The One Question to Ask Before You Agree to a Hip Replacement

Most people show up to the surgical consult with a list. How long does the implant last. Anterior or posterior. How long until I can drive. When can I get back on the boat.

Every one of those is a reasonable question. Ask all of them.

But there is a question that comes before all of them, and almost nobody asks it, because it feels rude and because we were not raised to ask it.

What is the evidence that doing this is better than not doing it?

Where I got this

There is an orthopedic surgeon in Australia named Ian Harris. He is a professor at the University of New South Wales, he operates, and he wrote a book called Surgery, The Ultimate Placebo that made a lot of his colleagues unhappy.

His argument is not that surgeons are crooks. It is something more uncomfortable. A lot of operations became standard practice without ever being tested against a real comparison. Not against no surgery. Not against a sham procedure. They worked in the sense that patients got better afterward, and everyone reasonably concluded the operation was why.

Except people also get better without operations. Symptoms wax and wane. Bodies heal. Expectation is powerful. When you test some long-standing procedures against a placebo operation, the difference shrinks or disappears.

We already wrote about that book here on this blog, so I am not going to walk through it again. What I want is the one habit it leaves you with.

The question is not an accusation

Here is what makes people squirm about asking it. They think it sounds like "I do not trust you."

It is not that. It is a request for information that the surgeon almost certainly has.

Ask it plainly. "What does the evidence say about how people like me do with this surgery compared to people like me who do not have it?" A good surgeon will answer that without blinking. For some operations the answer is strong. For others the honest answer is that the evidence is thin, and a surgeon who says so out loud is one you can trust with the rest of it.

The uncomfortable version is this: if a surgeon gets defensive at the question, that is information too.

And here is the part that matters for your hip

Harris is not against surgery. He is a surgeon. He is careful in that book to point out that some operations plainly work, and hip replacement is one of the ones he holds up as an example of an operation that earns its place.

I want that stated flatly, because posts like this one usually get used as ammunition by people who want to talk you out of an operation you need.

Hip replacement is one of the genuine wins in medicine. The pain relief is large, it is reliable, and it lasts. If your hip is wrecking your sleep, keeping you off the trail, and shrinking your life to the size of your living room, having it replaced is very likely the right call and I will tell you so to your face.

So the question does not exist to talk you out of it. It exists so you know why you are saying yes.

What the question is really protecting you from

Not the surgery. The timing, and everything that got skipped on the way there.

Because here is what I actually see. A man came in this spring, seventy, hip on the schedule for June. Pain started in the fall, x-ray in January, surgical date in March. In all of that, nobody had checked whether his right ankle moved. It barely did. He had a hip that had been picking up an ankle's slack on every step for four years, and the hip was the link that finally gave in. He still may need that replacement. But nobody had ever looked at the leg the hip lives in.

That is the pattern. Somebody has hip pain, gets an x-ray, gets told there is arthritis, and is on the schedule within two months. Nobody looked at what the other hip is doing. Nobody had them do twelve weeks of real strength work to see how much of the problem was the joint and how much was everything the joint was covering for.

A randomized trial out of Norway followed 109 people with hip arthritis for years. Half did twelve weeks of supervised exercise on top of education, half got education alone. At six years, 41% of the exercise group still had their own hip, against 25% of the education-only group, and the median time to replacement was 5.4 years versus 3.5. Everyone in that trial had mild to moderate symptoms and none of them were surgical candidates at the start, so it does not apply to a hip that has already taken your life away. It applies to the hip that is on its way there.

That is the window the question protects. Not "do not have the surgery." More like "am I at the point where surgery is the best available option, or am I at the point where I have not tried the cheaper thing yet."

What to do about it

Take this to your consult.

• Ask the question. "What is the evidence that having this is better than not having it, for someone in my situation?" Then be quiet and listen to the whole answer.
• Ask what happens if you wait six months and do a real strengthening program first. Ask specifically whether waiting makes the surgery harder or the outcome worse. For most hips the honest answer is no, and hearing that out loud changes how the decision feels.
• Ask what your surgeon considers a good result, in your terms. Sleeping through the night is a different target than walking Sleeping Bear.
• Find out what happens if you do nothing at all. That is a legitimate option and it belongs on the list even if you reject it in the next breath.

If the answers come back strong and you decide to have the surgery, good. You will go in with a clearer head, and there is decent evidence that people who do structured strength work in the weeks before surgery come out of it better positioned.

The bottom line

The point of the question is not to catch anybody. Most surgeons in this town are careful people doing good work with real evidence behind them.

The point is that this is your decision and nobody else's. Not your surgeon's, not your daughter's, and not mine. A decision you cannot explain to yourself is not really a decision. It is a default.

I have watched people go through this both ways. The ones who did the asking, and then had the surgery anyway, walked in calm. That is worth something on a morning when you are checking in at 5:30 with an empty stomach.

Ask the question. If the answer is good, and for hip replacement it usually is, you get to walk into the operating room knowing exactly why you are there.

If you are weighing a hip replacement and want a second look at what your body is doing before you commit, come in. The first visit is a free 20-minute movement assessment, in clinic, with an honest read on what conservative care could and could not do for you. No charge, no insurance, and nobody here is going to tell you to cancel your surgery or push you to book anything with us. Call the West Front St office at (231) 944-6541.

My book on hip replacement recovery is free at thesuperiortherapy.com.