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Arthritis Today

What to Expect After Hip Replacement

Most patients have mild or no pain, and improved function, at two- and five-year marks post surgery.

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For more than four decades, total hip replacement has dramatically reduced pain and improved function in patients with severe joint damage from osteoarthritisrheumatoid arthritis and other causes. But a new study aims to pinpoint how significant the improvement can be on an individual, patient level after the surgery – which is also called total hip arthroplasty (THA).

Researchers say most previous data has primarily compared outcomes on a group level between those that had the procedure and those that did not. “The study provides more insights and a clearer picture of what happens to people after the surgery at two and five years.” says lead author Jasvinder Singh, MD, an associate professor of medicine in the division of clinical immunology and rheumatology at the University of Alabama at Birmingham School of Medicine. “I think this study helps clarify for patients and their providers and policy makers what patients can expect in explicit terms.”

According to various estimates, approximately 430,000 total hip arthroplasties were performed in the United States in 2009 – and that number is expected to triple by 2030, according to a projection made by researchers at Exponent, an engineering and scientific consulting firm, published in The Journal of Bone and Joint Surgery in 2007. It is a common treatment for severe end-stage arthritis.

The study, published in the February issue of the journal Rheumatology, analyzed data from the Mayo Clinic Total Joint Registry, which contains information on nearly all of the joint replacement surgeries done at Mayo Clinic since it performed the first FDA-approved total hip replacement roughly 43 years ago. This research looked at 6,168 patients getting their first (or primary) total hip replacement and 2,063 getting revision surgery between 1993 and 2005.

Patients answered questionnaires (by mail, telephone or during a doctor visit) two and five years after surgery. Patients on average were in their mid 60s.

Researchers found that improvements were more significant in those getting their first surgery and those whose pain and limitations was “moderate” before the procedure rather than “severe.”

The researchers found, for primary THA patients, among those with “moderate” preoperative pain, 94 percent reported “mild” or “no” pain after 2 years and 91 percent reported “mild” or “no” pain after 5 years.

Among patients with “severe” preoperative pain, 91 percent reported “mild” or “no” pain after 2 years and 89 percent reported “mild” or “no” pain after 5 years.

For revision THA patients, among those with “moderate” preoperative pain, 84 percent reported “mild” or “no” pain after 2 years and 80 percent reported “mild” or “no” pain after 5 years.

Among those with “severe” preoperative pain, 77 percent reported “mild” or “no” pain after 2 years and 78 percent reported “mild” or “no” pain after 5 years.

“Patients can look at this and say – if I have severe pain before surgery, what are the chances I’ll end up with mild pain after. If your pain went from severe to moderate or moderate to mild, I don’t think there’s any question that you will perceive that as meaningful,” Dr. Singh explains. “This is an easier way for patients to look at the data and understand what will happen to them depending on their preoperative status.”  

The study also looked at changes in people’s activity limitations, which is their ability to do daily tasks like walking, climbing steps, getting in and out of a car and putting their shoes and socks on. For primary THA patients, four percent with moderate preoperative limitation and 17 percent with severe limitations reported still having severe limitations after two years. Severe limitations with walking for example meant only being able to walk indoors or still being unable to walk. Those numbers moved up to seven percent and 20 percent at five years – but that means 80 percent reported improvements in their abilities to do daily tasks.

For revision THA patients, 10 percent with moderate preoperative limitation and 26 percent with severe limitations reported severe limitations after two years. Those numbers moved up to 13 percent and 30 percent after five years. But again – that means 70 percent were doing well.

“That’s pretty encouraging,” says Dr. Singh, adding that he hopes this information helps patients better understand what they can expect after undergoing this surgery.

“I think people already have faith in the surgery,” Dr. Singh says. “But perhaps this is information they can use to have conversations with their surgeons to make best the decisions for themselves when taking into account risks and benefits.”

Michael M. Alexiades, MD, an orthopaedic surgeon specializing in hip and knee surgery at the Hospital for Special Surgery in New York, says this study is especially encouraging because it analyzes data on procedures done by a variety of surgeons using different kinds of implants. “It’s nice to see a study where it’s not one surgeon’s results using one particular implant,” Dr. Alexiades says. “Overall this shows hip replacement is a very successful procedure and it’s gratifying to see it.”

Dr. Alexiades says these results are also important because they show there is a solution to the severe, often debilitating pain that accompanies hip arthritis and keeps people from taking part in daily living including playing with grandchildren, enjoying retirement or working to provide for their families.

“Hip arthritis, when it gets bad, gets exceedingly painful where you have pain 24/7 – even at night. That tends to be one of the more painful times. So a lot of things get disrupted: normal daily activities, sleep activity, you get very irritable, and your brain functions differently,” Dr. Alexiades says. “Your whole life really changes around that arthritic hip and what this study shows is a hip replacement is very effective at eliminating that pain for a prolonged period of time.”

Dr. Alexiades says he hopes to see research looking at even longer-term effects of THA. “Even two and five years are not long-term enough for us. We want to know 10-year and 20-year and even 30-year data because so many [younger] people are getting joint replacements,” Dr. Alexiades says.

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