Most people need a hip replacement when arthritis pain stops them from walking, climbing stairs, or sleeping through the night — and when physical therapy and medication have not helped for at least several months

Hip replacement is not a first choice. Doctors recommend it only after other treatments have failed and the damage to your hip joint is severe enough that surgery will likely improve your life more than it disrupts it. The decision depends on your pain level, how much your hip limits daily activity, your age and overall health, and whether you have already tried conservative treatments.

This guide explains what conditions lead to hip replacement, what signs suggest you might be a candidate, what happens before surgery, and what questions to ask your doctor. It does not replace a medical evaluation — only your orthopedic surgeon can determine whether surgery is right for you.

Key Takeaways

  • Osteoarthritis is the most common reason for hip replacement, but rheumatoid arthritis, hip fracture, and avascular necrosis also lead to surgery.
  • Doctors typically recommend surgery only after physical therapy, weight management, anti-inflammatory medication, and injections have been tried for at least three to six months without enough relief.
  • Constant pain that wakes you at night, inability to walk more than a short distance, and difficulty with stairs or getting in and out of a car are signs your doctor may discuss surgery.
  • Your age alone does not disqualify you — surgeons now routinely replace hips in people in their 50s and even younger if the damage is severe enough.
  • Before surgery, your doctor will order imaging tests, blood work, and a cardiac evaluation to make sure your body can handle the procedure.

Osteoarthritis and other conditions that damage the hip joint

Osteoarthritis accounts for about 90 percent of hip replacements. It develops when the cartilage that cushions the hip joint wears down over time, causing bone to rub against bone. This can happen from age, previous injury, or straightforward how your hip was shaped from birth. Pain usually starts gradually and gets worse over months or years.

Rheumatoid arthritis is an autoimmune disease that attacks the joint lining and can damage the hip in people much younger than those with osteoarthritis. Avascular necrosis occurs when the blood supply to the hip bone is cut off, causing the bone to collapse — this can follow a hip fracture, heavy steroid use, or sickle cell disease. Hip fracture from a fall or accident sometimes requires replacement rather than repair, especially in older adults, because the bone may not heal well enough to restore normal function.

Less common reasons include severe hip dysplasia (a hip socket that did not form correctly), Paget's disease, and complications from previous hip surgery. Your doctor will identify which condition you have through imaging and physical examination.

Pain and loss of function that suggests surgery may help

Pain alone does not mean you need surgery. Many people live with hip pain for years without needing replacement. The key question is whether the pain, combined with loss of function, has become severe enough that surgery offers a real improvement.

Signs that surgery might help include constant or near-constant pain even at rest, pain that wakes you multiple times at night, inability to walk more than a block or two without severe pain, difficulty climbing stairs or using a car, and pain that limits your work or hobbies despite medication and physical therapy. You may also notice you are limping, your hip feels unstable, or you cannot put weight on the leg.

If you can still walk reasonable distances, sleep through the night with medication, and manage daily tasks, your doctor will likely recommend continuing conservative treatment rather than moving to surgery. The goal is to reach a point where surgery will genuinely give you back function you have lost, not straightforward reduce pain that is already manageable.

Why doctors start with physical therapy and medication first

Hip replacement is major surgery. It requires anesthesia, carries risks of infection and blood clots, and involves months of recovery. For that reason, doctors recommend trying other treatments first — not because they are stalling, but because many people get enough relief to avoid surgery altogether.

Physical therapy strengthens the muscles around the hip, which can reduce stress on the damaged joint and improve stability. Anti-inflammatory medications like ibuprofen or naproxen reduce swelling. Corticosteroid injections into the joint can provide relief for weeks or months. Weight loss, if you are overweight, reduces the load on the hip. Assistive devices like a cane or walker change how you move and can ease pain.

Doctors typically want to see you try these approaches for at least three to six months before discussing surgery. If you have significant pain relief from any of these treatments, surgery may not be necessary. If none of them help enough, and your imaging shows severe joint damage, surgery becomes a reasonable next step.

Age and overall health: who is a candidate for surgery

Age alone does not determine whether you can have hip replacement. Surgeons routinely perform the procedure on people in their 50s, 60s, and beyond. Some patients in their 40s have surgery if the damage is severe. The real question is whether your overall health — your heart, lungs, kidneys, and ability to recover — can handle the procedure and the rehabilitation afterward.

