Should You Delay Hip Replacement Surgery for Osteoarthritis?

Replacement of hip joint liner?

Doctor's diagnosis: OA (unspecified)/Osteoarthrosis/Osteoarthritis.
Currently experiencing pain while walking, with a 2 cm leg length discrepancy.
The doctor suggested that a total hip replacement surgery could be performed when the pain becomes unbearable, considering the patient is young (39 years old).
Given that a hip replacement will likely require revision surgery in 10-15 years, and due to the fear of the trauma and complexity of revision surgery, I would like to ask: (1) Should the patient wait until they can no longer walk before undergoing the initial replacement surgery to extend the age for potential revision surgeries? (2) I have heard that after the initial installation of a prosthetic joint, regular follow-up appointments can detect wear on the liner, and it is possible to replace just the liner (a procedure that takes only half an hour) without needing to remove the entire prosthesis for revision surgery.
Is this feasible? If (2) is feasible, would it be advisable to schedule the initial hip replacement surgery immediately, allowing the patient to walk normally without pain, and perhaps only needing to replace the liner every 10 years, thus avoiding the need for complex revision surgeries and maintaining normal walking ability? Is this statement correct, doctor?

athena, 30~39 year old female. Ask Date: 2010/05/14

Dr. Shi Guozheng reply Orthopedics

Based on your current condition, you should be able to undergo joint replacement surgery.
Delaying the procedure too long could lead to significant bone wear, making the surgery more complicated.
Moreover, you already have a leg length discrepancy.
Under the National Health Insurance, you can pay a little extra to receive a more durable prosthetic joint, which can extend its lifespan.
If, after the initial surgery, only the spacer wears out while the other parts of the joint remain intact, it is possible to replace just the spacer.
However, regular follow-up is necessary, and any issues should be addressed promptly.

Reply Date: 2010/05/14

More Info

When considering whether to delay hip replacement surgery for osteoarthritis (OA), several factors must be taken into account, especially given your age of 39 and the current symptoms you are experiencing, including pain while walking and a 2 cm leg length discrepancy.
1. Should You Delay Surgery?
Delaying hip replacement surgery until you can no longer walk is generally not advisable. The rationale behind this is that waiting too long can lead to further deterioration of the joint, making the surgery more complicated and recovery more difficult. In your case, the presence of a leg length discrepancy indicates that the joint is already significantly affected. If you wait until you are unable to walk, you may also face additional complications, such as muscle atrophy and joint stiffness, which can complicate rehabilitation after surgery. Early intervention can lead to better outcomes, allowing you to regain mobility and quality of life sooner.

2. Replacement of the Liner vs. Full Replacement
It is true that in some cases, if the liner of the artificial joint wears out, it may be possible to replace just the liner rather than the entire joint. This procedure is less invasive and typically has a shorter recovery time. However, this is contingent upon the condition of the rest of the joint and the materials used in the initial surgery. If the initial surgery is performed with high-quality, durable materials, and if the rest of the joint remains healthy, then liner replacement could be a viable option in the future. However, it is essential to have regular follow-ups with your orthopedic surgeon to monitor the condition of the joint and the liner.

3. Immediate Surgery vs. Delayed Surgery
If you choose to proceed with the hip replacement now, you may experience significant pain relief and improved mobility, allowing you to return to normal activities. The idea that you could potentially replace the liner every ten years and avoid complex revision surgeries is appealing, but it is essential to understand that this is not guaranteed. The longevity of the artificial joint and the need for future surgeries depend on various factors, including your activity level, weight, and overall health.
In summary, delaying hip replacement surgery is not recommended, especially given your current symptoms and the potential for further joint deterioration. Early intervention could lead to a better quality of life and potentially reduce the need for more complex surgeries in the future. Additionally, while liner replacement is a possibility, it is crucial to have a thorough discussion with your orthopedic surgeon about the best course of action tailored to your specific situation. Regular monitoring and proactive management of your hip health will be key to maintaining mobility and minimizing pain.

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