Knowing when to have a total hip replacement?

About 2.5 yrs ago I suffered a hip labral tear. In hindsight all the weird niggles and acute pain after completing runs etc had been the warning signs of impending doom. X-rays and MRI confirmed the tear, arthritis and femoroacetabular impingement. Consultant review said that things would settle, and I should go away and do some physio and come back in a year.

After a year I go back and no acute pain, but limping on long walks ie 5 miles plus, broken sleep having to change positions, struggle to get dressed etc. He reviewed the MRI imagining again and said my arthritis wasnt that bad, and indeed in fact his hips were in worse shape, so come back and see me in 6 months.

I then go and see a private physio who was brilliant, and the exercises he gave me loosened up my legs and back. Pros and Cons – this meat I didnt feel so tight and had more movement, but also allowed more movement in the hip = more discomfort. On going back to the consultant he suggested an injection, which is basically the start of the road to total replacement. He said when the appointment comes through, if your not in pain dont have it (apparently not as effective). Of course when the letter arrived the pain had reduced so I declined the injection.

In the last year I havent really ridden my mtb or road and jogged max 2 miles at a time. I  purposely got the road bike out and started using it about a month ago, but even that now appeared to be causing hip pain. I’ve also gone back to the stretches etc religiously. Again this appears to have helped make things worse again by allowing the hip to move. I am also now getting ankle pain, which I am convinced is linked to a change in angle of the hip.

I have started to realise that actually I am not doing much that I want to do in life ie biking, running, hill walking. I tried skiing in the summer for 1hr and I was ok doing it, but certain movements were a no, and I paid for it for a week or so after, skiing used to be my passion. I cant even kick a football to my son.

I just keep thinking back to seeing people in the clinic at the hospital who were quite clearly in a great deal more discomfort than I am now, and the consultant saying my hips are not as bad as his. However when I look at where I was to where I am now it feels like I have very little left in life to enjoy, and I think Mrs FD hit the nail on the head when she said she thinks its effecting my mental health.

I dont feel ready to stop, but am I deluded in thinking that after a hip I could get back to some for of cycling, running, walking etc.

To me I just feel now that I am trapped in a cycle of try and exercise, it hurts so I stop, I try stretches, they improve it, but then it hurts so I stop. All the time the the overall tolerance to anything decreases. But this could take years before I am on the point of being on crutches, and then Ive wasted my 50’s.

How bad were other peoples hips before they had them done? I almost feel like if I go back now I will be a fraud.

Thanks

My BIL had his done in his late 30’s – put up with it for as long as he could bear the pain. He’s nearly 50 now and is walking and golfing plenty (he’s not particularly sporty). It’s a big op, but you’ll get your life back after the recovery period.

I’ve not had mine done, but I have a couple of friends, plus my mam, who’ve had theirs done. Very big improvement in quality of life and pretty fast recovery.

I got my knee done when I was 48. Quality of life was pretty bad, as was sleep, and just general discomfort. I was struggling to keep working too. I don’t regret it one bit.

From what you’ve said you mirror where I was with my knee. I’d get it done and get on with life. Hips are generally pretty quick recovery too compared to knees.

My wife had one of hers done @ 50. I think the biggest factor for her was sleep. Not being able to sleep for more that a short spell due to it being painful. For me it was the pain killers she was consuming just to carry on a normal life. Neither was sustainable. In my opinion she put it off for too long and it effected ‘us’ as we couldn’t do the things we wanted to do. Post op and these days (coming up for 10 years later) all good. Although the other side is now causing some issues – don’t think she will wait as long this time!

DOI I’m a GP.

Without knowing your age, it’s hard to tell you for sure. The long and short is that if you’re young (<~50) there’s a benefit to delaying a potential joint replacement, so that you don’t have to struggle with repeat “redo” operations in later life. Also the younger people are when they have hip replacements, the more that they tend to do with them, and so they may have a shorter lifespan.

Having said that, AFAIK, the indication for doing a hip replacement is when the arthritis in the hip stops you from doing your activities of daily living (ie the things that you want to do) despite taking the maximum tolerated analgesia.

Long and short of it is, if you’re not taking pain killers, get on them, and keep moving on the hip as much as possible. If you’re only taking them every now and again, take them regularly (cos they can work better) and keep doing as much as possible. If you’re already on the maximum painkillers and you can’t do what you want to do, then it’s probably time for a hip replacement.

How old are you? They last 15 years or so, give or take, and pretty much can only be redone once, so it’s worth think about whether they’ll last long enough. If you are walking 5 miles before it hurts then, normally, no.

Sorry I thought I had put my age in, I’m currently 49.

