Ask Dr. Hansen: Do I Have Hip Replacement Symptoms?

Total joint replacement surgery for a painful arthritic hip is a very safe and successful procedure. But when should hip symptoms be treated with surgery versus more conservative treatments? Hip specialist Dr. Dane Hansen explains that arthritis is not the only condition that can trigger hip replacement symptoms. He also describes his process for evaluating when to use conservative treatments and when it’s time to consider hip replacement surgery.

Multiple conditions can cause hip replacement symptoms

“Arthritis is the reason for the majority of hip replacements,” says Dr. Hansen. “But there are a lot of other reasons for joint pain and issues that can lead to hip arthritis. Any of these conditions can be treated with a hip replacement if symptoms are severe enough. One group of conditions in this category are mechanical or anatomic hip issues.”

• Hip fractures. “Certain types of hip fractures may be successfully treated with a hip replacement instead of a fracture fix,” notes Dr. Hansen. “This is true even when trauma damages the hip joint of a younger, more active patient.”
• Hip dysplasia. “With this condition,” explains Dr. Hansen, “the hip socket doesn’t develop as deeply as it should. Usually, dysplasia occurs during infancy or childhood development. The shallow socket can cause stress on the hip and may trigger the development of arthritis. Eventually, a hip replacement may be an appropriate treatment for this condition.”
• Hip impingement. “Impingement is a genetic issue,” notes Dr. Hansen. “When a hip is impinged, the joint doesn’t have as much motion as it should. There may be extra bone in places where the joint does not need bone. Essentially, if the anatomy of the joint is not correctly formed, it doesn’t function as well as it should, and it can wear out sooner in life.”

Hip replacement symptoms related to avascular necrosis

“A condition called avascular necrosis can also lead to a hip replacement,” says Dr. Hansen. “With avascular necrosis, the blood supply to the head or the ball of the hipbone is lost. Because the ball of the hip bone has no blood supply, any micro trauma to that portion of the bone can’t heal itself. Over time, the cumulative unhealed bone damage causes the bone beneath the cartilage to degenerate and collapse. At that point, the entire hip joint will start to collapse. This painful condition eventually leads to arthritis.”

Causes of avascular necrosis

“For the majority of patients affected by avascular necrosis, the cause is idiopathic,” says Dr. Hansen. “That means, simply, that we don’t know why it happens. It could be the result of trauma or other medical reasons. However, we do know two specific causes of avascular necrosis.”

• Chronic steroid use. “Patients using oral steroids to treat asthma, COPD, or some other medical condition may develop avascular necrosis. We don’t know how long you need to be using steroids in order to trigger the development of this condition.
• Chronic alcohol use. “Chronic drinkers may also develop avascular necrosis,” states Dr. Hansen. Again, we don’t have a specific time frame for high-risk use. But the more chronic the use is, the more likely you are to develop avascular necrosis.

The progression of hip replacement symptoms

“Pain is the No. 1 symptom,” states Dr. Hansen. “Sometimes that pain leads to muscle weakness or discomfort. For the majority of patients, the earliest symptom is activity-based pain, especially while performing tasks that require range of motion.  You may be fine while engaged in day-to-day tasks like walking. But increased activity—like exercise, long walks, or heavy lifting—leads to hip pain, soreness, or stiffness.” As arthritis progresses, symptoms become more severe, more common, and more chronic. They evolve into severe pain with activity and chronic pain even with lesser activities. “People may experience pain when they are sitting, walking, or when they turn a certain way,” explains Dr. Hansen.

Many people think that back discomfort at the waist or pelvis is an indication of hip replacement symptoms. “That’s not the case,” states Dr. Hansen. “You feel hip joint pain at the front of the hip in the groin. So, most people with hip issues are experiencing groin or thigh pain. Some hip patients do have pain on the side of the hip, but it’s in the upper thigh, not in the waist area.”

A secondary indication of potential hip replacement symptoms—that arise later in disease progression—is losing range of motion. “When you lose range of motion, you can’t rotate your hips as well,” explains Dr. Hansen. “People experience difficulty getting their shoes and socks on or crossing their legs.

How hip symptoms progress

Dr. Hansen points out that these painful conditions will not heal on their own. “Arthritis is not reversible,” he says. “We are exploring ways to regrow or to heal joint cartilage. Stem cell injections and regenerative medicine are promising, but we don’t have answers yet. Also, over time, nonsurgical options eventually lose their usefulness and effectiveness. Arthritis is a progressive disease; once it becomes more severe, the joint can’t be recuperated.”

The good news is that hip implants are more durable and longer lasting than ever. “You might assume that young, active patients put more stress on implants, wearing them out sooner,” says Dr. Hansen. “But implant technology has gotten so good that even with very active patients, we expect hip implants to last for 25 to 30 years and possibly longer. Our current implants are about 20 years into their life span and continue to function without signs of wear. This makes hip replacement a long-term solution that is appropriate even for younger patients.

Dr. Hansen’s evaluation of hip replacement symptoms

“I tell patients that when your hip joint is making your decisions for you, we should talk about surgery,” states Dr. Hansen. “If you have tried nonsurgical treatments and are still limiting or choosing your activities based on what you think your hip can handle, it’s time to consider surgical treatment options. Patients know when hip pain is the focal point for what they do and how they live. That’s when you’ve got hip replacement symptoms. It’s time to talk about what you can do to regain your preferred activity level and quality of life.

“When I have this conversation with patients, it has two parts,” says Dr. Hansen. “First, we talk about pain and functional limitations. The second part is a conversation about my patient’s level of activity and expectations.”

Dr. Hansen gives an example of two patients who have the same amount of pain and the same amount of arthritis. One patient is 55 and is a labor worker. The other patient is 85, retired, and lives in an assisted living facility. “My younger patient is in his prime. We will probably opt to treat him with a hip replacement to maintain his work function and enable him to continue to live an active life. On the other hand, my older patient may be able to continue to function very well without surgery. Activity modifications or use of a walker may be all this patient needs to address symptoms.”

When to seek treatment for your arthritis

Arthritis doesn’t have to spell the end of an active life. If you are experiencing worrisome symptoms or persistent pain, the renowned arthritis specialists at Summit Orthopedics can help. We work with you to confirm a diagnosis and develop an appropriate conservative treatment plan. If nonsurgical treatments fail to support your lifestyle goals, highly skilled orthopedic surgeons will consult with you and discuss appropriate surgical options. Summit is home to innovative joint replacement options. Our Vadnais Heights Surgery Center is one of only two surgery centers nationally to receive The Joint Commission’s Advanced Certification for Total Hip and Total Knee Replacement.

Start your journey to healthier joints. Find your arthritis expert, request an appointment online, or call us at (651) 968–5201 to schedule a consultation.

Summit has convenient locations across the Minneapolis-St. Paul metro area, serving Minnesota and western Wisconsin. We have state-of-the-art centers for comprehensive orthopedic care in Eagan, MN, Plymouth, MN, Vadnais Heights, MN, and Woodbury, MN, as well as additional community clinics throughout the metro and southern Minnesota. 

More resources for you

• Read about the best age for a hip replacement
• Learn more about younger patients and hip replacement
• Check out Hansen’s blog on hip replacement recovery
• Ask Dr. Hansen: Who Gets a Partial Hip Replacement?

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