Who Is Not a Good Candidate for Hip Replacement Surgery & Identifying a Good Candidate

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After rehabilitating hundreds, if not thousands, of total hip replacement recipients as an orthopedic physical therapist over more than four decades, I have observed the transformative power of hip replacement surgery in enhancing mobility and quality of life.

However, it is crucial to understand that this procedure is not suitable for everyone. In this article, I will delve into the criteria that determine who may not be an ideal candidate for hip replacement surgery, and contrastingly, we will identify the characteristics of individuals who could greatly benefit from this life-altering intervention.

Who Is Not a Good Candidate for Hip Replacement Surgery?

As an orthopedic physical therapist with a focused expertise spanning over four decades, I’ve come to realize that although hip replacement surgery can be a transformative procedure, it’s certainly not suitable for everyone.

Individuals who are not good candidates are those with certain health conditions and lifestyle factors that may complicate surgery or the postoperative process. People with a higher body mass index (BMI), specifically if they are overweight or obese, may face increased risks during and after surgery. Excess weight can place added strain on the new hip joint, potentially leading to premature joint damage.

Having identified obesity as a surgical risk factor, my experience is that obese patients do not show me any difference in the timeline or outcomes of post-surgical rehabilitation than their non-obese or even underweight counterparts.

No discussion about candidacy would be complete without addressing the significance of a clear, infection-free hip joint. A hip infection or sepsis within the joint is a red flag; such conditions must be resolved before considering surgery. Those who have dealt with chronic infections may find that they’re a poor candidate for the procedure, as the risk of re-infection is high and can lead to serious complications.

Another consideration is the overall health and ability to recover after surgery. Patients with systemic diseases or severe comorbid conditions might not be suitable for the stress of surgery.

Evaluating hip care and the prospective surgical benefits is crucial; if there’s doubt about your ability to recover or manage aftercare, surgery might not be a wise choice. Moreover, while hip conditions like chronic pain and hip arthritis are often reasons for a hip replacement, severe bone loss or significant muscle weakness around the hip may make the surgery more complex or less likely to succeed.

The quality of the bone supporting the hip joint is instrumental to a successful implant. Substantial hip joint damage that has led to bone loss or a depleted bone quality may render you not a good candidate. It’s pivotal to understand that hip pain alone does not dictate surgical necessity; the underlying causes of hip pain need to be conducive to surgical intervention for the procedure to be beneficial.

Those actively battling severe medical conditions or who exhibit poor nutritional status that hinder the body’s healing process may also find that they’re not good candidates for this surgery. Ultimately, shared decision-making between patient and surgeon is key in determining whether hip replacement is the appropriate route for your hip care, ensuring that the benefits of surgery vastly outweigh the potential risks.

Identifying Good Candidates for Hip Replacement Surgery

When considering whether someone is a good candidate for hip replacement surgery, multiple factors must be taken into account.

A hallmark sign that someone may be ready for this surgical intervention is severe hip pain that greatly limits everyday activities and undermines the ability to live life without any limitations. It is important to understand that hip replacement is not just about alleviating pain, but also about improving the quality of life.

Individuals who can no longer find relief from non-surgical treatments and are facing progressive difficulty with simple tasks, such as walking, climbing stairs, or getting in and out of chairs, may be good candidates for hip replacement.

Furthermore, candidates should generally be in good overall health to withstand the stress of surgery and navigate the journey of hip replacement recovery successfully. When assessing suitability, the presence of chronic conditions doesn’t necessarily preclude someone from being a good candidate, but such conditions must be well-managed.

Modern surgical techniques, including minimally invasive procedures, have expanded the spectrum of who might benefit from a joint replacement, allowing for faster recovery and less post-operative discomfort.

In my experience, as an orthopedic physical therapist for over forty years, a patient’s positive outlook and commitment to post-operative rehabilitation are imperative. Those who are ready to actively participate in their recovery and adhere to a rehabilitation plan often see the best outcomes.

It’s worth emphasizing that hip replacement surgery should be considered only after conservative treatments have failed to provide sufficient relief. With the advancements in surgical techniques and the success rates of hip replacements, many patients can anticipate returning to a more active lifestyle post-surgery.

Candidates who exhibit persistent, severe hip pain that disrupts daily life, have no significant relief from other treatments, are in good overall health, and are motivated to engage in their recovery process are typically considered good candidates for hip replacement surgery. It is crucial, however, to consult with a skilled orthopedic specialist who can provide a thorough evaluation and determine the best surgical or non-surgical course of action tailored to the individual’s unique situation.

The Role of Hip Care Prior to Considering Hip Replacement

Throughout my forty years as an orthopedic physical therapist, I’ve emphasized the importance of comprehensive hip care in managing hip pain. A thorough regime of hip care is crucial for patients suffering from hip arthritis and other forms of joint damage.

Hip pain is an indicator of underlying issues that could range from transient strains to chronic conditions warranting surgical intervention. However, not everyone experiencing hip pain makes a good candidate for hip replacement surgery.

