Questions regarding total hip replacement

Posted by Mamie @mamie, Dec 26, 2017

Hi, I would appreciate any feedback. My left hip joint is totally collapsed and has been for about 4 years. For some reason, I do not have pain. However, the collapse has left my leg shorter and has forced me to be heavily dependent on a cane. I’ve seen 4 orthopedic surgeons over the years and have gotten varying suggestions. One said not to get THR because I have no pain. Another said he could do it with anterior approach but it would require a lot of cutting, etc., and probably not be the best result. The third said he uses anterolateral approach but he had never seen a collapsed hip without pain. He said that the surgery would be a success but he didn’t think I would be happy with the outcome because of possible damage to already weak muscles. The 4th said that he would do it with a posterior approach (is there only one type of posterior approach?) that he thought would give me the least damage. I’m 65 and would like to again enjoy some active years without a cane. I’ve read that hip surgeries are among the most successful but I get scared when I read forums. My friends remind me that people who have successful THRs don’t usually get into forums because they don’t have problems. Is that right? Or is the marketing for THRs not mentioning the infections, etc., that come afterward? And how/why do these infections occur? I want to move on with my life but I don’t want to exchange a very inconvenient limp/cane for pain and problems. Am I just being a worrywart or ? Thanks for any thoughts.

Liked by lynzze

Hi @mamie, if you're still following this thread here is my two cents.

I would tend to agree with many of the other comments before that if you're not in pain, then THR surgery (or any surgery for that manner), might be overkill. But, I also see that you say, "the collapse has left my leg shorter and has forced me to be heavily dependent on a cane." Can this not be corrected by shoe lifts or custom shoes? Is there really no pain at all, or just not what you would consider to be significant pain?

If you've seen my thread, I've posted about the infection issues with my THR. It's been a tough road. I'm 5 surgeries into this thing (started in Dec '16), and I'm still not sure if all is good. But, I also acknowledge that I'm in the risk pool of less than 1-2% of THR surgeries that have infection complications (those %'s are what I've been told). My decision to undergo the THR was based on the recommedation from an old friend, who succesfully had both of her hips replaced (not at the same time) and with no complications. I think in another thread someone said that you don't hear or read about all the hip replacements that go well.

I will share the frustration that others have voiced: that the risks are not adequately explained ahead of time…just quick passing mentions by the surgeons who make their money by operating. From what I understand, the risks of infection are greater if you are elderly, diabetic, significantly overweight, experience a significant injury, or have some other issue that may affect your immune system. As I've fought through the treatments for my infection, the doctors have repeatedly said they're particularly puzzled by my situation and difficulty in curing the infection; I have none of those things going on (and they've also tested me recently for more uncommon issues that may compromise my immune system)…also all negative.

I want to mention that the anterior approach is the one with the smallest incision and far less muscle disruption, in my experience. If you are going to have THR surgery, I would highly recommend the anterior approach if that option is available; that's what I had for my first surgery. The anterior incision was less than 6 inches long and I was up doing physical therapy the same day. I was really impressed with how quickly I bounced back from that procedure (until the infection set in, about 3.5 months later). I did not need to use a walker at all, I was on crutches for less than a week, and I was done using a cane within a month. I also did not need other assitive devices like a transfer bench for showering, or a toilet seat riser/lift. Everyone is different, however.

Unfortunately, my next four surgeries all needed to be done by the posterior approach, since that involved removing hardware. This requires a much longer incision (mine is about 13-14 inches long). It starts at about crotch level on the outside of my upper thigh, goes straight up and then curves high along my buttock. It has also been, in my opinon, a much more difficult surgery to recover from. I've needed to use a walker for at least a few days, then cruches for a week or so, and then even more time on the cane. I've also needed to use a shower bench and toilet seat riser.

I hope this helps and I hope you get your problem resolved, through whatever means. Best regards, Art.

Hi @mrfish Yes, I am still following the thread but not as frequently because it depresses me. There are wonderful explanations on here of how people have persevered through all of the problems they have had after surgeries. I find those quite remarkable and uplifting, a tribute to all who have a positive attitude and keep on keeping on.

