Clinical Decision-Making in Total Hip Arthroplasty: Evaluating Indications and Alternatives

Total hip arthroplasty (THA) is widely regarded as the gold standard for the treatment of end-stage hip disease, yet not all patients require or are suitable for immediate surgery. For those with mild to moderate disease, particularly younger and more active individuals, alternative strategies such as hip arthroscopy, osteotomy, and intra-articular injections can provide symptomatic relief, delay disease progression, and preserve native joint function whenever possible. These approaches have gained attention in recent years as they may postpone the need for THA and reduce the risk of early revision in high-demand patients. However, for advanced disease with irreversible structural damage, THA remains the definitive option. Optimal decision-making requires careful integration of clinical symptoms, radiographic evidence, patient age, comorbidity profile, personal preference, surgical techniques, and perioperative risk assessment. This review aims to systematically summarize the indications and limitations of alternative treatments, explore the criteria for THA candidacy and the selection of surgical timing, and evaluate the contribution of predictive models and decision-support tools to clinical decision-making, with the goal of providing references for individualized management.