People arrive in the rooms having already decided they have left it too late, usually because someone told them so. It is worth saying plainly: there is no upper age limit for hip replacement. It is performed routinely in people in their eighties and nineties, and in that age group it is frequently the operation with the best ratio of benefit to risk that is available to them.
What actually decides it.
Three things, and chronological age is not one of them.
Fitness for an anaesthetic. Assessed by an anaesthetist rather than estimated. Heart and lung function, kidney function, diabetes control, anticoagulation and frailty all matter, and many conditions that sound prohibitive turn out to be manageable with planning. Hip replacement can be performed under spinal anaesthetic, which is often preferred in older patients and avoids a general anaesthetic altogether.
What the operation would give you back. This is the question that actually matters and it is specific to you. A hip that has stopped you leaving the house is a different proposition from a hip that has stopped you playing golf, whatever your age.
Whether the alternative is genuinely better. Not operating is also a decision with consequences, and in an older patient those consequences accumulate faster. That is covered below.
Why a hip is often the more reasonable operation late in life.
A hip replacement asks less of you afterwards than a knee replacement does. There is no six-week window of intensive physiotherapy that decides the result. You walk on the day of surgery, full weight bearing, and after an anterior approach there are usually no formal movement precautions. Most of the recovery is walking, which is something an older patient can do without supervision.
The other reason is that hip replacement is one of the more reliable operations in surgery for pain relief. Satisfaction after hip replacement runs consistently higher than after knee replacement in the published outcome literature, and the gain arrives sooner.
The cost of waiting.
Delay is usually presented as the cautious option. In an older patient it often is not.
An arthritic hip that stops you walking produces deconditioning, loss of muscle, loss of balance and loss of confidence, and those are precisely the things that make an operation riskier and a recovery slower. The person who waits three more years does not arrive at the same operation three years later; they arrive at a harder one.
There is also the falls question. A painful, stiff, unreliable hip is a falls risk, and a fall in an older person with an arthritic hip not uncommonly produces a fracture that then has to be operated on as an emergency, in worse circumstances, without planning and without an optimised patient. Elective surgery on a chosen day is a better proposition than the same anatomy addressed after a fall.
The revision arithmetic runs the other way.
The argument for waiting that applies to a fifty-year-old does not apply here, and it is worth understanding why. A joint replacement has a service life, so a younger patient may outlive their implant and need a revision. Lifetime revision risk falls sharply with age at surgery: population data puts it at around 5 per cent for patients having a hip replacement over the age of 70, against roughly 30 per cent for men in their early fifties.1
In other words, the single strongest argument for delaying a joint replacement disappears in older patients. If you are 78, the implant will almost certainly outlast the need for it.
How the assessment is actually made.
Not by a rule. The consultation covers what you can no longer do, what you have already tried, what the X-ray shows and what your general health is. Where fitness is the question, you are seen by an anaesthetist before anything is booked, and optimisation of anaemia, blood sugar and blood pressure happens first. See nutrition and joint replacement for what that involves.
Sometimes the answer is that the risk is too high, and that is said plainly rather than implied. More often the answer is that the risk is acceptable and the operation is worth doing, and the conversation moves on to when.
References.
- Bayliss LE, Culliford D, Monk AP, et al. The effect of patient age at intervention on risk of implant revision after total replacement of the hip or knee: a population-based cohort study. Lancet. 2017;389(10077):1424-1430.
- Australian Orthopaedic Association National Joint Replacement Registry. Hip, Knee & Shoulder Arthroplasty Annual Report. Adelaide: AOA.
Common questions.
Is 85 too old for a hip replacement?
No. There is no upper age limit. Hip replacement is performed routinely in people in their eighties and nineties. What decides it is fitness for an anaesthetic, assessed by an anaesthetist, and what the operation would give you back.
Can it be done without a general anaesthetic?
Often, yes. Hip replacement can be performed under spinal anaesthetic with sedation, which is frequently preferred in older patients. The anaesthetist decides this with you before surgery.
Will I be able to do the rehabilitation at my age?
A hip asks much less of you than a knee. You walk on the day of surgery and most of the recovery is walking a little and often rather than a structured six-week programme. There are usually no formal movement precautions after an anterior approach.
Am I too old for the implant to be worth it?
The arithmetic runs the other way. Lifetime risk of needing a revision falls sharply with age at surgery, to around 5 per cent for people operated on over 70. The implant will almost certainly outlast the need for it.
This page provides general information about a medical condition and a surgical procedure. It is not individual medical advice and does not replace consultation with a qualified practitioner. Outcomes vary between individuals and all surgery carries risk. A referral is needed for a consultation with Professor Daevyd Rodda; without one, you can start with the practice nurse practitioner, who can provide it.