Pain killers, sometimes it’s nothing others it’s neproxen. Paracetamol doesn’t touch it when bad and neproxen / <b>anti-inflammatories even taken with food upset my stomach</b>

I understand the concerns re revisions but I almost would prefer to be a cabbage aged 85 than 50 which is what I feel at the minute

I understand the concerns re revisions but I almost would prefer to be a cabbage aged 85 than 50 which is what I feel at the minute

My feeling, and that of my surgeon when I had my knee done at 48. It’ll be 5 in July!

Have you tried taking the paracetamol at maximum dose (two tablets four times a day) regularly?

There is a balance between quality of life now, and when we’re older. However having a failing hip or knee can make the difference between living independently when we’re older, or needing to be in a home, and in my experience that’s something that most people find very important as they age.

If it were me, I’d take as many pain killers as possible, whilst trying to maintain a reasonable quality of life. If I couldn’t then that’s when I’d have the op.

Slightly earlier in the journey here, approaching 48, had to give up running a few months ago, luckily can still cycle which is about the only time it doesn’t hurt. Can just about walk 3-4 miles. Now waiting for the results of an x-ray to see what to do next.

Agree about mental health suffering when it hurts every step you take and find it very frustrating carrying bags around.

Good luck

Just do it!

You won’t regret it…. But you will regret not getting it done.

Guy I work with put it off to what sounds like the point you’re at now. He had it done 2 years ago, around your age. He’s always benn pretty fit. Last year he walked 5000km (walks to and from work, the long way, walks at the weekend too, no kids). He doesn’t regret it.

A friend has both done in his 40s, they left extra bone apparently as he’ll need both done again at least once…

Made a massive difference to his quality of life….

I had a hip resurfacing 12 years ago (the one that Andy Murray had recently) and it has been superb so far with no problems at all.
Yearly check ups,X ray and blood test to check for metal in your bloodstream but so far so good.
Although it is a hip replacement they leave more bone on the femur which means if necessary you can have it done again.
I would have it done again in a heartbeat as the pain disappeared overnight and quality of life returned.

I was 50 when I had the op.

A hip resurfacing is different to a hip replacement. Not everyone is suitable though.

I had a replacement in 2020 aged 48.

I started to get a few niggling injuries & pains in my knee and achilles in my early 40’s. I used to run a lot, played football, rugby and ex-forces so just thought it was a combination of those things and getting older.

I was generally OK while I was moving but really suffered when trying to sleep.

Went to see the GP after a fall on a snowboarding holiday. This is when I started to get sharp pains in my hip / groin. Sent straight for an x-ray and 4 weeks later was having surgery due to osteoarthritis and having no cartlidge left.

The other side is worn out too and getting to a point where I’m considering getting it done. The surgeon said come back when it stops you doing the things you enjoy.

Went snowboarding in Feb and suffered from the same hip / groin pain, know what it is this time so can cope with it. Managed the Lakes Jennride this weekend too 🙂

I’d rather have fun in my 50’s and see what happens in my 70’s.

I have the same or very similar injury. Maybe yours has progressed more than mine, but it did take me a fair bit of experimentation to get mine to hurt enough to crack on with life. Mountain biking was actually something I got into because I couldn’t do other stuff. Running was off the cards for years but off road up to 5km is now manageable. Basically had to make a bunch of adjustments, leave it a year without flaring it up, and then I was able to walk longer distances again. Adjustments were:
– Light weight flat shoes as all times. Lightest possible. Anything with any weight seems to pull at the hip joint.
– No carrying heavy things – Eg garden work, sacks of compost
– no carrying a backpack on a walk, even if very light. The weight seems to crush the hip joint.
– no extremes of movement in the hips, like in rock climbing, cyclocross dismounts, aggressive time trial positions, or some yoga positions, or er… use your imagination!
– no jumping over streams/ legs apart type jumping (Eg star jumps). Landing on one leg especially. Ouch.
– no running on the road, ever. Didn’t run at all for approx 5 years. Now only ever run on moors and uneven ground.
– avoid any repetitive walking, uneven ground seems more forgiving.
– avoid hard mattress/camping mattress. Seems to make hip joints press together.

Maybe you’re ahead of me and ready for the op, but perhaps some of the above might help you get more comfortable. Having figured out how not to aggravate it I can now do a lot more than before. Good luck!

I had a resurfacing done 6 years ago at the age of 60 after doing a lot of research as they did get some bad publicity . Theoretically the resurfaced hip should last longer than a total replacement and if you need the hip doing again in 20 years you still have the whole of your femur so can have a regular hip replacement . Somebody told me that they are no longer doing them in the UK but I don’t know if that is true or not . Mine was definitely life changing and my symptoms were not as bad as yours sound when I had it done .

