Hip arthritis tends to announce itself in the groin. Dr. Kenneth Milligan, an orthopedic surgeon at Monument Health, says that throws people off, because they’re waiting to feel something on the outside of the hip where they’d grab it. You feel it after sitting a while, or climbing out of the car, or bending down to pull your socks on. And it’s rarely a sharp, obvious pain. It’s a dull ache that creeps up so slowly you talk yourself out of it.

“We can even see patients who really never endorse pain, and yet they have a quite noticeable gait disturbance or a limp,” Milligan said. Everybody around them notices. They shrug and say it kind of hurts, not too bad. Then they get the hip replaced and they can’t believe the difference.

Knees are louder about it. Swelling. Crepitus, which is the clinical word for the clicking and popping you hear when you bend. A knee that catches partway through, or won’t straighten all the way. Those are the signs Milligan says should send you in for a look.

What arthritis is

Cartilage is the slick surface covering the ends of your bones where they meet. Milligan tells patients it’s slipperier than ice sliding on ice. It’s made of collagen and a lot of water, and it does two jobs: it lets bone glide against bone with almost no friction, and it cushions the impact.

Arthritis is that surface wearing out. Mechanical wear and tear is osteoarthritis. An autoimmune condition breaking it down is inflammatory arthritis. Either way, the cushion goes away.

Small cartilage defects, a few centimeters across, can sometimes be repaired. Surgeons can harvest a bit of your cartilage, grow it in a petri dish, and put it back. Cadaver tissue is another option. Those procedures are aimed mostly at younger patients with one isolated injury. Once the damage is widespread and bone spurs show up, replacement becomes the answer.

Before surgery

Milligan is a surgeon, and he’d still rather you try the other things first. Anti-inflammatories. Activity changes. Steroid injections, PRP, hyaluronic acid, particularly in the knee. Catch it early enough and there’s a whole tier of less invasive procedures that can relieve pain and slow arthritis from ever reaching replacement territory.

The numbers

Hip replacement satisfaction runs 98 percent or better in the large national registries. Milligan calls it one of the best performing surgeries in all of medicine.

Knee replacement lands around 85 to 87 percent, still comfortably in medicine’s top five procedures. The gap comes down to recovery. Knee surgery requires splitting some tendon, and the joint depends on its ligaments for stability in a way a ball-and-socket hip does not. Range of motion has to be earned back, and the physical therapy that gets you there is hard work.

A newer approach

The big shift in hip surgery is the anterior approach, an incision in the front that spares muscle entirely. Coming in from the back means splitting the gluteus maximus and cutting muscles off the back of the joint, then repairing them and waiting for them to heal. From the front, the surgeon retracts muscles aside inside their fascial compartments and reaches the joint without cutting any of them.

Recovery is faster and dislocation rates run slightly lower. Milligan has had patients running in place at their two-week visit. Nationally, roughly 60 to 70 percent of younger surgeons are now using it.

He was a research coordinator on some of the original anterior approach studies 15 to 20 years ago. Back then, hip patients spent days in the hospital with drains and dressing changes and a trapeze bar over the bed. Today they’re walking the hallway an hour or two after surgery.

The myth

People come in convinced the implant expires at 10 or 15 years and they’ll need another surgery. The parts that anchor into bone are titanium. The moving surface pairs ceramic against a newer plastic that outperforms the old material by about ten thousand times. Early data shows implants 100 percent intact at 30 years in young patients.

“We only will take you back if there’s a problem,” Milligan said. Breaks and infection are the reasons for revision now.

As for age, Milligan says advanced arthritis matters more than the year you were born.