The Two Years You Might Be Giving Away

A man in his early sixties sat in my office last spring and told me he had been given the news. Hip arthritis, both sides, worse on the right. The orthopedist said he was not bad enough for surgery yet, come back when it gets unbearable.

So he went home and waited for it to get unbearable. He also sold the kayak. He did not mention that part until the second visit.

That is what gets me. Not the diagnosis. The waiting. Somewhere between the exam room and the parking lot, "you are not ready for surgery" turned into "there is nothing to do until you are."

There is something to do. And there is a decent randomized trial that says the something is worth roughly two years.

What they did in Oslo

Researchers in Norway recruited 109 people with hip arthritis, average age 57. Everybody had hip pain for at least three months and joint space narrowing you could see on an x-ray. Nobody was on a surgical waiting list at the start.

They flipped a coin, essentially. Half got a patient education program, three group sessions on what arthritis is and how to manage it. The other half got the same education plus a twelve-week exercise program: strength, flexibility, and functional work, two or three times a week, supervised by a physical therapist at least once a week.

Twelve weeks. That is it. Then everybody went back to their lives and the researchers followed them for between three and a half and six years.

What happened

By the end, 22 people in the exercise group had gone on to hip replacement. In the education-only group, 31 had.

Run out to the six-year mark, 41% of the exercise group still had their own hip. In the education-only group it was 25%. That difference held up statistically. The estimated median time to replacement was 5.4 years for the exercise group and 3.5 years for the education-only group.

Read that again slowly. Same diagnosis. Same starting point. Twelve weeks of work at the front end. Almost two years of difference in when the operating room showed up.

The authors put it in plain terms in their conclusion: participating in exercise therapy on top of education can reduce the need for hip replacement by 44% or postpone the surgery.

Now the honest part

I am not going to oversell this, because you have probably been oversold before.

This trial does not say exercise cures hip arthritis. It does not say you can avoid surgery. It says that in this group of people, the ones who did the work went longer before they needed it, and some never got there during the study window.

It also has real limits, and the authors said so. Everybody in it had mild to moderate symptoms. Nobody was a surgical candidate at the start. If you are waking up four times a night and cannot get your sock on, you are not the person in this study. Only about half the exercise group actually completed 20 or more of their 24 sessions, which tells you something about how hard this is to stick with. And people who volunteer for a non-surgical trial probably want to avoid surgery more than the average person does, which can tilt the result.

One more thing that matters. The exercise group did significantly better on measured physical function over the follow-up period, but their pain scores were not statistically different from the control group. The authors' read was that the delay came from better hip function, with or without less pain.

So the mechanism is not "it hurt less." It is "the leg worked better."

That distinction is the reason I do this work the way I do. A hip does not fail in one direction. It loses rotation. It loses the ability to accept load coming at it from the side. It stops letting your body travel forward over the foot. Life asks for all of that at once, usually while you are carrying a bag of mulch. Training a hip to be strong in a straight line and calling that done misses most of what the joint is actually for.

And hip replacement is a very good operation

I want to be clear, because this is where posts like this usually go off the rails.

Hip replacement is one of the genuine successes of modern surgery. Most people who get one are glad they did. If your hip is destroying your sleep, your work, and your ability to leave the house, delaying that surgery to prove a point is not a win. It is just more suffering with a nobler-sounding name.

Most people I meet in this spot are torn, and they rarely say so out loud. Part of you wants it handled and over with. One surgery, one recovery, done, and you stop organizing your year around a joint. Another part does not want to become a person who had a hip replaced at fifty-eight. Both of those make sense and they live in the same head at the same time.

The question is not whether hip replacement works. The question is whether right now is the right time for yours, and you are the only one who can answer that.

Because a replacement has a service life. A hip put in at 58 is going to have a longer job than one put in at 68. Every year you get out of your own joint, while still living the way you want to live, is a year you are not spending on the revision clock.

What to do about it

If a doctor has told you that you have hip arthritis but you are not ready for surgery, one option is to treat that as an assignment rather than a dismissal.

• Get someone to look at how the whole leg is loading, not just the hip. In my experience the ankle and the opposite hip are almost always part of the story, and neither one shows up on a hip x-ray.
• Do the strength work. Real load, progressive, at least twice a week. Walking on the flat is good for you and it is not strength work. Your glutes barely notice it.
• Track something objective. How many times can you stand up out of a kitchen chair in 30 seconds without using your hands? Write the number down. Check it in eight weeks.
• Do not use pain as the only scoreboard. In the Norwegian trial pain was not what separated the groups. Function was.

In Michigan you do not need a referral from a physician to see a physical therapist. If you have been told to wait, you can start on your own.

The bottom line

The choice was never surgery or nothing. It has always been surgery, or building the leg up and seeing how far that carries you, then having surgery when it is genuinely time.

You might read all of this and book the operation for February anyway. That is a completely reasonable call, and if it is the one you make, I would rather you walk in strong than walk in the way most people do.

The people in that Norwegian study who did the work bought themselves a median of nearly two extra years with their own hip. Some of them will still end up in the operating room. They will get there stronger.

The waiting room strategy gets you neither.

If your hip has been slowing you down and nobody has offered you anything but "come back when it gets worse," come see us. The first visit is a free 20-minute movement assessment. Twenty minutes, in clinic, a real look at how you move. No charge, no insurance, no pressure to book anything afterward, and no argument from me if you decide surgery is the right answer for you. Call the West Front St office at (231) 944-6541.

There is also a free copy of my book on hip replacement recovery waiting for you at thesuperiortherapy.com.