My brother in law had a replacement at 50 and it was needed. He has four children to bring up as a single parent and mobility was a challenge. It has been a great outcome. He’s walking now and has lost weight. He was a very good footballer as a youth and this may have exacerbated the onset.

By contrast, my father in law had a replacement replaced at 80. They weee unable to remove the original prosthetic, it led to a massive stroke in the OR, chronic disability and two years immobile in a nursing home before he starved himself to death.

Personally, I’d do all I can and hold out with available non-opioid pain relief.

My hip replacement was needed after breaking the hip, which the surgeon pinned, then unfortunately I got avascular necrosis and was in pain and struggled to walk.

Kramer – I wish my surgeon had explained later life problems as I may have ‘hung on’ a bit longer.
Frightening to think the replacement will last around 15 years, will keep fingers crossed that it lasts longer. The thought of going through the surgery again (after it being pinned, then full hip replacement a year or so later fills me with dread).

O.P only you can decide to go ahead or not. But I would personally pay for a really good ‘sports physiotherapist’ and see if they can work some magic.

Good luck.

MIL had 1 hip done 11 years ago, then the left knee, now the right knee, a few weeks ago.
Anyway, the point is, she was like a new woman after it (she’s 68), she can ride her bike, walk the dog, she was playing squash up until a year ago when she got the first knee done.
Keep going with the doctor, it’ll be worth it in the end.
Don’t downplay the pain you’re in, and don’t underestimate how much it can affect your wellbeing and quality of life.
The doctor will understand if you tell him/her that it’s having a negative effect on your mental as well as physical health.
Good luck

Had my replacement in Dec of 2017. Worked with a S&C coach and was back sprinting etc in 7 months. When they say “you’ll know when you need it doing” it was spot on for me. Basically on 8 Zapain a day and it wasn’t helping. Seeing the wincing faces of my year 11 pupils as I got up at the front of the class was the final straw alongside sleepless nights.

Am now back there again with the other one. Zapained up again, plenty or tears at bedtime and most importantly not able to do what I want to be doing (and was doing pre Christmas)

Good luck

My Mum had her first hip done 11 years ago and the second 2 years later in her mid 50s. She could hardly walk a mile by the time she finally got the op and now regularly cycles 30-60 miles (ok on an ebike but in the lowest setting as she is stubborn) and walks 5-12 miles. Massively quality of life improvement. However, she is really starting to notice the first hip now and thinks she is heading towards it having to be redone in the next couple of years or so, and given underlying health issues that isn’t an easy decision to make.

I had/have acetabular impingement in both hips. I had the right one replaced aged 53 after spending years on painkillers, eventually having to retire early as I was unfit for full duties, permanently stoned and unable to work in critical roles.

Up until the last year I was functioning ok on analgesics but I was eventually taking 1000mg paracetamol and 60mg codeine four times a day interspersed with ibuprofen, and even then I was pretty much unable to sleep and couldn’t put my socks on.

That was the point I decided to bite the bullet and have it done. Absolutely miraculous change to my well-being and happiness. Haven’t looked back at all. The left hip is now occasionally starting to bother me, and X rays show very little joint spacing, so it’s only a matter of time.

Don’t be afraid to take plenty of painkillers, they make a huge difference to your head as well as allowing you a bit more leisure choices. But don’t put off the op too long, as the pain and immobility can be sorted.

Unfortunately they don’t allow you to keep the removed bone. So there goes most likely a good pot of soup.

@dyna-ti this thread was pretty grim reading, but I am dying now reading that 😂

I had no idea anyone could need a hip repalcement in their 40s… jeez

I am also now getting ankle pain, which I am convinced is linked to a change in angle of the hip.

Back in 2005 when i was playing competitive football and was playing on rock hard Brisbane pitches I started getting terrible knee and lower back/hip pain. Seeing a really good sports physio was virtually lifechanging. After he’d done some work he referred me to a podiatrist (who looked after international cricket players amongst others). The podiatrist identified the source of most of my issues was unequal leg length. He then made me custom insoles which corrected the balance by changing the angle of my feet and nearly 20 years later I know that when my right hip starts to give me grief, it’s time to get my orthotics replaced.

Interestingly the last time I saw a podiatrist he noticed how much better my walking posture was since riding hard technical mtb trails.

OP, obviously you’re in much worse shape than I was, but your comment made me think about the importance of angles.

