Newly replaced hip dislocated after 4 weeks.

Posted by heyjoe415 @heyjoe415, Apr 18 8:18am

Hi everyone,

I had my right hip replaced 4 weeks ago. Just over 2 weeks after surgery, I was back in the gym and spinning 5x/week. I felt great. And I got the go ahead from my surgeon to do this after my two week post-op visit. I would get cramps in my buttocks that felt like dislocations, but they were only severe cramps.

There are things to avoid post-surgery - crossing your legs, squats, and not bending your hips more than 90 degrees.

For years I have been stretching my ITB by bending at the waist, crossing one foot over the other, and putting my hands on the floor (I am very flexible for a 70 y/o!)

Well as I was doing this yesterday, I felt my hip shift and could not stand on that leg without excruciating pain. Short story - I had dislocated the new hip. It was the most painful injury I've ever had, and worse than a kidney stone I had to have removed.

In the ER, after X-rays and waiting forever (lives come before hips!), the ER doc and two assistants first gave me an IV cocktail of ketamine and propofol. I felt like Alice in Wonderland, but the doc got my hip back in place.

My question - is bending at the hip to this extent equivalent to bending my hip past 90 degrees? I guess I can see that from a standing position, I'm bending 180 degrees by touching the floor. Maybe that's the answer and I'm just a dope.......

Has anyone experienced this? Has anyone had a hip dislocation after a replacement, and what were the affects? I think I extended my recovery by two weeks. I'm mad at myself for doing something I guess I shouldn't have done.

Any information or experiences you can share will be extremely valuable. Thanks in advance!

Joe

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Profile picture for heyjoe415 @heyjoe415

Thanks Sue, I'm glad you're working on your quads!

One easy exercise is to sit straight up in a chair, preferably on a firm surface, extend one leg and contract the quad. Hold this for 30 to 45 seconds, enough so that it gets uncomfortable, starts to burn a little, and then switch legs. Three sets of these each day will keep your quads alert.

A variation on this is to extend your leg and, engage quads, and for your right hip, extend your leg out to the right away from your body and bring it back in - and reverse for the left - each time for 30 to 45 seconds with continuous motion, away from the body and back in, rinse and repeat. This will strengthen the quad and some muscles, mostly glutes, that keep the hip stable.

I got the ok from my surgeon to return to spinning after the hip dislocation last week! The only rule, don't bend over the handlebars. That one is easy because I always spin upright, with a slight forward lean - mostly to keep my lumbar spine in its correct position and to engage core muscles.

Sue have you heard of the SuperPATH method for hip replacement mentioned by Steve? It sounds too good to be true - smaller incision than anterior and no post-op restrictions on hip movement, bending, tying shoes, and on. I never heard of it but plan to ask my surgeon on my second post-op visit next week. Well for what that's worth, the surgery is done......

The surgeon who came up with this has patented the method. So I wonder if Drs and hospitals have to pay a licensing fee every time they use the procedure. I have a very good knee/hip surgeon, Cleveland Clinic experience, and I'm sure he would have mentioned this - unless the hospital is unwilling to pay licensing fees.

It looks to be a far better procedure than the anterior approach, which itself is a vast improvement over posterior and lateral methods. Just curious.

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Re Superpath.

There are patents out there so there might be some licensing fees. I doubt they are a reason to use Superpath or not.

Even though my surgeon (Jimmy chow) is the primary inventor of that approach, he and I both agree that if the choice is between someone who does Superpath but has only done a handful of them and someone who has done hundreds or thousands of posterior replacements (the oldest method), go for the experienced surgeon. Muscle memory and surgical skill are critical.

There may be more but I am aware of five current methods: posterior, anterior, superpath, supercap and STAR. The last three are all somewhat variants of each other.

I would not go to a surgeon who uses multiple methods. Even with robots (mine exclusively uses a robot) I would want someone whose extensive successful experience is with a particular method.

It would be interesting, however, to ask your surgeon. I asked mine when we were chatting one day about Jiffy Knee (a friend of mine is scheduled for a Jiffy Knee replacement in December) and he said that Jiffy Knee was fine but everything depended upon the surgeon. He asked me who my friend's surgeon was. I told him it was Timothy Kavanaugh. He said that he has not seen any problems with Kavanaugh's work. My point is that my surgeon is confident enough of his own work to be willing to praise another. If your surgeon went into a lengthy discussion of the various approaches and advantages and disadvantages, that would be good.

Here is some information on Superpath:
https://pmc.ncbi.nlm.nih.gov/articles/PMC10759432/#:~:text=of%20the%20study.-,Conclusion,the%20impact%20of%20its%20shortcomings.
This is the most recent study I have found. Note that there is no indication that the ultimate outcome is better or worse using Superpath. The advantage over more traditional methods is the speed of recovery and pain during recovery.

