaced, but IF I can get out of this pain temporarily and be able to walk, this is what my goal is for now. I am obese and I doubt any doctor would do a hip replacement with my weight. I LOVE to walk and lost quite a few pounds a few years ago, and when your in severe pain, it is easy to lose muscle mass and gain weight. This is exactly what has happened to me. I want my life back!!

February 17, 2013 at 11:28 pm
(3) Jo E says:

It took 2 years to find out that the reason I was falling was not neurological. By the time my degenerative arthritis was finally diagnosed the Dr said I needed hip replacement – not now – but years ago. He couldn’t figure out why it had taken so long to diagnose (I wasn’t complaining of pain when my PCP send me to a neurologist). The ortho surg said my x-ray was the worst he had ever seen. When the surgery was over, he told me that he didn’t know that it could get that bad. I was past bone on bone. Unfortunately, he put in metal-on-metal. Chromium inhibits potassium. Before the surgery, I was not taking K+. A few months after surgery, I was put on an Rx K+ supplement. Later, it was raised to 2. Then to 3. Now I am up to 4 of those Rx tablets per day. I wonder if there is a relationship. My Cr and Co levels are elevated. I will be going back for a 3rd blood test in a few weeks. I may end up getting an MARS MRI or an ultrasound to see if there is loose metal. Xrays are clear, but that is no guarantee that everything is okay. I hope that the implant manufacturers lose and lose big time. They have caused too many people to lose because of their irresponsibility.

February 27, 2013 at 9:19 am
(4) Carissa says:

Well put together comment! I totally loved it. I’ve read through a very similar web blog with regards to orthopedic health professionals. Its totally worth looking at.

May 6, 2014 at 10:47 am
(5) NT says:

Hi

I have Avascular Necrosis of my left hip which was diagnosed after several years of misdiagnosis as the pain was showing up in my knee rather than in my hip. Anyhow at 28 I have been told by some doctors that I need the surgery right away. One went so far as to give me a cane. I have not done it as I know that at my age this could mean a potential revision before the age of 50 and I honestly do not want to go through that then.

I am bearing the pain for the last 2 years (and 5 years before that without being diagnosed) and have watched it grow worse and affect my demeanor and my relationships. I do not know how helpful it is to go through with it and I have benefitted from alternative therapy in tolerating my pain. My doctor’s latest prediction was that I will need the surgery by December 2014. I hope and pray everyday to be able to beat that prediction as well.

I believe that delaying it is worth it. I do not believe that surgery at my age will end well for me under any circumstances. However that is my personal opinion.

May 6, 2014 at 7:05 pm
(6) Jan Butler says:

I have psoratic arthritis and spent most of my life as a landscaper, or in a horticultural setting with a very high cost to my joints. My first total hip replacement was at 57 years and was life changing. I had retrained so as not to still be working so hard, and I was asked to donate the excess bone as it was very strong due to my physical lifestyle. I was delighted to be able to do that as I have since had breast cancer and not able to be an organ donor. I had a second total hip replacement when I was 62 and it was also very much a life changer. Unfortunately I dislocated that one [in the garden] and it was replaced with a different style of prothesis a year later. Fantastic if you do all the excercises and respect the joint and are sensible and careful. I am now waiting for my new knee! Jan B,Queensland, Australia

May 6, 2014 at 9:18 pm
(7) Donna says:

My mother put her hip replacement off for 10 years with the idea that the longer she held out, the longer it would be until she needed it to be replaced. Unfortunately, the constant limping affected her other hip and she has now had two total hip replacements. At 52, I had my total hip replacement (Nov 1/13). Should you wait? NO WAY! What are you waiting for….to be mobile when you are too old to enjoy it? My other hip is showing no signs of deterioration so hopefully not limping on it for years waiting to get old has saved it. I am young now and am not guaranteed old age. Every step I now take I am grateful that I live in a time where hip replacements are possible. I LOVE my new hip and am SO glad I did it now instead of suffering these good years away. I still can’t believe how pain free I now am. When I see people with “the limp” I want to go and tell them to just bite the bullet and get it done as they will be glad they did.

May 7, 2014 at 7:06 am
(8) Hallie Bass says:

The pain and mobility issues associated with an orthopedic condition can be disabling and can cause additional health problems. Persons who are in chronic pain and cannot exercise or even get around well are more subject to weight gain, side effects from their pain medication, depression and loss of cardiovascular fitness. Why wait until someone is chronically disabled before they can be helped with a joint replacement or ortho intervention?

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