Osteoarthritis is the most common reason surgeons might suggest replacement surgery, particularly when joint damage leads to severe chronic pain. Yet, it’s essential to understand that replacement surgery is a significant undertaking and not suitable for everyone with hip issues. A meticulous evaluation by surgeons is necessary to establish if one is a good candidate for hip replacement surgery.

Poor candidates typically include those with systemic diseases, severe muscle weakness, uncontrolled diabetes, or infections that can impact the success of the surgical procedure. We also consider patients with high risk for anesthesia complications as not good candidates for the replacement surgery.

It is imperative for surgeons to rule out these concerns before proceeding with a surgical solution. Moreover, individuals who are heavily overweight or who have not attempted other forms of hip care might be advised by their surgeon to consider alternative treatments before surgical ones, as being obese presents its own surgical risks.

A person severely underweight presents with their own surgical risks as well.

On the flip side, a good candidate for hip replacement surgery is often someone who has exhausted other treatments without relief from severe hip pain. Surgeons will usually have tried conservative hip care measures before deliberating on surgical options.

Patients with significant hip pain due to osteoarthritis, and who meet health criteria for a safe surgical procedure, are often deemed suitable candidates.
In my experience, good orthopedic surgeons are hesitant to perform a total hip replacement until imaging clearly shows bone-on-bone.

While hip replacement surgery can offer relief and improved quality of life for many, it’s not the first or best option for those not suitable due to other health constraints or those who have not engaged in prior hip care.

In my practice, I sought to offer the best care by carefully considering each patient’s unique situation, thus ensuring that only those who are deemed a good fit undergo this life-changing surgery. It’s about striking a balance between the severity of hip arthritis and the overall health of the patient, ensuring those who proceed are likely to experience a significant improvement in their hip pain and mobility post-surgery.

One aspect of rehabilitation I recommended to many patients prior to consenting to surgical replacement, especially those with severe hip pain but still showing some articular cartilage between the acetabulum and femoral head, was to incorporate pool therapy as a way to improve strength and mobility without the pain of weight bearing.

Many of my patients found significant improvement with pool therapy programs at our local Easter Seals and YMCA facilities

Exploring Minimally Invasive Hip Replacement Surgery Options

As an orthopedic physical therapist with a wealth of experience, I’ve seen the evolution of joint replacement procedures, particularly those for the hip joint.

In my mind, when I hear the words hip replacement surgery and minimally invasive, I immediately think “Anterior approach to total hip replacement.”

Read my article:
Anterior vs. Posterior Hip Replacement: Pain, Surgery & Approaches Compared

Minimally invasive hip replacement surgery has become a front-runner for many patients seeking an alternative to traditional surgical approaches. This technique typically involves smaller incisions and often results in quicker replacement recovery times. Notably, the muscle disruption is lessened, potentially leading to a better outcome for the patient. However, it’s important to understand that not everyone is the right candidate for minimally invasive procedures.

THR Scar Anterior cropped watermarked
Anterior Approach Total Hip Replacement
THR Scar Posterior cropped Watermarked
Posterior Approach Total Hip Replacement

Good candidates for hip replacement surgery considering minimally invasive techniques are typically younger, healthier individuals with a strong commitment to post-surgical rehabilitation. These candidates generally have fewer comorbidities, a lower body mass index, and an active lifestyle they wish to return to. Surgeons screen patients extensively to ensure their suitability for this less invasive option. The procedure itself, while less invasive, still demands precision and skill from surgeons, and patient selection is crucial for optimal outcomes.

Just for clarification, in referrals I receive are patients of all ages being referred after anterior approach total hip replacement.
All my referrals after total hip surgery have a strong commitment to post-surgical rehabilitation, be it anterior, lateral, or posterior approach technique.

It’s imperative to explore all hip replacement options, including traditional hip replacement, with your surgeon. Some patients might be better suited to conventional approaches given their unique anatomy or underlying health issues. For those who do qualify for minimally invasive surgery, it’s encouraging to note that both techniques aim to restore mobility and alleviate pain in the hip joint, allowing patients a return to their everyday activities.

When considering the right approach, hip arthroscopy might also be discussed, though this procedure is typically reserved for diagnosing and treating specific joint problems rather than full joint replacement. Nevertheless, surgeons are increasingly harnessing minimally invasive techniques across a variety of procedures to enhance patient recovery.

Ultimately, identifying the correct candidates for minimally invasive hip replacement surgery revolves around a comprehensive clinical evaluation and a detailed understanding of the patient’s goals and expectations. It’s essential to have candid discussions with healthcare providers about the potential risks and benefits.

As medical professionals, we continuously strive to ensure that each patient receives the care that fits their individual needs best, whether that be a minimally invasive approach or another suitable treatment plan. Remember, the path to a successful hip replacement begins with selecting the right procedure for the right patient at the right time, with the right expectations, and under the care of skilled surgeons.

Physical therapists play an important role in helping the patient and surgeon select the right time and possibly help the surgeon select the right surgical approach if they are lucky enough to have that kind of relationship with the surgeon.