If you are able to find someone who is very experienced in Superpath, I would recommend going to that surgeon. But if the choice is between someone who has just started doing Superpath and someone who does and is very experienced in the Anterior approach, I would recommend going with the latter.

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Profile picture for steveinarizona @steveinarizona

Re Superpath.

There are patents out there so there might be some licensing fees. I doubt they are a reason to use Superpath or not.

Even though my surgeon (Jimmy chow) is the primary inventor of that approach, he and I both agree that if the choice is between someone who does Superpath but has only done a handful of them and someone who has done hundreds or thousands of posterior replacements (the oldest method), go for the experienced surgeon. Muscle memory and surgical skill are critical.

There may be more but I am aware of five current methods: posterior, anterior, superpath, supercap and STAR. The last three are all somewhat variants of each other.

I would not go to a surgeon who uses multiple methods. Even with robots (mine exclusively uses a robot) I would want someone whose extensive successful experience is with a particular method.

It would be interesting, however, to ask your surgeon. I asked mine when we were chatting one day about Jiffy Knee (a friend of mine is scheduled for a Jiffy Knee replacement in December) and he said that Jiffy Knee was fine but everything depended upon the surgeon. He asked me who my friend's surgeon was. I told him it was Timothy Kavanaugh. He said that he has not seen any problems with Kavanaugh's work. My point is that my surgeon is confident enough of his own work to be willing to praise another. If your surgeon went into a lengthy discussion of the various approaches and advantages and disadvantages, that would be good.

Here is some information on Superpath:
https://pmc.ncbi.nlm.nih.gov/articles/PMC10759432/#:~:text=of%20the%20study.-,Conclusion,the%20impact%20of%20its%20shortcomings.
This is the most recent study I have found. Note that there is no indication that the ultimate outcome is better or worse using Superpath. The advantage over more traditional methods is the speed of recovery and pain during recovery.

If you are able to find someone who is very experienced in Superpath, I would recommend going to that surgeon. But if the choice is between someone who has just started doing Superpath and someone who does and is very experienced in the Anterior approach, I would recommend going with the latter.

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Hi Steve and thanks for all this info.

It's true, good surgeons are not concerned with losing business. If anything, the best are scheduling visits out 3 months and surgeries out 6 months. That's been mostly true for my knee surgeon and shoulder surgeon.

Another thing I believe, and you mention part of it, a good surgeon will almost never recommend surgery as the only option. It was my knee surgeon who explained that.

He gives his patients a range of options, starting with the most conservative (RICE, for example) all the way to surgery as the last option. He talks about the pros and cons of each, but leaves the decision up to the patient.

One thing a surgeon probably won't admit to - they don't want a patient coming back feeling worse than before surgery. When I first had my knees checked out, I was bone-on-bone but with little daily pain. I wanted the surgery, but he recommend that I hire a personal trainer and get the muscles supporting the knee in top shape. As long as I was relatively pain free - he wanted me to use the time and strengthen my leg to have a better surgical outcome.

I did that, and six months later, slipped off a 2x4 balance beam about 6" off the floor (while working with my trainer - but the fall was on me!). I had incredible shooting pain starting on the outside of my left knee, radiating up my left side. After that, I couldn't sleep on my side even with a pillow between my knees. I scheduled the surgery, and immediately felt so much better afterwards.

I had my left shoulder replaced seven weeks ago, and the same thing happened. I waited until I was in daily pain, scheduled the surgery, and again, felt immediately better. (OK, with knees and shoulders, the first few weeks of recovery are tough - but doable and still with less pain.)

I would be very leery of a surgeon who went right to a recommendation of surgery. Again, the great ones don't need or want to do that. The decision is with the patient.

(I think the reality is that once a joint is bone-on-bone, replacement is inevitable, as is pain. Knowing what I know now, I would have scheduled the surgeries earlier, before I was in daily pain. But to my surgeon's point, if you're feeling fine, it's hard to appreciate what replacement can do. I only have one hip and one shoulder left that I had at birth. Once they start to cause problems, I'm getting the surgery.)

I hope that added to the discussion. And thanks again Steve for your insight into the replacement process, especially for hips. At this point, with enough surgeons skilled with anterior incisions and the SuperPATH method you described - I'd forgo a posterior or lateral incision, and avoid cutting any muscles.

Joe

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Profile picture for hippychick @hippychick

Good to hear about everyone’s experience and thoughts on recovery. I had my hip replacement in April 2021 and made a full recovery. The initial dislocation in July 2024 was due to a fall. My recovery was good but I did not appreciate the time it would take for soft tissue recovery and this led to second dislocation as I did not exercise enough caution in returning exercise. Use of brace seems to be standard protocol in UK following closed reduction. Currently taking a pragmatic approach and realise that sometimes things cannot be rushed!

