I’ve been diagnosed with hip osteoarthritis: do I need an operation?
When conservative treatment is advisable – and when a hip replacement may be the better option.
“The X-ray shows clear signs of hip osteoarthritis.” For many patients, this statement almost automatically suggests a hip replacement. However, an X-ray finding on its own is not in itself an indication for surgery.
The crucial question is rather: to what extent does the osteoarthritis affect your daily life – and what can still be achieved with consistent conservative treatment?
This is precisely where treatment at Dr Beate Helgers’ private orthopaedic practice in Dorsten-Lembeck comes in. Not every diagnosed case of coxarthrosis requires immediate surgery. Nor, however, should surgery be put off indefinitely simply out of fear if pain, loss of mobility and functional limitations continue to worsen despite appropriate treatment.
Key points at a glance
A confirmed diagnosis of hip osteoarthritis does not automatically mean that a hip replacement is required straight away.
The decision on treatment is based not only on the X-ray, but above all on the interplay between pain, function, everyday activities and quality of life.
Before planning a total hip replacement (THR), effective conservative measures should have been tried to a sufficient extent – in particular, exercise therapy and pain management tailored to the individual.
Conservative treatment can reduce pain, improve function and delay surgery or, in suitable cases, avoid it altogether. However, it cannot fully restore damaged joint cartilage.
If quality of life remains significantly impaired despite consistent conservative treatment, a hip replacement may be the more appropriate course of action.
The decision should be made in consultation with a specialist in orthopaedics, based on the findings, the course of the condition to date and the patient’s personal goals.
It is not the X-ray that matters – it is the person
In coxarthrosis, the cartilage and bony joint structures undergo changes. An X-ray may, for example, reveal a narrowed joint space, bony spurs or changes to the bone beneath the cartilage.
Such findings are important – but they do not automatically indicate the extent to which a person is restricted in their daily life. Some patients have pronounced radiological changes yet are still able to walk surprisingly well. Others experience severe functional limitations even with less noticeable changes.
For this reason, surgery should not be recommended solely on the basis of the severity of an X-ray. The decisive factors are whether the findings correspond to the symptoms and to what extent the hip limits daily life.
What questions are really important before deciding on surgery?
Before asking ‘Surgery or no surgery?’, several aspects should be systematically assessed:
Has the diagnosis of hip osteoarthritis been plausibly confirmed both clinically and through imaging?
How severe are the pain and loss of function in reality?
Which specific activities are no longer possible – walking, getting dressed, sleeping, working, exercising, doing household chores?
What non-surgical treatments have already been tried – and for a sufficiently long period?
Are there any treatable contributing factors that further exacerbate the symptoms?
What are the expectations regarding surgery – and how realistic are they?
What individual surgical risks need to be taken into account or managed beforehand?
These questions are medically more important than the blanket statement: ‘The hip is worn out.’
When can hip osteoarthritis be treated conservatively?
Conservative treatment is particularly advisable when pain and functional limitations are still manageable to the extent that daily life, physical activity and sleep remain acceptable – or improve again with treatment.
It is also important before an elective hip replacement is considered. The existing S3 guideline on total hip replacement (THR) explicitly recommended using a combination of pharmacological and non-pharmacological conservative treatments before indicating surgery. This guideline formally expired in 2026; an updated joint EKIT guideline for hip and knee replacements is currently being revised.
What can conservative treatment achieve?
Conservative treatment cannot reverse osteoarthritis itself. However, it can certainly influence how well the hip copes with everyday activities and the intensity of the pain experienced.
Reducing pain and inflammatory symptoms
Maintaining mobility as far as possible
Improve muscle strength and coordination
Optimise gait and weight-bearing distribution
Restore the ability to carry out everyday activities
Overcome compensatory movement patterns and fear of movement
Delay the need for surgery or, if progress is favourable, avoid surgery altogether
The basis: exercise rather than complete rest
Exercise is one of the most important measures in the conservative treatment of hip osteoarthritis. The aim is not to ‘train the pain away’, but to build up the joint’s load-bearing capacity so that it is better supported in everyday life.
