For many years, surgeons felt that hip replacement surgery should be reserved for elderly patients. No one knew how long a hip replacement would last. It made sense to only do the operation in older patients whose life expectancy was shorter.
Over time, implant design has improved. Better materials have made the components more durable. Newer techniques for implanting the components have meant that they will stay fixed to bone for a longer period of time. All of these factors mean that a hip replacement is likely to last longer in your body. Most younger patients want to remain active and will not accept the pain and limitation caused by an arthritic hip. They will not accept the loss of movement of a hip fusion. They do not want to undergo the prolonged recovery and unpredictable results of an osteotomy.
Hip replacement offers predictable relief of pain, a short recovery period, and a low complication rate. For this reason, the number of patients in their 30s, 40s, and 50s having hip replacement surgery is increasing. Some studies show that the number of hip replacement surgeries done in younger patients will soon approach the number being done in the Medicare population.
Newer procedures such as resurfacing arthroplasty conserve bone and are available for younger patients. Alternate bearing surfaces (covered later in this book) such as metal on metal and ceramics are felt to last longer than traditional metal on polyethylene and are considered an option for younger patients.
If you are young and contemplating hip replacement surgery, you should remember that you will be placing a higher demand on your new joint than older patients. There will be greater wear over a longer period of time. Even though surgical techniques and materials have improved, it is not yet known what the long-term results will be over a 20-, 30-, or 50-year period. You may need a second surgery or revision procedure years down the line if your first hip wears out.
Before you plan surgery, you should have a frank discussion with your surgeon about the long-term risks and consequences of hip replacement at a young age. You should understand the limits of what you will be able to do in terms of everyday and recreational or sports activities.
You will want to do everything possible to make your new hip last as long as it can. The decision to have hip replacement surgery is a life-time decision and you want your hip to last a lifetime. Linda W., a patient, says:
My hips first began to bother me at age 42. I finally went to the doctor. The x-rays showed that I had dysplasia, which contributed to the hip problems I was having. The pain became unbearable, and I knew that I could not live a reasonable life without doing something.
Boris K., a patient, says:
I think it is not a matter of age, but rather a matter of how far the disease has progressed. I asked the doctor all the time, “When should I have surgery?” and the answer always was, “ You will feel it yourself.” And he was right— when I felt the quality of my life suffer, I decided to go for the surgery.