Hip replacement, when is it necessary?

More than 100 thousand every year: that is how many hip replacement interventions are performed today. A number, explain the Italian Society of Orthopedics and Traumatology, Siot, that is constantly increasing, partly due to the aging of the population, and partly also the understandable desire to overcome as soon as possible the pain and limitations that derive from hip arthrosis. But it is precisely from the experts at Siot that precious recommendations are coming today to help understand more deeply all the implications of a prosthetic intervention.

“Minimally invasive” but not without complexity

The complication rate for hip replacement surgery is quite low and recovery is extremely fast; however, Siot points out, it is important to remember that this is a major orthopedic surgery. What does this mean? That despite the fact that techniques have become less and less invasive – to the point that today patients on average start walking again the day after surgery , thanks also to the so-called 'bikini technique', which allows the prosthesis to be inserted without cutting the muscles, but only by spreading them – these are still complex operations. In which the patient's health obviously plays a role, both in terms of general conditions and those more specifically linked to recovery, such as the starting muscular state.

"It is always essential that the patient is informed about the real extent of the surgery and the possible, even if rare, complications. Sometimes, unfortunately, the patient's expectations are not realistic due to inappropriate information from 'doctor Google'", commented Pietro Simone Randelli , President of the Italian Society of Orthopedics and Traumatology-Siot, Professor of Orthopedics at the University of Milan and Director of the Orthopedic Clinic of the Gaetano Pini Institute.

When to resort to prosthetics and at what age

“The intervention must be performed when the patient feels that his quality of life is no longer acceptable due to the painful symptoms and functional limitation. - clarifies Alessandro Massè , director of the Orthopedics and Traumatology Unit at the Città della Salute e della Scienza-Cto hospital in Turin, and SIOT expert in prosthetic surgery - it is not a 'preventive intervention' and therefore if the patient with a few acceptable limitations maintains a good quality of life, it can be postponed without this leading to a worse outcome".

As regards the age of “candidable” patients, thanks to the improvement of the implants in terms of life expectancy, experts underline that today the intervention can be substantially performed at any age, taking into account the premises just made.

Interventions to correct structural defects and delay osteoarthritis

Prosthetic interventions often concern older people, where the onset of degenerative disorders is more common. But if it is true that the most classic arthrosis manifests itself more frequently in adulthood, with equal frequency in both sexes, they explain from Siot, even young people are not strangers to the problem. "The initial joint damage pictures can give the first symptoms in youth, or even pediatric age, if there are pathologies or malformations that produce early damage to the joint structures: the so-called 'pubalgia' of young athletes, is often an expression of initial joint damage", specifies Massè.

If there are structural defects of the hip, the experts conclude, clinicians can recommend surgical interventions to avoid damaging the cartilage and the onset of osteoarthritis and thus a hip replacement. Where necessary, it is good to remember that although the duration of the prosthesis is very high - on the order of decades - post-surgery it is still necessary to "maintain" the health of the prosthesis, muscles and bones. With an active lifestyle but not too much and weight control, so as not to wear out the prosthesis too much, the clinicians recommend.