If you have a physically strenuous job you will know when to have it done. I hung on far too long , eating painkillers for breakfast dinner and tea , can you tell I’m northern ? My GP practise kept telling me that I was too young but another month or so and I would have been walking with a stick and squirming in pain all day in an armchair. Do the Oxford test , you can find it online, be honest . A low score denotes severity , I had to get my GP to do one with me in the surgery and he didn’t understand it! My consultant had no qualms about repeating the operation again even to the point of saying he would correct it if I wasn’t happy with the first one. His mantra was ,quality of life comes first, and there were all ages in there when I went He was knocking out four per day , it’s a pretty routine op nowadays. Had mine done in 2012 and it squeaks a bit now but has been a revelation . A friend who had the same work as myself spent a fortune on quack physio , sports massage , back doctors etc , I told him that his symptoms were identical to mine but he wouldn’t have it until the pain became too much and hey presto his op last year has changed his life. On another note do you have a family history of hip problems because there is a strong genetic link. Do it , you will not regret it .
PS , I had pushed for X-ray the previous year which the GP said was fine , the consultant took one look at an old X-ray and said you need it done , and your other side has the same faults but don’t bother until the pain becomes too much, however all good so far just occasional twinges but I will not wait so long for another one .

PPS you cannot push through the pain barrier if it is too much you can harm yourself in many other ways . I tried copper bracelets , vitamin supplements , walnut oil , lavender, strange exercises and more, the consultant told me that it’s all a waste of time and money .

my sister inlaw had both hers done in her late 40s, maybe the 2nd one was early 50s.
Means she can now carry on her regular swimming and entering triathlons.
She wasn’t even in that much pain beforehand, just annoyed it was getting in the way of her regular training.

Like bunnyhop – broken hip (hit by a car). Got it pinned. But luckily didnt get avascular necrosis (avn) and its still functioning.

However in the intervening time from surgery and waiting to see if id get avn. There was talk about hip replacements etc and longevity/prognosis.
Surgeon recommended at the time – as i asked him beforehand and did reading on the possible outcomes – that if it struck was to wait until as long as possible for a hip replacement due to being ‘young’ (i was 39 when it happened).

My findings were – which echo others here – wait as long as possible until the painkillers no longer work, and you really cant do what you need to do. Get a good physio to help strengthen the muscles area to support the hip joint.
In a ‘young patient’ a hip replacement can last a very short time due to activity. Id read/been told as little as 6 years before revision. Suposed to get 15-20 years but thats mainly seen in older, and more sedentary, patients.
What i read was that you can probably get 2 revisions max, at that point not much bone left to revise with with respect to the implant.

I investigated hip resurfacing too, which is much more sparing to the bone and would have been my preferred option (would have paid for it myself) if i was suitable.

Thanks all some interesting food for thought.

I am pretty certain its not a genetic thing. I skied to international level when young, and the damage is apparently consistent with that.

I am quite clearly not in the same level of pain as some people get in before they had theirs done. Mine appears to flare up rather than be a constant level of pain. Dont get me wrong there is always chronic low level pain but for example this last 2 weeks it has been more someone prodding me with a pointy stick pain and my ankle has been playing up for about 4 weeks.

I am ‘lucky’ that my job is desk based, as in that enables we relax the joints for 8hrs a day, if I had an active job I would be a cripple by now. A few weeks back my son was at a football tournament so I had to stand for 5-6 hrs. I was pilled up for 2 weeks or so after.

Basically anything other than doing the minimum flares it up, and at 50 is it right to be acting like an old aged person. My parents are in their 80’s and in some ways do more than I do  (no disrespect to the elderly meant !)

Part of the reason I am asking here is because Mrs FD is an Orthopaedic Surgeon and done a few total hips in her time (although not her speciality). It makes discussing it all very difficult, as she is fully aware of clinical outcomes, and what can go wrong now or further down the line. She has always been in the ‘your not ready camp’. However weirdly this week she said 2 things to me. Firstly was that she is seeing how this is effecting me mentally, and also how this is ageing me way beyond my years in terms of what i can do / cant do.

STWHannah – I had found the majority of the same stuff as you, although I found uneven ground made things much worse. I am sure my tear was brought on by moving to Shropshire and every 100 yds or so there being either fences or stiles that need getting over. It was always going to happen, I think this just brought it on sooner. Its very difficult not to have to do alot of the stuff you suggested ie moving heavy items etc etc. Until 3 years ago I did alot of off road half marathons. After my injury I got back to jogging 3 miles ish max, I am now down to about 2 miles and it is impossible to get under 10 min miles, however more recently this isnt even happening.

O.P only you can decide to go ahead or not. But I would personally pay for a really good ‘sports physiotherapist’ and see if they can work some magic.