Your doctor will evaluate your medical history, current medications, and any conditions like diabetes, heart disease, or lung disease. You will have blood work and usually an electrocardiogram (EKG) to check your heart. If you smoke, your doctor will discuss quitting before surgery, because smoking slows healing and increases infection risk.

People with severe heart or lung disease, uncontrolled diabetes, or active infections may need to delay surgery or may not be candidates at all. But most people over 50 with severe hip arthritis can safely have the procedure. Younger patients may be candidates too, though surgeons sometimes hesitate because the artificial joint may eventually wear out and require a second surgery decades later.

What to expect before surgery: tests and preparation

Once you and your surgeon decide to proceed, you will have several appointments before the operation. Your surgeon will order X-rays or an MRI to see the exact damage and plan the surgery. You will have blood work to check your blood count, kidney function, and clotting ability. An EKG or stress test checks your heart.

You will meet with an anesthesiologist who will review your medical history and medications and discuss what type of anesthesia will be used. You will likely have a pre-operative physical with your primary care doctor. If you take blood thinners like warfarin or aspirin, your doctor will tell you when to stop. If you take other medications, your surgeon will advise which ones to continue or pause.

Your surgeon will explain the surgical approach — whether the incision will be in front, side, or back of the hip — and what type of implant will be used. You will receive instructions on fasting the night before surgery and what to bring to the hospital. Many surgeons ask you to attend a class on what to expect after surgery and how to protect your new hip during recovery.

Questions to ask your orthopedic surgeon

Before you commit to surgery, make sure you understand your surgeon's reasoning and what the procedure involves. Ask why they believe surgery will help your specific situation, what imaging shows about your joint damage, and what they expect your function to be after recovery. Ask about the type of implant they recommend and why — some are designed to last longer, some move more naturally, and some are better for younger or older patients.

Ask about the surgical approach and why they chose it. Ask what the recovery timeline looks like — how long before you can walk without a walker, drive, return to work, or resume sports. Ask about restrictions you will have on your new hip, because some activities like running or high-impact sports may not be recommended. Ask what complications are possible and how often they occur in their practice.

Ask whether you will need blood transfusion, what pain management will look like after surgery, and whether you will go home or to a rehabilitation facility. Ask how many hip replacements they perform per year — surgeons who do many procedures typically have better outcomes. If anything is unclear, ask again. You should feel confident in your surgeon's answers before you schedule surgery.

Frequently Asked Questions

Can I have a hip replacement if I am under 50?

Yes, if the damage is severe enough and conservative treatments have not worked. Surgeons are more cautious with younger patients because the artificial joint may eventually wear out and require revision surgery in 15 to 20 years. But if your pain and loss of function are significant, surgery may still be the best option. Discuss the long-term outlook with your surgeon.

What if my doctor says I should wait, but I am in a lot of pain?

Ask your doctor specifically what they want to see improve before surgery becomes appropriate — more time on physical therapy, better results from injections, or weight loss. If you disagree with their recommendation, you can seek a second opinion from another orthopedic surgeon. Sometimes a different surgeon will recommend surgery sooner, and sometimes they will agree with waiting.

Does hip replacement mean I will never have pain again?

Most people have significant pain relief after hip replacement, but not all pain disappears. Some people experience mild discomfort with certain activities or weather changes. Realistic expectations are important — surgery usually restores function and reduces pain enough to return to daily activities, but it is not a cure for all hip-related discomfort.

How long does a hip replacement last?

Modern hip implants typically last 15 to 20 years or longer, depending on the type and how much stress you put on the joint. Some last 25 years or more. If your implant wears out, revision surgery is possible but is more complex than the first surgery. Your surgeon can discuss the expected lifespan of the specific implant they recommend.

What if I have both hips that need replacement?

Surgeons can replace both hips, but usually not at the same time. Most commonly, they do one hip first, let you recover for several weeks or months, and then replace the other. Doing both at once increases the risk of complications and makes recovery harder. Discuss the timing with your surgeon based on your pain levels and function in each hip.