But my friends/family suggest that I not read the forum because the chances are "so small" and, as you said, people with all of the successful surgeries aren't going to be on such a forum talking about how great things are.

I do have pain but it still is not in the classic hip area, except for an odd rare tweak. Instead it is in my lower back on that side and the knee on that side. The knee seems to get aggravated by the exercises I do (as suggested by PTs) but I am told I need to strengthen my muscles. Also have pain in right shoulder/arm from leaning on cane.

Conflicting info from ortho surgeons/radiologists does not help. Do I or don't I have avascular necrosis? Who knows? They disagree.
Two PTs said that the X-ray of the top-middle of my femur on the bad hip side looks odd but no doc has commented.
Maybe my back is involved from the fall?
No one looks at my overall "offness" — it's all just piecemeal.

As far as approach — if I ever decide to go that way/my gut is still telling me "no" — a doc who does anterior said it would take too much tissue cutting for the collapsed joint so he would not do it; another says his anterolateral approach could leave me in a wheelchair; one who does posterior said he would not because of lack of classic hip pain. Only one who did not look at my MRIs and did no more than a cursory review but said he could do posterior. But he did not make me feel confident.

Are you aware of mini posterior? I plan to see an ortho surgeon who does that just to see what his take is.

Shoe lift does not work. Makes knee and back feel even worse.

Meanwhile, I'm going to chiropractor and getting laser therapy which eases the pain and get adjustments when back tightens up. Walk with cane at the park for about 30-40 minutes as weather permits. Oddly, my back/knee feel better the longer I walk but then everything resets once I stop and sit.

I am glad that the forum has made me aware that complications do occur. They certainly are breezed over in all of the joint replacement marketing materials. A friend just had a total knee replacement and said she had no idea it would hurt as much as it has. And she is out about a month.

Regarding infections, what causes them?
I read that dental problems are the main source but what else?
How has everyone (outside the group you mentioned) gotten an infection?
Does this happen in knee replacements as well?

Didn't someone in this forum mention going to an alternative medicine doc who got rid of their infection?

I wish you well and hope that you now or soon will be infection- and problem-free.
Thanks for thinking of me.
Kind regards,
Mamie

My opinion, you are NOT being a worry wart, Dr's don't spend enough time explaining staph infections and how hard they are to get rid of and all that is involved in treating them. Your best bet is going to be doing your own investigating online. Google "staph infections while having THR". I was shocked how many people have contracted staph during THR and how many people choose to keep having the surgery over and over despite infection after infection. I've been without a hip joint now for 14 months and was seriously considering a fifth surgery. I didn't want to walk with a walker or a cane for the rest of my life and all my old back, neck and shoulder pains are back so I thought I'd give it another try. But after hearing about Art's new infection and another woman who finally had to have her leg amputated, I'm done. No more. Do your homework!!!!!

Does anyone has ideas on how to strengthen whatever atrophying muscle(s) are causing me to have to use a cane?
I went to my fifth ortho surgeon a month ago for his take on what I can do with a collapsed hip joint (that may/may not have AVN) so I can stop using a cane. My leg is shorter because the joint has collapsed but the hip area has no pain so no hip replacement because I could get pain and have to walk with cane..
I can't use a heel lift but I do put a few full shoe inserts in to make up some of the difference.
I was told that it would take a lot of very difficult exercise for months to possibly get away from my cane — but then not told what to do!
I've been to PTs in the past who won't give me exercises because they said I needed a new hip because collapsed joint limited my ROM.
So, a catch-22.
Problem is that walking with a cane is making my shoulder/hand on cane arm get very sore as well as opposite side lower back.
I've looked online for exercises and can do some (bridges, etc.,) but most (lunges, etc.) are beyond me.
Has anyone had to strengthen a muscle so they are then able to stand on the one bad leg?
That would seem to be what I need.
Doc says I can't do it because my "muscle" is too weak. So how do I strengthen it?
Very frustrating!
Thanks for any suggestions.