I have had access to really good physio (same bloke who looks after Gee Atherton and the Welsh Football Team, amongst others) Its all a balance. Muscles stiffen up to protect the joint, which causes back pain, to some extent this makes things like putting socks on harder too, although some of that is the mechanics of whats happening. Every so often I go through phases of doing the right stretches etc. This releases the pressure on the back and other muscles but opens up the hip to more damage ( I am not saying it isnt the right thing to do)

I investigated hip resurfacing too, which is much more sparing to the bone and would have been my preferred option (would have paid for it myself) if i was suitable.

I asked this early doors and they said its beyond that as an option.

I’ve actually found this thread very informative but quite depressing too.

After a skiing holiday in 2022, I had trouble walking at the end of the day. A really good sports physio said my leg was now shorter (after being pinned in my first op, then the following year full hip replacement). She explained nowadays the surgeon will take a lot of care getting the legs ‘even’, but that hadn’t been possible in my case.
Since then I’ve had acupuncture, exercises and an insole in the shorter leg shoe, they have all worked.
So many things to consider and so many things that one isn’t told before surgery.

@SSS – it took longer for my recovery, as the pin holes have to heal (I think this is 6 wks as a broken/fractured bone). Good luck for the future. You can send me a message if you need to have a chat.

Cheers @bunnyhop
My broken hip was in 2011. Got a Dynamic Hip Screw (DHS) fitted. Screwed it all back together and waited 2 years to see if i got AVN. The hip screw is still in there.

I have to keep the joint mobilised. If i dont, it hurts and get a lot of referred pain down the leg. Likelyhood of hip replacement in future quite high on that hip – and with the DHS means its a ‘complicated’ case. But cross that bridge when it comes.

I found a ‘broken hip thread’ on BikeRadar invaluable in my recovery where real life accounts from younger patients in same situation. Broken Hip

My left hip is getting replaced in October, been on the priority list for 18 months, so finally going to get it done, from talking to others, it’s a simple operation, done in an hour or two, back up on your feet later and released a day or two later. It’ll be the prep for toilet, shower, etc that’ll be annoying, but from discussions with ortho surgeons, they’ve moved on quite a bit over the last decade or two in terms of how invasive they are, and how reliable the materials and standards are, so less onerous on recovery than a few years back, and they now believe they will last longer than the old 10-15 year belief.

Go and see your doctor, get that appointment at the ortho dept and just get it checked out and down for a hip replacement if that’s the option, i was getting checked every year in my late 30s and early 40s as they didn’t want to replace at the age i was when it surfaced, but two years ago they put me down for the op as it was properly knackered, can’t wait to be able to put socks on properly and tie my left shoelace when wearing work shoes!

OP something to note from your original post – more pain does not mean that you’re doing more damage with osteoarthritis, and recently the advice has changed because of that.

Previously we told people to avoid painful activities, these days we encourage people to continue doing them as much as possible, using pain killers if necessary, as although it may be painful, keeping the joint in motion is likely to be benefiting it. I don’t know whether this may change your thinking?

As Bunnyhop says, what a depressing thread.

So sorry to hear about this OP, and others with similar. Hope you get it sorted.

My neighbour had a resurface last summer, he is back doing Army Type fitness classes (Boot Camp – Beasting thing) It’s full on, he is very fit. Had niggles but mostly back to much better than he was pre op.
My best mate and someone you would have raced against (on dry slope, back in the day) had a full replacement before Christmas. We skied together at Easter, we were with his young kids but he was able to ski. We did a run without the kids and he was tentative and was saying on the chair back up that he was at full gas, but was delighted to be out on skis again.
He rides lots too (on an e-bike)

The consultant comparing you to his own situation is unhelpful I think. He isn’t doing what you do is he, his goals are different too.
I think when the time comes, do it sooner rather than later. You are younger, fitter and more able to recover post op, the outcome should be better if you have it done younger and do the physio.
Get recommendations, you wife can probably help with this. You need a safe pair of hands!
Good luck!

Previously we told people to avoid painful activities, these days we encourage people to continue doing them as much as possible, using pain killers if necessary, as although it may be painful, keeping the joint in motion is likely to be benefiting it. I don’t know whether this may change your thinking?

Yes and no – The last week I’ve had a nasty bug (could have been COVID) so I haven’t done much moving ie a lot of being in bed or sitting in a chair. This has made it 100% worse! So I get the logic, now I am up and moving again it has released the pain some what

However (sweeping generalisation) perhaps people who require hips doing in the general population are not as active as I used to be. I see my exercise threshold dwindling away, so telling someone who used to be active to go and be active isnt really helpful.