2nd Opinion Hip Replacement for Young Patients

Expert Perspective from Benedict Nwachukwu, MD, MBA – NYC Hip Conservancy Surgeon

“Many of my patients think that hip replacement is their only option, but after proper evaluation, we often find that hip preservation is possible and a treatment option.”

If you are an active young adult and have just been told that you need a hip replacement, you may be shocked, or even scared. I see many patients in their 30s, 40s, and 50s seeking a second opinion after they were told by another orthopedic surgeon that joint replacement was their only option. In many cases, hip preserving procedures such as arthroscopy may still be a more effective treatment in the long term. They are often confused as to why they were not informed about this option and the potential risks of undergoing joint replacement surgery at too young an age.

Here are some reasons why an orthopedic surgeon might push for hip replacement too early – and what you need to know to make the right decision:

1. The Majority of Orthopedic Surgeons Focus on Joint Replacement

Although nearly all orthopedic surgeons receive joint replacement training, few commit to the specialized training required to perform hip preservation procedures. Labral repair, cam/pincer reshaping, and postless hip arthroscopy require fellowship-level training and a great deal of experience.

When a surgeon is unskilled in these new methods, they will fall back on replacement surgery—even when preservation is still a viable or preferred option.

2. Hip Replacement is Faster and More Predictable than Hip Preservation

Technically, hip replacement surgery is quicker, easier, and more planned, than hip preservation surgery. For some orthopedic surgeons, joint replacement is a procedure that must be performed by a surgeon specially trained in preservation techniques.

However, in younger patients, premature joint replacement can cause long-term problems, such as requiring revision surgery later in life.

3. Imagery Alone Doesn’t Tell the Whole Story

Labral tears, mild cartilage damage, or bony impingement (FAI) may be visible on an X-ray or MRI, but this does not necessarily mean that the joint cannot be preserved. A surgeon who is not trained in conservation may exaggerate the severity of what they see on film or assume that joint replacement is inevitable.

To determine whether hip joint preservation is still a viable option. In my practice, I consider all of the following:

• Imaging
• Detailed physical examination
• patient history
• activity goals

4. Inadequate Equipment or Unavailability of Postless Technique

Although most hospitals are equipped with OR traction tables that use lasting posts, not all hospitals or surgical centers are equipped with the specialized traction tables required for post-post hip arthroscopies to reduce the risks associated with lasting posts including nerve compression, groin injury, and perineal discomfort.

Specialized equipment and surgeons trained to use it are typically found at academic medical centers and large-scale hip preservation practices, such as HSS. Without the appropriate table and equipment, a surgeon may not offer arthroscopy as a treatment option even if you are a perfect candidate.

5. Institutional Patterns or Practices

In some other cases, the hospital or practice culture is heavily based on joint replacement, due to referral patterns, reimbursement mechanisms, or clinical practice history. In situations like these, preservation may be unthinkable.

Why I Do Things Differently

Hip preservation is about restoring function and preserving your joint itself.

Here’s how I approach treatment for younger, active patients:

• Preserve joints whenever possible, especially for patients under 50 who wish to maintain their current level of activity and sports performance
• Use minimally invasive and postoperative hip arthroscopy to reduce risks and improve outcomes.
• Delay hip replacement if necessary, giving patients the opportunity to benefit from future innovations.
• Coordinate long-term rehabilitation and performance goals, especially for athletes and highly active individuals.

This is especially important in athletes and active patients, where joint mechanics, range of motion, and proprioception are more important than pain relief alone. Total hip replacement limits some athletic activities and limits long-term high-impact activities.

However, hip preservation surgery addresses the underlying structural problem—such as a labral tear or femoroacetabular impingement—while preserving the bone and cartilage. For athletes, this means a better chance of returning to high-level sporting performance without the initial limitations of a prosthetic joint.

Another important consideration is the influence of time. Waiting a decade to have a total hip replacement may open the door to future innovations. In the shoulder area, for example, newer stemless implants have made future revisions much easier for younger patients. Because hip replacement technology is advancing rapidly, delaying replacement for 5-10 years can significantly increase your revision surgery options in the future.

It is important to realize that although hip preservation is less surgically invasive—it does not require much cutting and no replacement of joint surfaces or bones—it generally requires more extensive rehabilitation than a hip replacement. Physical therapy is necessary to restore strength, flexibility, and joint control, especially in patients who wish to resume high levels of activity. Recovery may take several months and requires commitment from the PT.

In contrast, hip replacement usually results in quicker recovery from pain and walking ability in the short term, and less formal rehabilitation is required by some patients. Younger, more active patients must be willing to sacrifice permanent activity restrictions and long-term endurance issues for a quicker recovery.

Considering Hip Replacement Surgery? Get a Second Opinion First

If you are a young athlete or active person who has been told that you need a hip replacement, a second opinion from a trained hip preservation specialist can help you explore additional hip preservation options.