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Deciding to have knee or hip replacement

There are many things you can do to help decide whether to have knee or hip replacement surgery or not. These may include reading about the operation and talking to others with knee or hip problems.

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

Surgery may or may not be the right choice for you. Only careful 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 provider 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.
  • You cannot safely care for yourself due to your level of pain and disability.
  • 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 more 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 most often 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. This means these surgeries are done when you are ready to seek relief for your pain, not for emergency 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, the provider 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 provider may recommend against knee or hip replacement surgery if you have any of the following:

  • Extreme obesity (weighing over 300 pounds or 135 kilograms)
  • 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
  • Previous surgery or injuries that do not allow for a successful joint replacement
  • Heart or lung problems, which make major surgery more risky
  • Unhealthy behaviors such as drinking, drug use, or high risk activities
  • Other health conditions that may not allow you to recover well from joint replacement surgery

References

Felson DT. Treatment of osteoarthritis. In: Firestein GS, Budd RC, Gabriel SE, McInnes IB, O'Dell JR, eds. Kelley and Firestein's Textbook of Rheumatology. 10th ed. Philadelphia, PA: Elsevier; 2017:chap 100.

Ferguson RJ, Palmer AJ, Taylor A, Porter ML, Malchau H, Glyn-Jones S. Hip replacement. Lancet. 2018;392(10158):1662-1671. PMID: 30496081 www.ncbi.nlm.nih.gov/pubmed/30496081.

Harkess JW, Crockarell JR. Arthroplasty of the hip. In: Azar FM, Beaty JH, Canale ST, eds. Campbell's Operative Orthopaedics. 13th ed. Philadelphia, PA: Elsevier; 2017:chap 3.

Mihalko WM. Arthroplasty of the knee. In: Azar FM, Beaty JH, Canale ST, eds. Campbell's Operative Orthopaedics. 13th ed. Philadelphia, PA: Elsevier; 2017:chap 7.

  • Hip joint replacement

    Animation

  •  

    Hip joint replacement - Animation

    Your hip is hurting so bad, you can't sleep. It's hard to bathe, to clean, make it to the mailbox or shop at the mall. You may have severe arthritis in your hip, and there's a good chance you need a hip replacement. Hip replacements are usually done in people age 60 and older. If you need one, you probably have severe arthritis that limits your daily life, or perhaps have a hip fracture. Your hip joint is made up of two parts, the hip socket and the upper end of the thigh bone. One or both parts may be replaced during surgery. Your new hip will probably have a socket made of strong metal, a liner that fits inside the socket, usually plastic, a metal or ceramic ball to replace the round head of your thigh bone, and a metal stem attached to the thigh bone to make your joint more stable. So, how is the hip replacement procedure done? Well you won't not feel any pain during surgery because you will have medicine to make you fall asleep. The surgeon will cut and remove the head of your thigh bone and clean out your hip socket, removing cartilage and damaged or arthritic bone. The surgeon will put the new hip socket in place, insert the metal stem into your thigh bone, and place the ball for a new joint. Cement will probably hold the new joint in place. The surgery can take several hours. After the surgery, you will probably stay in the hospital for three to five days. As soon as the first day after surgery, you will be asked to start moving and walking around with a walker, crutches, or a cane. You will need physical therapy to strengthen your new joint for up to several weeks after your operation. Some people need a short stay in a rehabilitation center after they leave the hospital. At the rehab center, you will learn how to safely do your daily activities on your own. Your new hip should allow you to resume your daily activities once you've learned to move around on your own. In the long run, over 20 years or so, the joint may need to be placed again. But, in the short run, most or all of your pain should go away. The stiffness should go away. Your doctor should be able to monitor any problems and you should enjoy your new joint.

  • Knee joint replacement

    Animation

  •  

    Knee joint replacement - Animation

    Your knee has been hurting for a while, and it hurts bad. You've had trouble sleeping. It may be hard to bathe, to do normal chores like wash the car, or even be comfortable on the job. You may have severe arthritis in your knee, and if so there's a good chance you need a knee replacement. So, what is a knee replacement? Knee replacements are usually done in people age 60 and older. If you need one, you probably have severe arthritis that limits your daily life. During knee joint replacement, your surgeon will remove damaged cartilage and bone from the knee joint. The surgeon then puts man-made pieces, called prostheses, in their place. The lower end of the thigh bone, also called the femur, is usually replaced with a metal part. The part that replaces the upper end of the shin bone, the tibia, is usually made from metal and a strong plastic. The piece that replaces the back side of your kneecap, or patella, is usually made from a strong plastic. You shouldn't feel any pain during surgery because you will have medicine to make you fall asleep. The surgeon will make a cut over your knee to open it up. The cut is usually eight to ten inches long. Your surgeon will move your kneecap out of the way, then cut the ends of your thigh bone and shin bone to fit the replacement part. The surgeon will then cut the underside of your kneecap and prepare it for the new pieces that will attach there. The surgeon then fastens the two parts of the prosthesis to your bones, the upper end of the shin bone and the lower end of the thigh bone. Then the parts are attached to the underside of your kneecap using a special cement. The surgery usually takes a couple hours. After surgery, you will probably stay in the hospital for three to five days. As soon as the first day after surgery, you will be asked to start moving and walking around with a walker, crutches, or a cane. You will likely need physical therapy to strengthen your new joint after your operation. Some people need a short stay in a rehabilitation center after they leave the hospital. At the rehab center, you will learn how to safely do your daily activities on your own. Full recovery can take three months to a year. Your new knee should last for 15 years or maybe even 20. And in the mean time, your new knee should allow you to resume your daily activities once you have learned to move around. Most or all of your pain and stiffness should go away.

