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QI have pain in my hip that is getting worse. If I need a hip replacement, I have read that there have been improvements in pain management after surgery and some people can go home the same day. How will I know if I need hip replacement surgery?

AHip replacement is a highly successful surgery to relieve hip pain caused by osteoarthritis, the type of arthritis caused by wear and tear. When you see an orthopedic specialist, the first step is to determine the specific cause of your pain. In addition to a discussion of your symptoms and the physical examination, an x-ray is the best way to see if a patient has osteoarthritis. The specialist will carefully evaluate the amount of space between the bones in the hip joint. If there is very little space, or no space at all, that means the cartilage is worn away. We call this “bone on bone” arthritis.

On the other hand, if an x-ray shows substantial space between the bones, it indicates that a patient still has good cartilage, so something else may be triggering the pain. There can be any number of causes, from an overuse injury resulting from repetitive stress to an inflammatory condition such as bursitis. Most conditions, including osteoarthritis, are treated with activity modification, anti-inflammatory medication, acetaminophen and sometimes a steroid or PRP injections.

To answer your original question, the time is usually right for hip replacement when a patient experiences ongoing pain and limited mobility, has clear joint space narrowing on an x-ray and is not helped by nonoperative treatment. The surgery entails replacing the painful, arthritic joint with a hip replacement implant. Advances in implant materials now allow a hip replacement to last decades, even a lifetime. Improved tissue-sparing surgical techniques and pain control have also been of great benefit.

Some people are surprised to learn that they will not need general anesthesia. At HSS, we use regional anesthesia during hip replacement surgery. An additional anesthetic injected at the end of surgery provides pain control for up to 72 hours after the procedure. Many patients can manage pain with acetaminophen and anti-inflammatory medication alone, and opioids are rarely needed.

These days, about half of the patients at HSS go home within 24 hours of hip replacement. Many motivated patients in good health even go home the same day. They generally have the surgery in the morning and go home that evening.

There is no age limit for total hip replacement surgery. A study at HSS found that hip replacement was just as successful in patients over age 90, although they usually stay in the hospital longer than younger individuals.

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