Depending on the individual’s starting point and tolerance, this may include strength training, mobilisation, coordination exercises, cycling, walking or exercise in water. The key is the right balance: training should be challenging, but should not regularly lead to a significant and persistent worsening of symptoms.
At Dr Beate Helgers’ private practice in Dorsten-Lembeck, this active approach can be supported by medical exercise therapy and functional movement analysis. The aim is to create a personalised exercise plan rather than a one-size-fits-all programme.
What role do painkillers play?
Anti-inflammatory painkillers can be useful during periods of pain to enable movement once again. At the same time, potential risks – such as to the stomach, kidneys, blood pressure and the cardiovascular system – must be taken into account.
The key question is therefore not: ‘Which painkiller is the strongest?’, but rather: ‘Which medication is medically justifiable in this situation and supports the actual aim of the treatment – regaining greater functional mobility?
Injections for hip osteoarthritis: what is realistic?
Intra-articular cortisone injections can temporarily reduce pain in selected patients. They are not a permanent solution and should not be regarded as a routine course of treatment. Due to the hip joint’s deep location, image-guided administration is advisable.
There is insufficient evidence to demonstrate a reliable benefit from hyaluronic acid injections for hip osteoarthritis. The same applies to some dietary supplements advertised as promoting ‘cartilage regeneration’. A reputable treatment plan should therefore clearly distinguish between plausible symptom relief and unsubstantiated promises of regeneration.
Avoiding surgery – but not at any cost
The desire to preserve one’s own joint for as long as possible is understandable. Nevertheless, ‘no surgery’ is not automatically the better outcome.
If, despite adequate conservative treatment, the hip continues to cause severe, persistent pain; walking distance decreases significantly; sleep and daily life are impaired; and important activities are no longer possible, the treatment strategy must be reassessed.
In cases of advanced, symptomatic coxarthrosis, a hip replacement can usually significantly reduce pain and improve function. At the same time, it is a major operation with its own risks. Therefore, neither rushing into surgery nor delaying it unnecessarily is advisable.
When is a hip replacement medically advisable?
According to established indication criteria, several factors combined are the main reasons for a total hip replacement (THR):
clinically and radiologically confirmed coxarthrosis,
severe pain or significant functional limitations,
a noticeably reduced quality of life,
insufficient success with effective conservative treatments over a reasonable period of time – often at least three months,
an informed shared decision following a weighing up of the benefits and risks.
The decision is therefore based neither purely on radiological findings nor purely on the level of pain. It is based on an overall assessment.
What else should be considered before hip surgery?
If surgery is being seriously considered, it is not just the hip itself that should be assessed. Modifiable risk factors may also be relevant to the patient’s long-term prognosis.
Is the patient’s general state of health sufficiently stable?
Are blood pressure, diabetes or other chronic conditions well managed?
Are there any relevant infections or skin problems?
Can physical fitness be improved before the operation?
Has home care been organised for the initial period following the procedure?
Are expectations regarding freedom from pain, mobility and exercise realistic?
This preparation is just as much a part of making an informed decision about surgery as the X-ray.
When is it advisable to seek a second opinion?
Before elective hip surgery, a second orthopaedic assessment may be advisable – particularly if there is uncertainty as to whether conservative treatment options have already been exhausted or whether the symptoms actually originate predominantly from the hip joint.
A second opinion should not be used simply to keep seeking a different answer until the desired recommendation is given. It should help you make a decision that is transparent and well-founded from a medical perspective.
What conservative treatment can achieve – and what it cannot
What is realistic
What cannot be credibly promised
Reducing pain and making movement easier
‘Cure’ advanced osteoarthritis
Improving strength, coordination and resilience
Completely restoring lost joint cartilage
Delaying surgery or, in suitable cases, avoiding it altogether
Guarantee that a prosthesis will never be necessary
Treat associated factors such as compensatory movement patterns
Attribute every symptom solely to osteoarthritis
help patients prepare for an informed decision
replace a medically justified operation as a matter of principle
Hip osteoarthritis in Dorsten-Lembeck: conservative treatment or surgery?
