Hip Replacement Surgery: When to proceed

Elliott,

Others may disagree (depending on their experience with THR), but I think you are wise to delay until it becomes more intrusive in your daily activities and your quality of life. It sounds like you are getting along pretty well right now. And I say this because of my experience with my left THR about 3 years ago. When I first noticed problems with the hip, I noticed groin pain on the left while doing yoga and finally had to stop doing the yoga. After awhile, I had a bit more discomfort bending over, painful moves at night (like you), so I went to the ortho, Xrays showed arthritis in both hips, the right (not left) being worse. But the right was not hurting a bit at that time. I had very good range of motion on both sides with no pain. Ortho said, you'll know when you need it.

I had friends in their 60s who had had anterior and told me it was "pretty easy" for them. I read a lot about it and am intelligent enough to know that the surgery is pretty drastic. But as the months went by, I began to search out referrals for a quality ortho, located a highly reputable ortho, and he had a long waiting list for the surgery. Finally, last year in March 2023 I had the left THR. The structural integrity of the left hip replacement itself has turned out well, but within 2 weeks after the surgery I had BAD nerve pain/numbness in the front of the left thigh. Long story, been back to ortho twice, he claims the nerve/numb in the thigh (above knee cap about 8-10 inches) should go away in 18 months, which will be Sept. 2024. The good news, the nerve/numb in the thigh has improved, but is still there. If I bumped into something in that thigh area--OUCH nerve pain. But I guess I"m getting used to it, and others have told me I'm lucky that's the only negative outcome because it could be a lot worse. The ortho's PA told me I would just need to live with it.

Now the right hip has started hurting. The same ortho who did the left said I can delay as long as I can tolerate the pain, (delaying won't create any problems) and no need to do the surgery unless I'm at the point where I can't tolerate the pain. I am 76, always been active, good health. I have decided to tolerate the right hip pain/discomfort until the bitter end of pain because as of now, the nerve/numb pain was worse than what the right hip pain is now. I guess I'd call it a choice of swapping the witch for the devil. And I have considered considering another ortho for the right, even though the ortho who did the left THR is among the best in the region, director of hip surgery at a large ortho group.

My sister and many friends in their mid-70s had the anterior THR and were back being active within a few months, no real problems. Everyone is different. I've had other people tell me that the nerve/numb situation on the left THR is pretty common with all surgeries because they pull/tug on nerves during surgeries and bruise them. So Elliott, I don't know what to say, except be sure you have the best ortho doc vetted and teed up, so you can proceed when that time comes. You will probably sail through fine!! Best of luck.

Elliott, correction in my reply above. In the first paragraph, 3 should be 1 year ago. Sorry for typo.

Thank you very much machad2024 for your thoughtful reply. I am leaning to deferring the surgery, and I am still undecided between two surgeons I've seen but both would use the anterior approach with me. Although I had dismissed injections such as platelet rich plasma (prp), hyaluronic acid, or cortisone for the hip, I might look into a hyaluronic shot if it buys me some additional time. My best wishes on your recovery,

Elliott

@elliott1953 , i had a THR (right hip) in January of 2023. I was diagnosed with severe hip osteoarthritis in September 2021. When i saw the orthopedic surgeon he told me that i had bone on bone and i was a candidate for surgery. At that time i wasn’t ready to consider surgery. Fast forward to summer 2022. I found the hip pain was interfering with my activities and limiting what i could do. I saw the surgeon who was surprised that I took so long to have the surgery. I was unable to schedule the surgery due to personal issues in the fall of 2022. I continued to walk several miles a day and workout at the gym. I also received PT prior to surgery. The surgeon’s PA told me that it would be a 4- 6 week recovery. I assumed that meant i would be back to regular T didn’t happen. I was going to PT for 2 months. Then i started walking a few miles around 2 1/2 months. I had the tingling, burning in the front of my thigh. My PT told me that this was the nerves regenerating. When i saw the surgeon several months post op, i asked about the recovery. He told me it takes about 12- 18 months to get back to your previous level of fitness. I am glad that i had the surgery, but it was a bigger shock to my body than i anticipated. It is major surgery. You will know when you are ready. Keep yourself in as good shape physically as you can before the surgery. I had the anterior approach. Good luck!