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Good for you HippyChick.

Once a hip is dislocated, the capsule that envelops all the structures inside the capsule are disrupted, strained, and/or torn. The capsule will heal and "scar over", but it takes time, probably 6 months.

I had "hip snapping" after my replacement, and it comes from muscle spasms as the joint heals. That resolved after about three months. Its was a challenge just to pull on socks without getting the spasms.

So it is better to take it slow while recovering. Trust HippyChick and me, you don't want to experience the pain of a dislocation.

All the best.

Joe

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Profile picture for heyjoe415 @heyjoe415

Agree completely own finding the right surgeon - for a hip or any other joint. What I look for:

1. A surgeon in their mid 30s to mid/late 40s. Why? They are still early in their career and very likely ambitious and current on the latest in replacement practice.

2. A surgeon with a good pedigree from a good med school and/or residency/fellowship. The best programs are very hard to get into. If a surgeon passes those hurdles, well it's a good sign they are very knowledgable, and have done their residency/fellowship under the best surgeons.

3. Once you've narrowed it down, look for references, and the number or procedures they have done. And to paraphrase your comment, all hip surgeons are not created equal. Older surgeons may only be comfortable with a posterior or lateral in incision. Unless they've done a lot on anteriors, look elsewhere. The anterior incision is the most challenging and imo requires the most talent.

4. Check references and reviews.

5. To prepare for the "down time" - I treated it psychologically as time off from the gym (I'm a 7x/week guy.). This advice is mostly for retired people, like me. But don't delay a surgery because you're concerned about "down time". Once therapy starts, that's your job.

6. If a joint replacement is inevitable, just get the surgery. Cortisone shots, gel shots are all band aids. Just do it. And a great surgeon will almost never recommend surgery. They present it as an option. Take it.

And that's about it. Steve mentions the SuperPATH method and I am unfamiliar with it, but it certainly sounds promising. The problem is that it is patented, so you may have trouble finding a hospital system willing to pay royalties for a relatively uncomplicated surgery, specifically referring to anterior.

Thanks Steve!

(FWIW I had my left shoulder replaced 7 weeks ago today. Surgeon is excellent. He did his fellowship and residency at the University of WI med school and associated Froedert Healthcare. Each year, UW only admits 6 students from across the world to its residency program. My shoulder guy met this hurdle, and he's just very good. And the recovery has gone better than expected!)

One last bit of advice - be in great shape ahead of the surgery, meaning normal weight, normal or close to normal body-fat percentage. This improves circulation, which in turn reduces inflammation and swelling. I dropped from 190 lbs to 155 lbs in one year, and took my PBF from 32% to 19%. Not easy, especially in my late 60s, but worth every moment spent.

Joe

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@heyjoe415 "And that's about it. Steve mentions the SuperPATH method and I am unfamiliar with it, but it certainly sounds promising. The problem is that it is patented, so you may have trouble finding a hospital system willing to pay royalties for a relatively uncomplicated surgery, specifically referring to anterior."

I don't think it is the patent costs. I suspect they are pretty minor compared to the total cost. The biggest problem is that hip surgery is complex and takes many years of practice to get really good at it. Once a practitioner learns a method, he usually doesn't want to learn another. For example, my brother and I are scheduled to have knee replacement surgery on the same day. His surgeon uses a tourniquet which causes considerable post surgical pain; my surgeon prescribed tranexamic acid to reduce bleeding and operates without a tournquet. Both doctors in my example are hip and knee surgeons. I was very surprised to read the other day that only 13% of knee surgeons use a robot. My surgeon, who works on the cutting edge of technology always uses a robotic assistant.

So I think it surgeon unwillingness to learn new methods and the time involved that stops more surgeons from using first anterior and now the supercapsulated methods.

I like your search criteria but I would slightly modify it. I would put less importance to where a surgeon went to school and did his fellowships. Being an academic high achiever doesn't necessarily make one good at other things (I was an academic high achiever going to the best law school but that doesn't mean I had the personality and skill to convince a jury that my position was correct). I would also modify your age criteria to move it slightly higher (say 40s and early fifties). You want the surgeon to have a lot of experience doing your type of surgery and that takes time.

Knowledgeable referrals also can be very helpful. A friend of mine needed should replacement surgery. My hip/knee surgeon was recovering from rotator cuff surgery (skateboarding) so I asked him who did his shoulder on the theory that a top rated surgeon would go to another equally skilled surgeon. He told me and I passed that info on to my friend. I was recently at my rheumatologist and he got a phone call and told me he had to take it because it was his wife and she was having her hip replaced the next day -- it was my surgeon (Jimmy Chow).

Greater Phoenix has a magazine that does annual doctor ratings based on other doctor responses. That has always been a good starting point for me.

