Evidence- and consensus-based indication criteria for total hip arthroplasty for coxarthrosis

Implantation of a total hip arthroplasty (hip TEP) is the most common endoprosthetic procedure in Germany. However, there are significant regional differences in the frequency of treatment. Despite predominantly very good results, risks are also associated with this intervention. The correct indication is therefore of great importance for the individual patient as well as for the health care system.
  • With the objective in mind, the authors of the guideline have answered clinically relevant questions on the following topics:
  • Confirming the diagnosis,
  • Suffering pressure of the patient,
  • Examination of alternative therapy measures,
  • Contraindications,
  • Optimization of modifiable risk factors,
  • Participatory decision-making
Checklist: Indication for hip TEP in coxarthrosis


Indication criteria
Structural damage Coxarthrosis at least Kellgren/Lawrence grade 3
(or femoral head necrosis at least ARCO III c)
Conservative therapy Combination of drug and non-drug therapy for at least therapy for at least 3 months
Core elements of non-drug conservative therapy
takes place: Information, exercise therapy, weight reduction if necessary
High suffering despite conservative therapy Hip-related complaints (pain, functional limitation)
Health-related quality of life
Contraindications Active infection (of joints, soft tissues or spreading hematogenously)
Acute or chronic concomitant diseases with increased risk of mortality
BMI ≥ 40 kg/m2
Other contraindications to surgery
Modifiable risk factors Nicotine: abstinence at least 4 weeks before surgery until wound healing recommended
Diabetes mellitus: HbA1c value below 8
BMI > 30 kg/m2
Anemia: optimization done
Intra-articular injection of corticosteroids: no hip TEP within 6 weeks
Suspicion of mental illness: specialist clarification recommended
Participatory decision making Patient goals
Author(s) Source
Schmitt J (Guidelines Coordinator) AWMF Online 24.03.2021, German Original: ©DGOU, Kurzfassung „Indikation Hüfttotalendoprothese“ AWMF-Registernr. 178-001| Version 1.
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