I put both of my THRs off as long as I could tolerate. Bear in mind my first was when I was 42 - nearly 20 years ago. There is definitely an advantage at our ages to having surgery sooner rather than later if for no other reason than an easier recovery. That you can still put your socks on unassisted is a sign to me that you're still in pretty good shape! I've had multiple revisions on one side due to infection, but even with all the pain and complications of recovery I have no regrets. I'm pain free for the most part, and that was the game changer. For me the pain eradication made the surgeries worthwhile, although I have lost some range of motion, for which I'm learning to adapt. Tough choice!

Thanks for your reply. Glad you are doing well and adapting.
Elliott

@elliott1953 As a veteran of 5 hip replacement surgeries between 2007 and 2012 , and ACL/MCL surgery before that, I feel like you are getting good advice from our cohorts here.
For years I have thought that if I had a dollar for every time someone I knew with a joint replacement or other orthopedic surgery believed what the surgeon said, "Recovery takes 4-6weeks (or 6-12, or 8-12 weeks, or even 3-4 months) I could cruise around the world. There ought to be a full disclosure law!
What the surgeon means is "Your incision will be healed, the implants will be well-fixed to the bones, and risk of infection decreases."
What you here is "I'll be the good, new me in 6 weeks or 3 months."

Every patient comes to surgery with their own unique body, other ailments, healing patterns and pain perception and pain tolerance. Some bleed a lot, or form scar tissue more than others. So the surgical
experience itself is different.

Doctors do not have x-ray vision, and even with imaging cannot always tell where there are nerves in strange places, microtears in muscle or ligaments, and slightly misaligned joints. So what they find in the OR may not be what they anticipated.

Nerves are notoriously slow to heal when irritated or cut - about 1mm per day (one inch per month) - and they don't always follow a straight path through your tissue. So "pins and needles", sensitivity and numbness can truly last anywhere from one to two years. In the surgeon's eyes, you have a perfectly good, functioning hip or knee, you just have this "other little issue." When I had ACL/MCL surgery and one of my hip surgeries, it took 2 years for the leg to feel normal again - and I still have a small numb patch on the side of one thigh, and a "stripe" about 4 inches long on the other thigh that is painful when the weather changes or I get an arthritis flare.

Muscles only heal if the patient "puts in the work" - getting in shape before, and doing diligent rehab afterwards. That is another reason people get such vastly different results.
PT/Rehab: 1) Takes hard work, 2) Hurts, 3) Is boring, 4) All of the above.

Here is my opinion - wait until it interferes with your life - either you cannot do what you need/want to do because of the joint condition, or because you are sleeping so poorly you have no energy.
BUT --- Don't wait too long - if muscles are weakened because you cannot be active, recovery will take longer. AND -- the older we the longer physical recovery from surgery takes. My ortho happily did my initial surgeries 4 weeks apart when I was in my early 50's, but says if he has to do them again when I hit 80, he'll want to do them 6 months apart.
Finally - Don't get fixated on the anterior approach. Now that it has been around long enough to make comparisons between large numbers of patients with each approach, the long term results are comparable. In some patients the posterior approach gives the surgeon better access - particularly for small people or those with anomalies in their joints.

My total hip replacement was delayed because doctors kept telling me my pain was from my back! Finally a back surgeon xrayed my hips and said it was bone on bone causing most of my pain. It took a while to line up the hip surgeon and that hip began to break apart, I could feel it and the pain intensified. My THR took 3 and a half hours cleaning out bone fragments. I spent 10 days in the hospital and recovery was slow. Now after ten months it feels good but my thigh muscles are still numb. You never know what waiting may cost you. Best of luck. I have had 4 joint replacements with two to go. I won’t delay next time.

Thank you so much for sharing your experience. I'm finding yours and the other comments here in response to my posting so very helpful. Best wishes,
Elliott

If you get a shot (cortizone for sure) you have to wait 3 months to do the surgery, we got the shot and did not know that , the shot didn't help which one of the docs said he did not think it would help, the pain has been getting wore and finally the 3 months is up on the 24th, my wife who hates surgery can't wit for the surgery.