At Dr Beate Helgers’ private orthopaedic practice in Dorsten-Lembeck, the focus when hip osteoarthritis is diagnosed is not on making a quick decision for or against surgery. The first step is to clarify how well the diagnostic findings, symptoms and function align, and what treatments have already been carried out.
We then discuss together:
Which conservative options are still worthwhile?
What goals are realistically achievable?
How can load-bearing capacity be objectively improved or assessed?
At what point does continuing to wait no longer offer sufficient benefit?
When is it sensible to seek surgical advice?
A well-informed decision against surgery is just as valuable as a well-informed decision in favour of surgery – provided it is medically justified and reached jointly.
Frequently asked questions about hip osteoarthritis and the decision to have surgery
Does advanced hip osteoarthritis always require surgery?
No. It is not just the changes visible on X-rays that are decisive, but symptoms, function and quality of life. If the hip can still bear weight well despite significant osteoarthritis, surgery is not automatically required.
How long should conservative treatment be continued before considering a hip replacement?
There is no fixed timeframe that applies to everyone. However, if a total hip replacement (THR) is planned, effective conservative measures should have been tried for a sufficient period. Established indication criteria often specify a period of at least three months, unless a specific situation necessitates an earlier decision.
Can exercise prevent the need for a hip replacement?
Exercise can improve pain levels, strength and everyday function, and may therefore delay surgery or, if progress is favourable, avoid the need for it altogether. However, it cannot reverse advanced structural osteoarthritis.
When is the right time for hip surgery?
The time has come when osteoarthritis has been medically confirmed, pain and loss of function significantly impair quality of life, and appropriate conservative treatments are no longer sufficiently effective. The decision should be made on an individual basis.
Is it harmful to delay necessary hip surgery for too long?
Waiting for a very long time can lead to a further decline in activity levels and muscle strength, and increasingly restrict everyday life. Therefore, in the event of a marked deterioration, the appropriateness of the current treatment goal should be regularly reassessed.
Should you seek a second opinion before hip surgery?
This can be advisable, particularly if there is uncertainty regarding the diagnosis, conservative alternatives or the timing of the operation. A second opinion can help you to better understand the decision.
Are hyaluronic acid or dietary supplements an alternative to surgery?
There is insufficient evidence to demonstrate a reliable benefit from hyaluronic acid injections and many so-called cartilage preparations in the treatment of hip osteoarthritis. They should therefore not be presented as a substitute for effective conservative treatment or medically justified surgery.
Have you been diagnosed with hip osteoarthritis?
Subheading: Find out whether surgery is really necessary at this stage.
Text: At Dr Beate Helgers’ private practice in Dorsten-Lembeck, we work with you to assess your X-ray findings, symptoms, function and previous treatment. The aim is to reach a clear decision – whether to continue with conservative treatment or to arrange a consultation regarding surgery.
Dr Beate Helgers studied medicine at Ruhr University Bochum. Her medical training took her, amongst other places, to the University Orthopaedic Clinic at St Josef’s Hospital in Bochum, the Department of General and Trauma Surgery at Marienkrankenhaus Schwerte, the University Orthopaedic Clinic at RWTH Aachen University, and the Paracelsus Clinic in Marl.
In 1996, she obtained her PhD in orthopaedics, and in 1998 she was recognised as a specialist in orthopaedics. In 2011, she established her own private practice in Dorsten-Lembeck; since 2020, she has also had a branch in Ahaus. Today, Steinfurt and Gescher are also part of the practice network.
Her treatment approach combines orthopaedic diagnostics and pain management with an analysis of functional relationships and – where medically appropriate – active stabilisation and exercise therapy.