@mamie

Does anyone has ideas on how to strengthen whatever atrophying muscle(s) are causing me to have to use a cane?
I went to my fifth ortho surgeon a month ago for his take on what I can do with a collapsed hip joint (that may/may not have AVN) so I can stop using a cane. My leg is shorter because the joint has collapsed but the hip area has no pain so no hip replacement because I could get pain and have to walk with cane..
I can't use a heel lift but I do put a few full shoe inserts in to make up some of the difference.
I was told that it would take a lot of very difficult exercise for months to possibly get away from my cane — but then not told what to do!
I've been to PTs in the past who won't give me exercises because they said I needed a new hip because collapsed joint limited my ROM.
So, a catch-22.
Problem is that walking with a cane is making my shoulder/hand on cane arm get very sore as well as opposite side lower back.
I've looked online for exercises and can do some (bridges, etc.,) but most (lunges, etc.) are beyond me.
Has anyone had to strengthen a muscle so they are then able to stand on the one bad leg?
That would seem to be what I need.
Doc says I can't do it because my "muscle" is too weak. So how do I strengthen it?
Very frustrating!
Thanks for any suggestions.

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@mamie, can you try finding another physical therapist that will work with you? After my surgeries, PT was key to my recovery. I know exactly what you mean about cane-walking causing pain in the arm and lower back…when I "over did it" while on the cane, my hip was the least of my worries. Much of the early PT work was stretching things back out that had contracted over time, and we gradually added a variety of strength building excercises. I've regained msot of my range of motion and flexibility, but I still have strength to work on. To me, the exercises that helped finally kick the cane were things that strengthened the area around my knee. Much of it was using gym/PT equipment and leg presses were very helpful.

@blundquist

I’m 61 and both hips have some degeneration and hurt, especially when working out. My left hip has a torn labrum. I’ve seen a few Orthopedic surgeons and the only answer i hear is THR. Insurance would gladly pay for that. What I don’t hear from Professionals is anything about Stem Cell therapy. I’ve looked into it and heard success stories, but insurance won’t pay for it so that is a no-go. It seems a lot less invasive and is being done, but the old school of THR won’t such it. Why is this? I would rather endure the pain than have THR.

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I am in the exact same spot as you….I am looking into stem cell therapy and will keep you posted. I’m 65 and hoping they can help. I’ve been talking with Regenerex, however because at our age our stem cells are older the best possible results they said would be to go to their facility in the Grand Caymen so they can culture my cells for 3 weeks, providing me with a much higher chance of it working. It is currently illegal to culture stem cells in the United States even though they are my own stem cells. I am being put in touch with one of their facilities in Van Nuys to be evaluated for the procedure. I also would like to consult with the Mayo Clinic in Phoenix to get their evaluation.

@blundquist

I’m 61 and both hips have some degeneration and hurt, especially when working out. My left hip has a torn labrum. I’ve seen a few Orthopedic surgeons and the only answer i hear is THR. Insurance would gladly pay for that. What I don’t hear from Professionals is anything about Stem Cell therapy. I’ve looked into it and heard success stories, but insurance won’t pay for it so that is a no-go. It seems a lot less invasive and is being done, but the old school of THR won’t such it. Why is this? I would rather endure the pain than have THR.

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I have gotten a lot of relief from the pain by taking Tumeric capsules twice a day and using a product by Modere called LIFE. Have no need for any kind of pain killers for the last two months since I started using these products. I also just started adding BAXYL, recommended by a friend

https://www.modere.com/1177171

@blundquist

I’m 61 and both hips have some degeneration and hurt, especially when working out. My left hip has a torn labrum. I’ve seen a few Orthopedic surgeons and the only answer i hear is THR. Insurance would gladly pay for that. What I don’t hear from Professionals is anything about Stem Cell therapy. I’ve looked into it and heard success stories, but insurance won’t pay for it so that is a no-go. It seems a lot less invasive and is being done, but the old school of THR won’t such it. Why is this? I would rather endure the pain than have THR.

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@kdukes52, you mentioned you wanted to consult with Mayo Clinic regarding stem cells? Have you had a chance to do so, or would you like more information?