Physical therapists can also influence the surgical approach technique by simply suggesting to the surgeon that they have seen the best post-surgical outcomes.
After all, the potential total hip replacement patient most likely already has a relationship with a physical therapist for hip issues prior to surgical considerations.

Read my article:
How To Choose A Surgeon For Hip Replacement: A PT’s View

Understanding the Impact of Hip Pain on Hip Replacement Surgery Decisions

Experiencing hip pain can significantly affect your daily activities and overall quality of life. For many individuals suffering from severe hip pain, hip replacement surgery can be a life-altering procedure, offering relief from chronic pain and a pathway to regain mobility.

However, it’s crucial to recognize if you’re a good candidate for hip replacement surgery. Hip conditions, such as hip arthritis, often lead to joint damage that may necessitate such a procedure, but not every individual with hip pain is suited for surgery.

When considering hip replacement surgery, it’s essential to evaluate the risk factors. For instance, people with a higher body mass index (BMI), specifically if they are overweight or obese, may experience high levels of pain and could be at an elevated risk for complications during and after surgery. Weight management can be an integral aspect of hip care prior to surgical decisions, and losing excess weight can improve surgical outcomes.

Moreover, those who have systemic issues, like sepsis or hip infection, are not suitable candidates due to the increased risk of the infection spreading or recurring in the prosthetic joint.

Identifying good candidates for hip replacement surgery involves a comprehensive assessment of an individual’s health profile. Patients who have tried nonsurgical hip care options, such as physical therapy or medications, and still experience high levels of pain, may be considered suitable for the procedure.

Hip replacement surgery is particularly beneficial for those with significant joint damage due to hip arthritis or other degenerative hip conditions, where other treatments have failed to provide adequate relief.
Surgeons reach the determination of significant joint damage, in my experience, when the surgeon sees bone-on-bone in the imaging of the hip joint.

Exploring minimally invasive hip replacement surgery options could be favorable for those who require surgical intervention but have concerns about traditional open surgery. Minimally invasive techniques typically involve smaller incisions and less tissue disruption, which can lead to quicker recovery times and less post-operative pain.

Nevertheless, it’s vital to consult with a healthcare professional specializing in hip care to discuss surgery decisions, as each case demands a personalized approach.

While hip replacement surgery can offer substantial benefits for many with severe hip pain, it’s not a one-size-fits-all solution. Each potential patient must consider their personal health risks and benefits, weigh the severity of their hip pain, and assess their overall readiness for surgery. By consulting with experienced professionals and by understanding one’s specific hip conditions, patients can make informed decisions about whether hip replacement is the right path for them.

Read my other articles about Total Hip Replacement

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Q: Who is considered not a good candidate for hip replacement surgery?
A: Individuals with a higher body mass index (BMI), especially those who are overweight or obese, may face increased risks and thus may not be considered good candidates. Patients with active hip infections, systemic diseases that are not well-controlled, severe comorbidity conditions, or substantial bone loss around the hip joint may also not be suitable. Those with chronic infections or serious medical conditions, as well as poor nutritional status that impairs healing, may find they are not good candidates for this surgery.

Q: Can someone with a serious medical condition undergo hip replacement surgery?
A: Patients with serious medical conditions such as systemic diseases, uncontrolled diabetes, or significant comorbidities may face higher risks during surgery and the recovery period. While these conditions do not automatically disqualify someone from hip replacement surgery, they must be well-managed and stable prior to consideration. The decision should be made along with a thorough consultation with an orthopedic specialist who can evaluate the risks and potential for a successful outcome.

Q: What makes someone a good candidate for hip replacement surgery?
A: Good candidates for hip replacement typically experience persistent, severe hip pain that limits daily activities, have found little to no relief from other non-surgical treatments, are in good overall health, and are motivated to engage in their recovery and rehabilitation process. This surgery is often considered after conservative treatments have been exhausted and if the person is likely to benefit from improved mobility and quality of life post-surgery.

Q: What are the benefits of minimally invasive hip replacement surgery?
A: Minimally invasive hip replacement surgery involves smaller incisions and typically results in quicker recovery times, less post-operative pain, and potentially better outcomes due to less muscle disruption. This type of surgery may be preferable for younger, healthier individuals who have a lower BMI, fewer medical comorbidities, and a strong commitment to post-surgical rehabilitation. However, it is not suitable for everyone, and a consultation with a surgeon is necessary to determine the best approach.

Q: How do I know if I should consider hip replacement surgery for my hip pain?
A: If you have hip conditions like severe arthritis that result in significant joint damage and chronic pain, and you’ve tried various nonsurgical hip care options without relief, you might consider hip replacement surgery. It is usually reserved for those who experience high levels of pain that affect their quality of life and ability to perform daily activities. Consultation with an experienced healthcare professional is crucial to assess your health profile and surgical options, including the possibility of minimally invasive techniques.


Dr. Donaldson is dually licensed; physical therapy in 1975 and doctor of chiropractic in 1995. He held credentials of Orthopedic Clinical Specialist in physical therapy for 20 years, QME in California, and taught at USC. He owns and operates an orthopedic physical therapy practice. See "About Me" page.

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