Hip replacement surgery: the good, the bad, and the ugly - personal experiences appreciated!

[Dr_Doolittle]

So, I need a new hip.

Last fall I met with a local (very good) orthopedist about my hip pain - he did an x-ray and confirmed that I had severe arthritis in my right hip (I had been having issues for about 6-8 months at that point but I thought it was soft tissue stuff!), and recommended a THR. Luckily my LEFT hip is fine! Go figure…

To forestall this, I have now had three injections: the first one worked like a charm and I was almost pain free!, second one not so much (the law of diminishing returns), and I just got the third one yesterday. Though the effects are not supposed to kick in immediately, it feels better already - but that might be the steroids talking.

Anyway, I know I have to “bite the bullet” at some point this year since I’ve been in a good bit of pain and it has been impacting my riding (not to mention walking and everything else) - luckily I always give my mare a winter vacation so she was off for two months; but I rode a couple of student’s horses on days when I was in less pain - they are both narrower than my horse, which helped. I’ve been on my mare 3 times now and OUCH!, luckily she is very patient and a good girl while I mount and dismount; my dressage saddle has a high cantle which SO does not help! Oy.

I’ve been putting it off for obvious reasons (6 weeks to recover, I already have a LOT of pain issues so my worry is that I will be in too much pain to get MOVING and rehabbing ASAP!, etc. which will delay my recovery) It will be a huge disruption to everything, I’ll be dependent on my husband, not able to care for my horse (luckily I board, but it’s not a full service facility), and I have many dog students and several regular horse students who I will leave hanging. My dogs won’t be getting exercised because we live in a TH with a small backyard and despite being a wonderful and helpful man, DH won’t run or walk them (one elderly Whippet and a 2 year old Whippet who NEEDS her daily runs!)

(Times like these I wish I had a desk job, but it is what it is!)

Since this is a board full of horse people I’m sure you can all relate - so!, I’m hoping to hear some personal stories from those who have gone through it: how much pain were you in, how immobilized were you, how long did it take to heal, how did you deal with stairs??

I am fit and thin, exercise and stretch every day and have a strong core - but I’m 66 and already have back issues. I have to move and stretch daily or I turn into the Tin Man.

TIA for any and all responses! (I did do a search on here and read about others’ experiences, but I would love to hear more details from fellow “survivors” if you would be so kind )

ETA - he does a direct anterior approach which is supposed to reduce pain and speed recovery. We have a consult this Friday - so have questions lined up, but any additional thoughts on what to ask would be fantastic!

[Simkie]

Have you spoken with a few different surgeons? It’s worthwhile, because there are a few different ways you can get into the hip for the replacement, and each approach comes with different pros & cons. The surgeons who do sedentary 80 yos are different than the surgeons who do really active younger people.

For example, the direct superior approach is even considered “minimally invasive” and preserves a ton of soft tissue violated in more traditional replacement, which reduces your risk of dislocation, and shortens recovery time.

[Dr_Doolittle]

What is the difference between that and the direct anterior approach? (I just edited my post to include that.)

[Bluey]

Our performance dog club had the occasional member that was sick or needed surgery.
Some members are dog trainers and have boarding kennels and will board and keep whatever training you want up on your dog or even come to your house, or your DH can drop the dog there a few hours some days, until you are back on your feet.
Could you find some such arrangement for your dogs, at least for your youngster?

Someone at the barn that could care for your horse for a few weeks?

Don’t know on the hip surgery, but best wishes.
Friends that had hip replaced said it was easier than other surgeries, hope yours goes well.

[Dr_Doolittle]

No, I would never do that to either of my whippets – they are extremely sensitive: the older one has some anxiety, and the younger one is very hyper if she doesn’t get enough exercise! They are both very well trained, have their CGC‘s, etc. I am a professional trainer so I’m not interested in sending them anywhere.

My daughter has offered to come over a couple of times a week and walk them both and run the younger one, and I have a neighbor with a Whippet - we do regular play dates, and she can probably help me out as well - it just won’t be as regular as it usually is for awhile.