Hi everyone, 3 years ago I fell and sustained fractures of my hip, shoulder and tibial plateau. I underwent fixation of the hip, which subsequently failed and was converted to a right THR. However, I'm having a great deal of pain in my groin, buttock and thigh. Just wondered if anyone is having any of the same symptoms. Thanx

@carolg

Hi everyone, 3 years ago I fell and sustained fractures of my hip, shoulder and tibial plateau. I underwent fixation of the hip, which subsequently failed and was converted to a right THR. However, I'm having a great deal of pain in my groin, buttock and thigh. Just wondered if anyone is having any of the same symptoms. Thanx

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Hi @carolg, welcome to Connect. You came to the right place regarding questions about hip replacements as we have many members on Connect discussing having gone through a hip replacement. You may notice I moved your discussion. I combined your discussion with an existing discussion titled, "Questions regarding hip replacement." I did this so you could both be introduced to the many members already discussing hip replacements and so you could also read some of the members' previous posts on their experiences with hip replacements. If you are replying by email, I suggest clicking on VIEW & REPLY so you will be brought to the new location of your discussion.

I'd like to also invite some recent members who have joined and discussed having a hip replacement to this discussion to share their experiences with post hip replacement: @50surgeries, @bobbielafleur and @hammerhead have all recently discussed having pain in their replaced hip and may be able to relate with your pain.

@carolg, have you had a chance to discuss your recent pain with your surgeon or medical provider?

I was told by my surgeon because the ORIF failed and I required a new hip, he wasn't sure what shape I would be in. I had an ultrasound Sat. My mobility has also decreased over the last several weeks. I spent 3 months nonweightbearing after my fall and was hospitalized for 4 months. I'm 55 now and am concerned about possibility of mire surgery.

Has anyone had a total anterior hip replacement and had their tendon cut? My sister had this happen and by the time it was addressed it was too late to fix. She now wobbles like a duck and has many additional problems due to this. Thank you in advance for anything you can tell me.

@mamm

Has anyone had a total anterior hip replacement and had their tendon cut? My sister had this happen and by the time it was addressed it was too late to fix. She now wobbles like a duck and has many additional problems due to this. Thank you in advance for anything you can tell me.

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HI, @mamm – welcome to Mayo Clinic Connect. I've merged your post with this discussion, "Questions about total hip replacement," so you could read what others have said about their experiences and talk with others who have discussed similar surgeries as your sister.

I'm sorry to hear about your sister's tendon cut being discovered too late to fix.

I'm hoping members like @carolg @mamie @mrfish will have some thoughts for you with your sister's case. @predictable @lynnmorgan0916 and @bobbielafleur may also have some input.

Will you also share some of the additional problems she is dealing with due to the tendon issue?

@mamm

Has anyone had a total anterior hip replacement and had their tendon cut? My sister had this happen and by the time it was addressed it was too late to fix. She now wobbles like a duck and has many additional problems due to this. Thank you in advance for anything you can tell me.

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@mamm. Hi there, I also wondered what other issues your sister is having. I had a total hip replacement in 2016…after a fall and subsequent failed fixation. I developed an antalgic gait afterwards. I went for a 2nd opinion a few weeks ag and was told that i likely have a neuroma from cutting through a nerve during surgery. This has left me with groin pain, pain in my buttock and a loping gait. I would suggest that your sister ask her surgeon for a CT scan and blood work, including a CRP to look for inflammation. I probably haven't helped you much but wish you and your sister well.

I am now 4 weeks into my THR on my left hip. My right hip was done Feb. 6, 2018. My left was done on September 11, 2018. My doctor did the anterior approach on both hips. I had this done at Mt. Sinai Hospital in Baltimore. The anterior approach is far less evasive and a much easier recovery. I would highly recommend this Hospital and the doctor that did the procedure. I am 70 years old and have osteoarthritis. When I finally decided to do the hip replacement they were bone on bone. I am doing very well. I was always very active and am looking forward to getting back to swimming, biking, taking my dog for long walks. Actually I did walk a half mile yesterday and did my stationary bike for 20 minutes. Of course I try to keep up with my hip exercises. I wish you luck.
Mamm

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