REPLY
Profile picture for hippychick @hippychick

Good to hear about everyone’s experience and thoughts on recovery. I had my hip replacement in April 2021 and made a full recovery. The initial dislocation in July 2024 was due to a fall. My recovery was good but I did not appreciate the time it would take for soft tissue recovery and this led to second dislocation as I did not exercise enough caution in returning exercise. Use of brace seems to be standard protocol in UK following closed reduction. Currently taking a pragmatic approach and realise that sometimes things cannot be rushed!

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Hi HippyChick,

One other idea - the brace may be required or suggested because this is your second dislocation. Not really sure. It may be that insurance requires it.

All the best!'

Joe

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Profile picture for steveinarizona @steveinarizona

@heyjoe415 "And that's about it. Steve mentions the SuperPATH method and I am unfamiliar with it, but it certainly sounds promising. The problem is that it is patented, so you may have trouble finding a hospital system willing to pay royalties for a relatively uncomplicated surgery, specifically referring to anterior."

I don't think it is the patent costs. I suspect they are pretty minor compared to the total cost. The biggest problem is that hip surgery is complex and takes many years of practice to get really good at it. Once a practitioner learns a method, he usually doesn't want to learn another. For example, my brother and I are scheduled to have knee replacement surgery on the same day. His surgeon uses a tourniquet which causes considerable post surgical pain; my surgeon prescribed tranexamic acid to reduce bleeding and operates without a tournquet. Both doctors in my example are hip and knee surgeons. I was very surprised to read the other day that only 13% of knee surgeons use a robot. My surgeon, who works on the cutting edge of technology always uses a robotic assistant.

So I think it surgeon unwillingness to learn new methods and the time involved that stops more surgeons from using first anterior and now the supercapsulated methods.

I like your search criteria but I would slightly modify it. I would put less importance to where a surgeon went to school and did his fellowships. Being an academic high achiever doesn't necessarily make one good at other things (I was an academic high achiever going to the best law school but that doesn't mean I had the personality and skill to convince a jury that my position was correct). I would also modify your age criteria to move it slightly higher (say 40s and early fifties). You want the surgeon to have a lot of experience doing your type of surgery and that takes time.

Knowledgeable referrals also can be very helpful. A friend of mine needed should replacement surgery. My hip/knee surgeon was recovering from rotator cuff surgery (skateboarding) so I asked him who did his shoulder on the theory that a top rated surgeon would go to another equally skilled surgeon. He told me and I passed that info on to my friend. I was recently at my rheumatologist and he got a phone call and told me he had to take it because it was his wife and she was having her hip replaced the next day -- it was my surgeon (Jimmy Chow).

Greater Phoenix has a magazine that does annual doctor ratings based on other doctor responses. That has always been a good starting point for me.

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Thanks Steve!

You make a good point - doing well at a highly-rated school in a certain subject area is no guarantee that will translate to practice. I didn't state it explicitly, but I couple that with where an ortho surgeon does their residency/fellowship (where they are accepted).

For example, my shoulder surgeon is in his mid 40s, attended U of WI Medical College (a high-regarded program), and was chosen for the residency/fellowship programs ultimately specializing in knees and shoulders.

UW only accepts 6 students per year to its ortho residency program. So my selection criteria requires a successful education at a highly-rated med school AND completion of a residency/fellowship program at a highly-regarded hospital or clinic. Then more elite the criteria, the better.

I'm also fortunate because my healthcare provider works with the UW Medical College. That means my hospital is a "learning facility" - a good way for all my Drs to stay current on best medical practices.

In the absence of any of this info - I think your idea of checking references, reviews, and looking at the number of procedures performed is also a good way to find a v good surgeon.

Joe

REPLY
Profile picture for heyjoe415 @heyjoe415

Thanks Steve!

You make a good point - doing well at a highly-rated school in a certain subject area is no guarantee that will translate to practice. I didn't state it explicitly, but I couple that with where an ortho surgeon does their residency/fellowship (where they are accepted).

For example, my shoulder surgeon is in his mid 40s, attended U of WI Medical College (a high-regarded program), and was chosen for the residency/fellowship programs ultimately specializing in knees and shoulders.

UW only accepts 6 students per year to its ortho residency program. So my selection criteria requires a successful education at a highly-rated med school AND completion of a residency/fellowship program at a highly-regarded hospital or clinic. Then more elite the criteria, the better.

I'm also fortunate because my healthcare provider works with the UW Medical College. That means my hospital is a "learning facility" - a good way for all my Drs to stay current on best medical practices.

In the absence of any of this info - I think your idea of checking references, reviews, and looking at the number of procedures performed is also a good way to find a v good surgeon.

Joe

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@heyjoe415

Hi, you must live near Seattle? I was tirned down by the UW for hip revision. They deferred to my surgeon with Proliance in Bellevue.

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