Expectations and satisfaction from total hip surgery
- How long will the new hip last?
- What depends your satisfaction on
- Satisfaction with pain relief and other desires
- Total hip and pregnancy
How long will the new hip last
This depends on several factors, among them on your age, the disease of your hip, and the type of total hip prosthesis.
Below is a Table that will help you to make an approximate picture how long a conventional cemented total hip prosthesis lasted for patents of different age categories.
This Table shows the 25 years results of a conventional, cemented, polyethylene on metal prosthesis achieved at the well renowned Mayo Clinic in the USA. The results thus reflect the prosthesis model and the operation technique that are 25 years old. The materials and the operation technique improved much since then.
The Table shows the percentage of total hips still in function after 25 years for patients of different age categories (Barry 2002)
|AGE AT OPERATION||Per cent of TH still in function 25 years later|
|< 50 years||63 %|
|50 – 59 years||76 %|
|60 – 69 years||87 %|
|>69 years||95 %|
Note that the chances to have a long lasting total hip increase with your age at the operation. 25 years after the surgery about one third of all total hips in patients 50 years old and younger already failed: on the other hand, 95% of all patients older than 69 years were still using their original total hip joints 25 years after the surgery. This is why the surgeons recommend to postpone the total hip surgery in young patients.
Remember also that these results were achieved with the old models of total hips, operated on in the early 1970’s.
The second Table shows how many total hips were still in function ten years after surgery for two categories of total hip prostheses: the cemented and the cementless total hips.
|Type of prosthesis||% still in function after ten years|
|Cemented total hip||92,2 %|
|Cementless total hip||81,7 %|
The data are coming from the Swedish National Hip Register; only 4% of all Swedish patient have been operated on with a cementless total hip system (Malchau 2002).
What influences your satisfaction
It is important that you should be satisfied with the result of your total hip operation. The satisfied patients follow all instructions better, their recovery is quicker and their total hip prostheses last longer!
Your satisfaction will depend on three factors:
- Severity of your preoperative pain and stiffness
- Relief of pain
- How high were your expectations before the operation
Severity of your preoperative pain and stiffness
the bigger the pain and stiffness you experienced before the operation, the bigger is the chance that you will be satisfied with the total hip operation.
The following Table demonstrates this fact:
|Preoperative hip condition||Percentage satisfied after operation|
The results in this Table relate to satisfaction 2 – 3 years after the total hip operation. Be patient!
This applies also to the changes on the X-ray pictures of your hip joint. The more severe these changes are, the better the immediate pain relief after the surgery. (Meding 2000)
Relief of pain
Your satisfaction with the operation will also depend on how good will be the result of your total hip operation.
With pain and stiffness completely gone, 99 % of patients have been satisfied with the operation; if there was some residual pain left, only 70% patients have been satisfied.
Note that many patients have been satisfied in spite of some residual hip pain.
How high were your expectations before the operation
You must have realistic expectations – if you expect to hike 15 miles a day with your new total hip (yes, there are such patients) then you will be probably dissatisfied with your new hip.
How many patients were satisfied with THR
The overall satisfaction
The overall satisfaction with total hip replacement is about 90 %. But you may be satisfied with your total hip although you feel still some minor troubles in your new total hip.
Here are some figures that show how the total hip hip operation satisfied different expectations. Remember, however, that these are average figures. Your experience, as the experience of your fellow patients, is always unique.
Relief of pain – 95%
Pain is one of the main complaints of patients operated on with a total hip joint. Thus, the majority of patients expect pain relief.
The total hip operation is a very reliable means to relieve pain. About 95% of all patients have been satisfied with pain relief after the total hip operation.
Return of good mood – 95%
The chronic pain in the hip causes bad mood and depression. The patients expect that the total hip operation will help them to feel “normal”, be on their own again, enjoy life again. Your chances to achieve these goals with the total hip replacement are excellent.
95 % of all patients were satisfied with return of good mood after the total hip operation.
Return of walking capacity – 85%
This means different things for different patients, such as stopping of limp, walking without a cane, or moving faster. For 85 % of patients the return of the walking capacity has been satisfactory.
Return to “essential daily activities” – 90%
Essential daily activities mean different things, such as a wish “to do more things” and “take care for themselves” or return to participation in social activities. 90% of all patients have been satisfied with return to other “essential” daily activities after the operation.
Return to work – 60%
Depends on the type of work, blue or white collar, travelling, etc. Here is total hip replacement less successful. Only 65% of patients were satisfied with their return to work.
Return to sports / recreational activities – 75%
Recreational activities may be as different as gardening, ball dancing, travelling, playing golf or tennis. The satisfaction with return to recreational activities clearly depends on whether the preoperative expectations were realistic. Rememeber also that the performance in sports diminishes with increasing age.
Total hip and pregnancy
More than 2 % of all female patients operated on with total hip replacement today are women in fertile age. So the question whether young women with total hips can conceive and give birth to healthy children is timely.
There is now evidence that even female patients with both hips replaced may successfully finish pregnancy and deliver healthy babies. Although these women increase their weight during pregnancy on average with 13 kilograms, the weight increase does not have any adverse effects on their total hip prostheses. (McDowel & Lachiewicz, 2001)
For more information please visit the chapter Women and total hip
About 90% of all patients are satisfied with their new hip. A very high figure, actually, compared with other kinds of surgery. Yet, about 10% of all patients operated on with the total hip replacement have been dissatisfied with the result of the operation.
