The American Academy of Orthopedic Surgeons estimates that each year, more than 450,000 Americans have their hips replaced—more than the entire population of Cleveland. According to the Journal of Bone and Joint Surgery, this surgery has been around for just over 50 years, since 1969.
Indeed, the surgery has become so common that older adults in America tend to talk about it as more a matter of when than if.
Here’s why: As we humans live longer lives, our hips suffer more wear and tear, which can lead to arthritis in the hip joint. Arthritis is swelling and tenderness on the joint, which can cause pain and stiffness and tends to worsen with age, according to the Mayo Clinic.
By 2025, experts project that over 650,000 people will have their hips replaced each year, and by 2040, some 1.5 million surgeries will be performed annually, according to a recent article in the Journal of Rheumatology.
These days, more than 7 million Americans are walking around on replacement hips.
Hip Replacement Surgery: What’s Involved?
The surgery involves replacing the rounded knob on the end of the largest bone in the leg, the femur, with a steel knob, and reinforcing its socket in the pelvic bone with a steel cup. There can also be another component inserted in between, or other materials used for either the knob or the socket reinforcement, including plastics and ceramics.You will either be given general anesthesia or spinal anesthesia, depending on your care team’s preferences and your medical history. Every case is different, of course, but the surgery usually takes about two hours. Some patients will be able to recover at home afterward, but if you have a preexisting condition, your doctor may want you to spend a night—or even two—in the hospital.
Recovery time and how much pain you feel will vary. While you should be able to walk within a day or two of the replacement (with or without a walker or a cane), it can take your body several weeks to several months to heal.
Complications: How Common Are They?
Multiple replacement models have been recalled since 2000 due to structural failure, according to a thorough review in the British Medical Journal.In addition, some patients with metal-on-metal hip replacements can get metallosis, a reaction to the microscopic metal debris that comes off as the joint rubs together over and over, causing tissue damage and/or immune reactions in the hip or elsewhere in the body.
According to a 2017 study in The Lancet, only 5 out of 100 people who have a hip replacement will need another one within 10 years. However, 15 percent of people will need the operation to be redone within 20 years. On average, outcomes are worse for younger adults: It’s common for younger people, particularly men in their early 50s, to need a second replacement within five years.
While hip replacement surgery is considered safe, in the short term, there is a very small increased risk of death following hip replacement surgery of about one-third of 1 percent in the first month, two-thirds of 1 percent within the first three months. These deaths are mostly from blood clots leading to heart attack or lung embolism, according to a 2014 study in the British journal Bone & Joint Research. If you have to have a second surgery, your risk of death increases to 2.5 percent.
Complications can include severe reaction to the cement used, nerve injury, internal bleeding, and dislocations, among others. Some people experience an annoying squeaking when walking.
Alternatives to Hip Replacement
Most patients don’t have any of these problems, but nobody wants to jump into major surgery without considering alternatives. And, as common as this surgery is, there are several other options.Your doctor may start by recommending that you have a hip resurfacing procedure. Other new medical possibilities are also in the works.
Subchondroplasty
This arthroscopic surgery repairs the tissues and injects a cement to shore up the bone. It’s being used mostly for younger patients in their 20s to 50s, and may be useful for older adults.
Stem cell therapy
These injections take progenitor cells from elsewhere in the hip and move them to the damaged areas to stimulate the body to regrow bone and cartilage.
Platelet-rich plasma therapy
You may have heard of top athletes such as golf superstar Tiger Woods and basketball genius Stephen Curry using PRP—platelet-rich plasma—therapy, both for knee problems. This intervention involves harvesting your own healing platelet cells from your blood plasma and redirecting them into the injured area, stimulating healing and regrowth of your tissues.
Keeping Your Hips Healthy
By the time you’re thinking about replacement, you may have already tried the low-intervention program that most doctors use to see if replacement can be avoided or put off: Conventional Western medical doctors usually recommend some combination of pain medication, anti-inflammatory drugs, cortisone injections, physical therapy, and supplements to improve bone health.These can all be helpful. But there are also other ways to improve hip health. Weakness of supporting muscles around the hip, along with tightness and inflexibility, can create bad patterns of movement. A program of stretching to loosen up your muscles, combined with targeted strength building to support your hips, can actually help you change the way you walk and run. That can get to the cause of what’s damaging your hips, helping you protect and preserve them.
A good physical therapist can guide you through the process of changing your stride. YouTube has helpful video demonstrations to see what’s involved and even get you started on a rehabilitation program.
Moving throughout the day is important, as sitting for long periods can exacerbate joint pain and cause arthritis. Low-impact aerobic activity to keep your hip joints moving in a healthy way is key. Many adults find walking, biking, dancing, or swimming most enjoyable. But you may have to change what you’re used to doing if you’re noticing pain in your hips. Try different activities to see what works.
Here’s where Eastern practices can really help. Tai chi and qigong are both excellent ways to increase hip mobility, strengthen muscles, and improve balance, and can be done in a gentle way into old age. If you’ve never tried a Chinese martial art form or energy exercise, don’t be intimidated. Consider this: Tai chi has been shown in clinical trials to help older adults with arthritis improve physical function, strengthen muscles around joints, and relieve pain.
You can watch in an inspiring 2007 YouTube video, family physician Dr. Paul Lam, M.D., a former lecturer at the University of New South Wales Sydney, who has spent his career teaching people how tai chi can help with arthritis and other common ailments of aging to improve their health and restore function.
Tai chi also improves mood and builds physical confidence, helping you increase mobility in general, which in turn may inspire you to be more active. In fact, a 1996 study led by researchers at Emory University’s School of Medicine in Atlanta found that older adults practicing tai chi could reduce their incidence of falls by almost 50 percent.
Learning qigong, a gentle Chinese meditation and exercise practice can also help you avoid needing to have your hips replaced. A 2017 review article found that for people with disabling arthritis, qigong exercises reduced pain, improved mobility, and even helped alleviate depression.
If there are no qigong classes offered at your local community center or qigong academy, there are helpful YouTube videos and web pages that show you how to use qigong to improve hip mobility. A good place to start educating yourself is the Qigong Institute’s website. This California-based nonprofit is dedicated to promoting our scientific understanding of the practice.
Yoga, which originated in northern India more than 5,000 years ago, can also help you improve or avoid hip pain. Yoga combines stretching with strengthening, and can help keep you mobile into old age. Yoga studios are everywhere these days, and YMCAs often offer yoga classes with classes tailored to healthy aging. Consider trying a private lesson or two with a teacher who can get you started on an individualized program for your needs and ability. Here, too, free YouTube videos that showcase therapeutic yoga for the hips are a great way to see what’s involved and get started.
Finally, to keep your mobility, it’s also important to keep your weight down. This eases the load on your joints. While you’re at it, make it a priority to eat lots of dark leafy greens, nuts, soy, and fish to build calcium levels for bone health. Rosehip tea has also been shown to provide mild relief from osteoarthritis.
The take-away: There’s hope for your hips. Like most things, the earlier you start, the more successful you'll be. But even if you’re new to tai chi, qigong, yoga, and healthy eating, engaging in these practices will help. It’s true you may end up needing a hip replacement at some point. But that’s okay. After all, you’re in this for the long run.
