Total Hip Arthroplasty (THA) and Total Knee Arthroplasty (TKA) are highly successful orthopedic operations for relieving chronic pain and improving function in patients with severe joint arthritis. Both procedures involve replacing damaged joint surfaces with prosthetic components to restore smooth movement. It is inaccurate to label one procedure as universally “worse” than the other, as both carry distinct challenges and benefits. Comparing the immediate post-operative experience, rehabilitation demands, and long-term functional results helps patients understand the unique difficulties associated with each replacement.
Comparing Immediate Post-Operative Pain and Hospital Stay
The first few days following surgery show a noticeable difference in acute pain management. Total Knee Arthroplasty (TKA) is associated with a higher intensity of immediate post-surgical pain compared to Total Hip Arthroplasty (THA). This difference is attributed to TKA involving more extensive bone cuts and manipulation of surrounding soft tissues and ligaments. Consequently, TKA patients often require a higher amount of pain medication, even with multimodal pain management like nerve blocks. Hospital stays are short for both, often between one and three days. THA patients generally find their immediate post-operative experience less painful and may be ready for discharge slightly sooner.
Differences in Recovery Time and Rehabilitation Needs
The recovery phase shows the most significant experiential difference between the two procedures. Total Hip Arthroplasty (THA) patients often demonstrate faster initial progress and a quicker return to mobility milestones. Many hip patients can walk without a full assistive device and feel a substantial reduction in pain within a few weeks. This rapid early improvement contributes to the perception that hip replacement recovery is generally smoother.
Conversely, Total Knee Arthroplasty (TKA) recovery is typically more intensive, prolonged, and physically demanding, primarily due to the need to regain functional range of motion. The goal of physical therapy for TKA is to restore both knee flexion (bending) and extension (straightening), which can be painful and challenging. Patients often require a dedicated, prolonged period of physical therapy, sometimes lasting up to 12 weeks.
Knee patients face a slower, more deliberate path, often requiring three to six months before returning to low-impact activities.
THA patients often return to work sooner. Functional recovery after THA is often superior in the short-term (first six months), though objective functional measures show similar results after a year. The extended and painful nature of knee rehabilitation is the primary reason TKA is perceived as the more challenging recovery.
Distinct Functional Outcomes and Activity Limitations
Once the primary recovery period is complete, typically six to twelve months after surgery, the final functional outcomes reveal differing limitations for each joint. For Total Knee Arthroplasty, a common and persistent limitation is the difficulty or complete inability to kneel comfortably. The artificial components and the surrounding scar tissue can make kneeling painful, restricting activities that require a deep bend, such as gardening or certain household tasks. While a significant improvement in pain and mobility is expected, about 20% of TKA patients may still report persistent pain after the first year.
Total Hip Arthroplasty generally results in fewer long-term functional limitations, leading to a higher rate of clinically significant improvement compared to TKA.
Historically, THA patients were subject to strict hip precautions to prevent dislocation, such as avoiding extreme flexion or rotation. However, modern surgical techniques, including the anterior approach, have reduced the need for these long-term restrictions for many patients.
While the risk of dislocation is a specific concern for THA, the overall outcome is often characterized by a near-normal return to most activities, except for high-impact sports like running or jumping.
Long-Term Risks and Revision Rates
Both hip and knee replacements are durable, with modern implants having an expected lifespan of 15 to 20 years or more. However, a comparison of long-term risk profiles shows slight differences in implant longevity and specific complications. The lifetime risk of requiring a revision surgery, where the original implant is replaced, increases significantly for patients who undergo the procedure at a younger age. For younger patients, the lifetime risk of revision is statistically higher for a Total Knee Arthroplasty than for a Total Hip Arthroplasty.
Long-term complication risks are also different; the primary concern for THA is the risk of dislocation, especially in the early post-operative period. For TKA, the most common long-term issue is persistent stiffness or chronic pain, which is reported by a greater percentage of patients compared to THA.
Overall, the Total Hip Arthroplasty is frequently cited as one of the most successful orthopedic procedures due to its long-term durability and high rate of patient satisfaction.