Octogenarians are one of the fastest growing segments of the U.S. population today. At the age of 75, a person in reasonably good health can expect to live another 10 to 12 years. Osteoarthritis (OA) of the hip joint is a common cause of pain and disability in the elderly, leading to loss of mobility, difficulty with common daily activities, and loss of independent lifestyle.
Total hip arthroplasty can dramatically improve quality of life for many older people with hip OA.
What are the symptoms of hip OA?
The most common symptom is pain felt in the groin and front of the thigh with weight-bearing activities and activities involving twisting, such as putting on socks and shoes or getting into and out of cars. In the early stages, pain might be intermittent and relieved by rest. As joint deterioration progresses, pain might become constant and occur at night. Sometimes pain is perceived only in the knee area (referred pain). Back pain can often be aggravated by an arthritic hip joint.
People with OA of the hip often develop a distinctive limp, as the body tries to protect or compensate for pain, muscle weakness, and deformity by reducing the forces across the damaged joint. Loss of flexibility (stiffness) contributes to gait disturbance, and difficulty bending and rotating the leg.
Who is a candidate for hip replacement surgery?
Patients in whom hip joint arthritis is causing significant limitation in quality of life should seriously consider surgery as the best option for relief of pain and disability. While conservative measures such as medicine, weight control, walking aids, physical and occupational therapy, and exercise can often help, surgery is the definitive treatment for end-stage hip joint arthritis.
Am I "too old" for surgery?
Meticulous preoperative medical evaluation and management of common conditions such as hypertension, diabetes, and heart and lung disease reduce the inherent risks of surgery in older persons. Advances in anesthetic management and medical care during the early postoperative period can minimize postoperative complications.
For the individual patient considering hip replacement surgery, it is useful to consider the risk to benefit ratio. Risk of postoperative complications increases with advancing age, yet many older individuals are physiologically "young." The ideal candidate for surgery will be limited only by hip joint disease. In reality, many older persons have limitations caused by other medical conditions (co-morbidities), which should be taken into account when assessing the potential benefits of surgery.
What are the risks?
Older patients as a group do have an increased risk of death, blood clots, heart attack, and confusion during the early postoperative period. Careful preoperative optimization of medical conditions reduces these risks.
The risk of infection for primary total hip arthroplasty is about 0.1 percent (1 in 1000) at centers doing more than 100 cases per year in Medicare-age patients. The frequency of prosthesis dislocation (1 percent to 2 percent) is also less at high volume facilities.
Older patients are at less risk of long-term prosthesis failure.
What are the benefits?
The most important benefit of surgery, relief of hip joint pain, can be expected in the vast majority of patients. The ability to walk without pain and to do normal physical activities can dramatically enhance quality of life.
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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 1/3/2005…#8513
