Indications and Eligibility for Total Hip Replacement Surgery

Not everyone with hip arthritis is a candidate for total hip replacement surgery. Orthopedic surgeons look for specific signs and symptoms that indicate hip replacement might be an appropriate treatment. Likewise, certain factors (called contraindications) may suggest that surgery poses more potential risks than benefits and should not be recommended.

Indications for Hip Replacement Surgery

People eligible for this surgery have moderate to severe arthritis in the hip—including osteoarthritis, rheumatoid arthritis or post-traumatic arthritis—that causes pain and/or interferes with activities of daily living.

For example:

• Walking, going up stairs, and bending to get in and out of chairs is difficult.
• Pain is moderate to severe even while resting, and may affect sleep.
• Joint degeneration has caused stiffness that affects the hip’s range of motion during normal activities. The person may have a limp.
• Symptoms are not adequately alleviated by non-surgical treatments, such as non-steroidal anti-inflammatory drugs (NSAIDs), physical therapy, steroid injections, or the use of a cane or walker.

About 90% of people who undergo hip replacement have osteoarthritis.¹Pivec et al. Hip arthroplasty. Lancet. 2012 Sep 25. pii: S0140-6736(12)60607-2. doi: 10.1016/S0140-6736(12)60607-2. In addition to arthritis, some people have hip replacement surgery to correct problems related to broken bones or other medical conditions, such as osteonecrosis (bone death caused by inadequate blood supply).

Contraindications for Hip Replacement Surgery

Orthopedic surgeons carefully screen patients to help ensure surgeries are successful and the chance of problems is low. People who have a greater-than-average risk of post-surgical complications may be told they are not currently eligible for hip replacement surgery.

Reasons for ineligibility include:

Infection
An existing infection is an absolute contraindication, and patients who are prone to infection may not be eligible for this surgery. Serious cases of post-surgical infection can cause a patient to be readmitted to the hospital, require prolonged courses of intravenous antibiotics, and in some cases require the removal of the artificial hip.

Nicotine
Smokers and other tobacco users face a higher rate of medical complications and a higher risk of needing follow-up surgery or revision hip replacement surgery. One research study²Kapadia BH, Johnson AJ, Naziri Q, Mont MA, Delanois RE, Bonutti PM. Increased Revision Rates After Total Knee Arthroplasty in Patients Who Smoke. J Arthroplasty. 2012 May 23. [Epub ahead of print] PubMed PMID: 22633104. found smokers were about 10 times more likely than nonsmokers to have had a second (revision) joint replacement surgery. To lower post-surgical risks, candidates for total hip replacement are encouraged to quit or cut back on tobacco use.

See Preparing for Total Hip Replacement Surgery

Severe osteoporosis
Brittle bones cannot support and adhere to a new joint prosthesis. Mild to moderate osteoporosis is typically okay, but it may affect how a surgeon plans for surgery. In addition, a patient may be asked to take steps to improve bone density before hip replacement surgery. This treatment may continue after surgery to enhance the lifespan of the hip replacement.

Age Requirements for Hip Replacement

People as young as 19 and as old as 90 can undergo hip replacement surgery (younger patients must have reached their full adult size). While there is no upper age limit, patients who are older often have medical conditions, such as type 2 diabetes and heart disease, that can increase the risk of post-operative medical complications.

See Hip Osteoarthritis Symptoms

Other factors
Patients may be ineligible for surgery if they are unable to follow through with pre- and post-surgical instructions. For example, people who suffer from dementia or alcoholism are more prone to dangerous falls and may not be able to reliably comply with the recommendations of their surgeons. In turn, they are at greater risk for complications related to broken bones, hip dislocations, pain medications, and more.

Orthopedic surgeons must consider all factors that may compromise the success of the procedure or the health of the patient. A team approach between the surgeon, medical consultants, and the patient should be used to modify and mitigate these risk factors when possible.

See Choosing a Surgeon for Total Hip Replacement Surgery

Weight Requirements for Hip Replacement

There are no set weight limits regarding who can have hip replacement surgery. However, being overweight can decrease the lifespan of a joint implant. In addition, obese patients are more prone to medical complications, post-surgical infections, and wound healing complications.

Though the infection risk for obese patients is still relatively low, overweight patients are encouraged to lose weight prior to surgery. Losing excess weight before surgery is just one of many ways patients can lower their surgical risks and help ensure positive outcomes.

See Preparing for Total Hip Replacement Surgery