Among the 10% of dissatisfied patients have been following groups of patients:
Patients with remaining hip pain and bad function of the new hip joint.
The main complaints of dissatisfied patients in this group were:
- Remaining pain in the joint that interferes with sleep (about 5%),
- unequal leg length (about 1%), and
- instability in the new hip joint (about 1-2%).
Patients with heart and lung condition
About 1% of the patients with heart and lung condition are dissatisfied with the results of total hip operation, although the function in their new hip has been restored and is pain-free. They are dissatisfied because their heart and lung condition remained unchanged after the hip operation and they cannot exploit the good function of their new hip joint.
Patients with exaggerated expectations
There is also a small group of patients who nourished exaggerated hopes that the artificial joint operation will give them unlimited sporting, or sometimes working, capacity. These patients are often dissatisfied with the operation. Their dissatisfaction is caused mainly by the wrong preoperative information. Artificial joints still do not perform as normal healthy joints.
How long will I have pain after the THR surgery?
Can I return to playing sports after my hip replacement?
When will I experience full benefit of my total hip?
Can my preoperative X-ray pictures tell how satisfied I will be?
Are obese patients equally satisfied with THR as other patients?
You will recognize already 1-2 days after the surgery that pain in your hip is different. The gnawing, severe pain you experienced before the operation will be gone. You will, however, feel “surgical” pain, pain provoked by movement of severed tissues. This pain lasts longer, perhaps up to 12 weeks, it depends on several factors such as the type of the operation (first operation or revision operation), type of prosthesis (cemented or cementless), etc. Expect this pain to diminish progressively and be prepared to use pain medication to stifle it.
You may experience occasional pain after walking and other activities. This pain may persist for several months after the operation. The relief of this type of pain is individual, depending among other thing on the severity of the preoperative deformity in you hip, on the state of your muscles and so on.
You may certainly return to playing low-impact sports, that means sports which don’t put high stresses on your new total hip. Examples of low-impact sports are golf, doubles tennis, bowling, cross country skiing.
Activities such as running, jumping, (and stumbling) puts high impacts on your total hip. All sport activities which include these activities are called high- impact sports. Examples of such high-impact sports are singles tennis, basketball, football.
High-impact sports puts excessive stresses on the hip joint prosthesis and on its fixation to the skeleton. There is a risk that this overload may lead to premature failure of the total hip replacement.
It is safer for orthopedic surgeons to recommend low levels of all activity after joint replacement operations than to advocate high demand athletic activity. However, young patients seek joint replacement surgery both to be relieved of their joint stiffness and pain and to increase their activity, including participation in sports.
- When the patients understand the risks associated with increased wear of bearing surfaces in their new joints caused by high activity and
- when the patients are prepared to accept these risk and
- when the patients are specially training to diminish these risks, then there is no reason to dissuade the young patients from athletic activity. (Healy, 2001)
For more information visit please the chapter Sports after total hip surgery
Although you will experience relief of your preoperative pain and anxiety very soon after the operation, the return of function in your hip and leg will take much longer time. After three months you will probably have restored the force in the muscles around your hip, but the range of movement will take longer to restore. Consider that it will take about one year of vigorous training before you will achieve full benefit from your total hip.(Orbell, 1998)
Usually, patients with more severe changes on X-ray pictures (loss of “joint space”) experience quicker relief of preoperative pain after the total hip replacement operation. But one year after the operation, patients with less severe degrees of X-ray changes have equally good relief of pain as patients with severe X-ray changes. (Meding 2000)
(Remember, however, that the severity of preoperative hip pain is often independent of the changes as seen on the X-ray pictures of your hip joint).
Yes, both obese and non-obese patients are equally satisfied with the result of their THR operation. The difference is that the obese patients have more difficulties with their motion after the surgery (such as with ascending and descending stairs).
The question whether the total hip prostheses fail more often in obese patients is still undecided. According to some reports the failure rate of total hips is higher in obese patients whereas other surgeons did not see more total hip failures among obese patients.
The explanation for this puzzling fact may be the following: The obese patients move less and have more stronger skeleton then normal-weight patients. These factors might outweigh the disadvantage of the increased load that a heavy body puts on the total hip (Stickles 2001). Another reason may be the fact that obese patients usually have stronger skeletons, thanks to production of hormon-like substances (leptines).
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Before you take any decision, please read carefully the Disclaimer
- Berry DJ et al. J Bone Joint Surg-Am. 2002; 84-A, 171 -77
- Meding JB et al. Clin Orthop 2000; 376:156-60
- Malchau H et al J Bone Joint Surg-Am; 2002; 84-A, Suppl 2:, 2-20
- Healy WL. Am J Sports Medicine, 2001, 29, 377-88
- Orbell, et al. J Epidemiol Community Health 1998;52:564-70
- Stickles B et al. Obes Res 2001;9:219-23
- McDowel & Lachiewicz. J Bone Joint Surg-Am; 2001; 83-A:, 1490-4