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.

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Profile picture for steveinarizona @steveinarizona

@kildaren96

We each must do what we think is best for us. I opted for a surgeon who is the primary inventor of the superpath method which is supposed to be (and I believe is) a successor to and improvement to the anterior approach. But in chatting with him one day, he thinks the most important criteria is extensive experience.

If it came down to a decision between a skilled and experienced surgeon doing posterior or a surgeon doing Superpath who has only done ten of them, I would opt for the posterior method and so would my incredibly skilled surgeon. But there is little reason if one's insurance allows it not to be greedy and get a surgeon who has the experience and is using the newer methods.

Nice post.

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@steveinarizona I agree with the experience. “ Joshua Carothers, MD, is a board-certified and fellowship-trained orthopedic surgeon, specializing in total joint hip and knee surgery. He joins CHRISTUS St. Vincent with more than 14 years of experience and has completed more 10,000 total joint surgeries.”

Also, he had a great video posted explaining in detail what a hip or knee replacement entailed. What sealed the deal was that I couldn’t find one bad thing about him in my online searching. He was great as was my experience from start to finish.

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Profile picture for Nanci @kildaren96

I had a very positive experience with posterior hip replacement. Although called posterior, my surgeon actually went in through the side if the hip. I chose him because he DID posterior, not anterior and my research indicated the ability to choose from a more varied length of the titanium piece that goes in and so able to have a more custom match to the other leg length. The drawback is not to be able to bend forward past the waist for 12 weeks although my PT agreed that at 11 weeks, I was ready. I had next to no surgical pain afterwards but I had had a lot of pain in my leg for a long time beforehand so the comparison at the very least, was that I was able to walk on that leg with no pain afterwards. I used a scant few of the tramadol they gave me and none of the other heavier pain drugs that had been prescribed for me.

I did NOT have any hip pain either; all my pain was referred pain: my left leg, knee, calf and ankle were in great pain when I walked and I had to walk with a cane and acquired both a small indoor rollator with a basket and a tray (very handy around the house) and a wonderful Trionic Veloped outdoor all terrain rollator so that I could continue to walk my dog with less effort. It was “assumed” that the leg pain was from my back issues. One day, sitting with my feet up on an ottoman, I noticed that my left knee was turned outward and when I couldn’t rotate it, my hip couldn’t rotate, it occurred to me that maybe it was my hip causing problems. That’s when I learned about referred pain. My leg pain was referred hip pain. By the time I saw an orthopedic surgeon and said that I wanted a hip replacement, he gently told me that I really should have had it done a year earlier. I told him that I would have, had I known it was my hip. Incidentally, both my legs match in length now.

I recommend googling Talk to the Docs, orthopedic surgeons, Canadian to watch their very excellent videos on hip replacement. They’ve branched out and cover a lot of medical issues now, bringing in doctors who are experts in those fields. I live in the US but love their Talk to the Docs videos on YouTube.

Even my long suffering physical therapist questioned why I went posterior. Everyone seems to think that anterior is better because it has a faster recovery and you can bend forward past the hip, right away. But as someone mentioned here, having an excellent surgeon is the key. You can also look up pros and cons of anterior vs posterior hip replacement. I know that more surgeons now do anterior but I would have posterior done again in a heartbeat. I do still have walking issues due to my “severely disintegrating spine” as one radiologist called an x-ray. I can walk without pain now that my hip’s been replaced but walking feels like slogging through mud from the pressure on the nerves that go to the legs. So I still use a cane when I go out, or take my small indoor rollator to a place like a mall and I walk my dog a mile or more a day with my Veloped. I can walk normal and even zip around quickly, using a rollator or a grocery cart. I walk well with a cane now too, not having to lean heavily on it. I just need a small assist to take the pressure off those nerves in my spine. I really want to avoid back surgery if at all possible.

Best of luck to you. Surgical outcomes are highly individual and the decision to have surgery can be for many reasons. I do believe that hip replacement, regardless of how it’s done, probably has one of the best outcomes of surgeries one can have. I don’t know anyone who in my cohort of friends who have had one who hasn’t been happy with the outcome.

My hospital had stringent requirements regarding germ control. I showered with a special soap they gave me before coming in. Then before I put on my gown for surgery I had to wipe my entire body with germicidal cloths they gave me. That was just my part but they had so many protocols in place for just me, I imagine that was true for the entire operation. I went home just a few hours after my surgery and had no issues with infection, ever.

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@kildaren96 I agree. The left hip was posterior approach and the right was anterior. The anterior was far worse and the incision much larger. Two different doctors and two different outcomes. I am set to go to a revision surgeon as the right hip 14 months out has never healed. Best bet is gaining a knowledgeable, experienced surgeon more than the approach.

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I am so sorry that the anterior hip replacement didn’t do well and hope that the revision will fix the problem(s). Even the talk with the docs who do posterior said that the best procedure is by an experienced physician in the format that they are trained in and experienced in doing whether anterior, posterior or the side thing…which again, my posterior surgery was done by going in the side of my hip but my doctor said specifically that that it was posterior surgery. Maybe all posterior surgery goes into the side but the hip is accessed from the back. Sending you healing thoughts!

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