  • Hip joint replacement

    Animation

  •  

    Hip joint replacement - Animation

    Your hip is hurting so bad, you can't sleep. It's hard to bathe, to clean, make it to the mailbox or shop at the mall. You may have severe arthritis in your hip, and there's a good chance you need a hip replacement. Hip replacements are usually done in people age 60 and older. If you need one, you probably have severe arthritis that limits your daily life, or perhaps have a hip fracture. Your hip joint is made up of two parts, the hip socket and the upper end of the thigh bone. One or both parts may be replaced during surgery. Your new hip will probably have a socket made of strong metal, a liner that fits inside the socket, usually plastic, a metal or ceramic ball to replace the round head of your thigh bone, and a metal stem attached to the thigh bone to make your joint more stable. So, how is the hip replacement procedure done? Well you won't not feel any pain during surgery because you will have medicine to make you fall asleep. The surgeon will cut and remove the head of your thigh bone and clean out your hip socket, removing cartilage and damaged or arthritic bone. The surgeon will put the new hip socket in place, insert the metal stem into your thigh bone, and place the ball for a new joint. Cement will probably hold the new joint in place. The surgery can take several hours. After the surgery, you will probably stay in the hospital for three to five days. As soon as the first day after surgery, you will be asked to start moving and walking around with a walker, crutches, or a cane. You will need physical therapy to strengthen your new joint for up to several weeks after your operation. Some people need a short stay in a rehabilitation center after they leave the hospital. At the rehab center, you will learn how to safely do your daily activities on your own. Your new hip should allow you to resume your daily activities once you've learned to move around on your own. In the long run, over 20 years or so, the joint may need to be placed again. But, in the short run, most or all of your pain should go away. The stiffness should go away. Your doctor should be able to monitor any problems and you should enjoy your new joint.

  • Knee joint replacement

    Animation

  •  

    Knee joint replacement - Animation

    Your knee has been hurting for a while, and it hurts bad. You've had trouble sleeping. It may be hard to bathe, to do normal chores like wash the car, or even be comfortable on the job. You may have severe arthritis in your knee, and if so there's a good chance you need a knee replacement. So, what is a knee replacement? Knee replacements are usually done in people age 60 and older. If you need one, you probably have severe arthritis that limits your daily life. During knee joint replacement, your surgeon will remove damaged cartilage and bone from the knee joint. The surgeon then puts man-made pieces, called prostheses, in their place. The lower end of the thigh bone, also called the femur, is usually replaced with a metal part. The part that replaces the upper end of the shin bone, the tibia, is usually made from metal and a strong plastic. The piece that replaces the back side of your kneecap, or patella, is usually made from a strong plastic. You shouldn't feel any pain during surgery because you will have medicine to make you fall asleep. The surgeon will make a cut over your knee to open it up. The cut is usually eight to ten inches long. Your surgeon will move your kneecap out of the way, then cut the ends of your thigh bone and shin bone to fit the replacement part. The surgeon will then cut the underside of your kneecap and prepare it for the new pieces that will attach there. The surgeon then fastens the two parts of the prosthesis to your bones, the upper end of the shin bone and the lower end of the thigh bone. Then the parts are attached to the underside of your kneecap using a special cement. The surgery usually takes a couple hours. After surgery, you will probably stay in the hospital for three to five days. As soon as the first day after surgery, you will be asked to start moving and walking around with a walker, crutches, or a cane. You will likely need physical therapy to strengthen your new joint after your operation. Some people need a short stay in a rehabilitation center after they leave the hospital. At the rehab center, you will learn how to safely do your daily activities on your own. Full recovery can take three months to a year. Your new knee should last for 15 years or maybe even 20. And in the mean time, your new knee should allow you to resume your daily activities once you have learned to move around. Most or all of your pain and stiffness should go away.

    Self Care

     
     

    Review Date: 7/7/2019

    Reviewed By: C. Benjamin Ma, MD, Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery, San Francisco, CA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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