Are hip replacement surgeries as successful as doctors think they are?

Marc Darrow, MD, JD

Hip replacement surgery is one of the most commonly performed orthopedic procedures in the world. For many people with severe, end-stage hip arthritis, it can provide dramatic pain relief and restore mobility. Every year, hundreds of thousands of patients undergo total hip replacement with the hope of returning to a more active life.

However, during my years caring for patients with chronic musculoskeletal pain, I have also met many individuals whose outcomes did not meet their expectations. Some continue to struggle with pain, weakness, balance problems, or reduced function long after surgery. Others require additional procedures or remain dependent on pain medications.

The replacement surgery may not be as successful as we think

Let me be clear: I have tremendous respect for orthopedic surgeons. Hip replacement is a technically demanding operation, and many surgeons achieve excellent results. But like every medical intervention, it has limitations and risks that deserve careful consideration before proceeding.

In my opinion, elective surgery for arthritis should rarely be viewed as the first option. Patients deserve to understand both the benefits and the potential shortcomings of surgery, as well as the growing number of non-surgical treatments that may delay—or in some cases eliminate—the need for joint replacement.

Hip replacement has consistently demonstrated high patient satisfaction rates, particularly in people with advanced osteoarthritis. Nevertheless, success is not universal.

A recent review evaluating systematic reviews of total hip and total knee replacement concluded that although numerous reviews have been published, the quality of the evidence varies considerably. The study (1) discussed the “increasing numbers of systematic reviews on total knee arthroplasty and total hip arthroplasty (which) have been published in recent years, but their quality has been unclear.” What the researchers said were unclear were the study outcomes: “Clinicians should be judicious when applying the conclusions of the systematic reviews results to their own patients.” The surgery may not be as successful as we think.

This is an important point.

When patients hear that hip replacement has a “90–95% success rate,” they often assume this means nearly everyone becomes pain-free and returns to normal function. In reality, success can be measured in many different ways. A patient may avoid revision surgery yet continue to experience pain. Another may have improved mobility but remain unable to participate in desired activities.

The definition of success matters.

The feeling is that when traditional pain-relief treatments and pain medications have run their course and no longer relieve hip pain, hip replacement or arthroscopic surgery is readily available as options to the patients. There is an expectation that surgery fixes everything and improves general overall health and physical well-being and most importantly provides pain relief. There is a lot of expectation. Yet other research says these expectations are not met, and this is clearly cause for concern as post-surgical medications use and drugs for pain relief may be needed after surgery.

A May 2025 study (2) found at least 14% of patients reported persistent pain 6–12 months after total hip replacement. The researchers concluded: “Given the prevalence of chronic postsurgical pain, implementing existing and developing new preventive and management strategies is crucial for optimal patient outcomes.”

A December 2025 study (3) also suggested approximately 14% of patients develop chronic postsurgical pain one year after total hip arthroplasty. Causes were identified as “These studies identified multiple biopsychosocial factors that may contribute to the development of chronic postsurgical pain. These include body mass index, preoperative (neuropathic) pain, the presence of comorbidities and functional disability, smoking, non-white race, sleep disturbances, depressive symptoms, anxiety, central sensitization, and pain catastrophizing. ”

As controversial and unproven as arthroscopic surgery is, it may still be better than hip replacement.

Presenting alternatives to hip replacement surgery is an important function in the patient–doctor relationship, as suggested in this recent study published in The Journal of the American Academy of Orthopaedic Surgeons: (4)

“Arthroscopic surgery is commonly performed in the knee, shoulder, elbow, and hip. However, the role it plays in the management of osteoarthritis is controversial. Routine arthroscopic management of osteoarthritis was once common, but this practice has been recently scrutinized. Although some believe that there is no role for arthroscopic treatment in the management of osteoarthritis, it may be appropriate and beneficial in certain situations. The clinical success of such treatment may be rooted in appropriate patient selection and adherence to a specific surgical technique. Arthroscopy may serve as an effective and less invasive option than traditional methods of managing osteoarthritis.”

In other words, as controversial and unproven as arthroscopic surgery is, it may still be better than hip replacement. Far better than both as a first option, in my opinion, are the biomedicine treatments including Bone Marrow Aspirate and Platelet-Rich Plasma (PRP) Therapy. These are non-surgical options for pain relief.

Why some patients need to continue opioids six months after knee or hip replacement

In a July 2023 retrospective analysis of 10,140 consecutive patients (5) undergoing primary total hip replacement postponed total joint replacement revealed a higher 90-day revision rate, surgical complications, internal complications and transfusion rate than on-time total joint replacement. Delay in elective primary total joint replacement correlates with higher revision and complication rates.

Continued use of painkillers following surgery, in the case of the above study, for a minimum of three years after the surgery does give the appearance of a successful hip replacement surgery.

Balance Remains Impaired after Hip Replacement

A March 2022 study (6) examined the hoped for positive effects of hip replacement on patient balance. Overall, the evidence found suggested that balance is impaired immediately after surgery and, 4-12 months after surgery, it becomes better than preoperatively, although without reaching the level of healthy subjects. A strong level of evidence was found for hip resurfacing resulting in better balance restoration than total hip replacement, and for strength and ROM exercises after surgery positively influencing balance.

Do patients have side-effects or do they think they have side-effects.

A 2020 study (7) suggested that people who report side-effects after their hip replacement surgery or prone to have worse surgical outcomes. That is not the point of this study. This suggestion is is that patients who report side effects have worse outcomes whether they actually have side-effects that can be confirmed by standard medical record review methods or they think they are having side-effects. “The observed negative trends suggest that patient perception of adverse effects may influence patient outcome in a similar way to those with confirmed adverse effects.” In other words if you are not happy with the surgery, you will have a bad follow up.

The gluteus medius tendon and weakened muscles

A December 2024 study (8) wrote that while patient satisfaction is high and functional ability improves after total hip replacement, residual impairment and pain are common. Degenerative changes in tendons and muscles are probable causes. The researchers suggest degeneration in the gluteus medius tendon and muscle strength in the muscles acting around the hip in patients with hip osteoarthritis, before and after total hip replacement is occurring. Pre and post-surgery muscle strengthening exercises should be explored.

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While hip osteoarthritis can cause severe pain, conservative care or regenerative medicine can help many people with disability, pain and loss of function.

In our practice, bone marrow aspirate or bone marrow derived Stem Cell Therapy is a treatment for musculoskeletal disorders. We treat degenerative joint disease, degenerative disc disease of the spine, and tendon and ligament injury. With over 27 years of experience, Dr. Marc Darrow and his team are pioneers in regenerative treatments, offering expert insights and personalized care tailored to your needs.

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