[Dr_Doolittle]

My horse will be fine, barn manager is experienced and responsible but has 175 other horses to care for, so mine will get turned out and fed and her stall cleaned, and that’s about it! I could probably ask her to do blanket changes (which I don’t usually request, I just do everything myself even though the barn is an hour away from me.) It is what it is - she will live, and I’m hoping that my DH can take me out to the barn as soon as I am mobile enough. I won’t be able to drive because it’s my right hip, dammit.

[2DogsFarm]

No personal experience, but as a {ahem} Senior, I have several friends who have had hips done.
All - physical shape notwithstanding - reported the surgery was less problematical than TKR, most were up & about sooner than the 6wks.
YMMV, but all are still happy years later.

[Dr_Doolittle]

This is good to know, thanks!

Yes - while doing research I noticed the longer recovery times for knee replacements - which seemed odd to me considering the relative size of the joints and the major surgery thing But from all reports the hip replacement seems pretty straightforward with the modern surgical approaches. (Never would have believed it decades ago, but there have clearly been a lot of advances!)

[Simkie]

@Dr_Doolittle

What is the difference between that and the direct anterior approach? (I just edited my post to include that.)

Direct anterior is also considered minimally invasive, going through the front.

Here’s an article that discusses some cons and may help with some questions for your surgeon:

5 Reasons Not to Have Direct Anterior Total Hip Replacement

SuperPath is another approach to consider, reports of patients walking out of the hospital without even needing crutches. It’s a direct superior approach with portal assistance.

Robotic assistance is one more thing to think about, it allows for more precise positioning of the prosthetic: https://pubmed.ncbi.nlm.nih.gov/23662346/

Do they know why this hip is so bad? Some things, like hip dysplasia, can lead to early degeneration and also make replacement more challenging because there’s just less natural acetabulum to work with. Would be good to know before choosing an approach & surgeon.

[Dr_Doolittle]

Thank you, that’s helpful!

It’s a mystery as to why “just the one hip” - but after having various docs and a chiropractor review the x-rays, there was nothing mentioned about anything other than simple arthritis - it’s all anterior. When I scheduled my third injection they sent me an order for an MRI - I’m thinking that might provide more information.

[Simkie]

Unfortunately, dysplasia is so often missed. It might be a question for your surgeons as you work through opinions…do they see any evidence of hip dysplasia? Or version abnormality? If yes, how does that impact what they’re proposing, and do they have experience in hips like yours?

The MRI might give you a peek, but 3D CT is a better way to screen. You should have one before surgery to assess prosthesis size etc. That should tell you about acetabular coverage and version, if anyone looks at it with that question.

I know hip replacement is so commonplace anymore, but it’s still definitely worth seeing a few surgeons to get multiple opinions. Be sure to discuss what YOU need & expect in your outcome. There’s such a wide range in restrictions and recovery!

[Dr_Doolittle]

Thanks for all that information!

I scheduled an MRI, first available was a month out, of course – but I’m not going to be getting the replacement done before that so I guess it’s fine. Will ask the surgeon all of these things when I go on Friday, and as you say, I’m sure he will want further diagnostics.

This surgeon gets outstanding reviews and is very experienced. We live in Northern Virginia, this is a very upscale area (my husband, and I are the “relative poor” compared to most people around here, LOL!), and you can’t swing a dead cat without hitting an excellent surgeon so for that reason I don’t really see the need to shop around, as it were. I will ask him as many questions as possible though – so thanks for the suggestions!

[Kyrabee]

I had my right hip replaced via the SuperPath approach. I had an uncomplicated recovery and was back on my horse at 4 1/2 weeks. I did walk only rides for a couple weeks then slowly back to work as usual. At that time, this particular surgeon hadn’t been doing this approach for very long and still had everyone follow typical restrictions. At my last follow-up at the 6 year mark, he said he no longer did that.
My left hip only has moderate arthritis as of now. I think the right hip was the result of walking with torn peroneal tendons in my foot for 10 years. It took me that long to find an orthopedic doctor that would actually listen to the location of my pain and order an MRI. I tried the “I’ll just live with it (the torn tendons) tack for too long. I had a really funky gait and I think the hip bore the brunt of it.

I went to this surgeon because his wife is an accomplished FEI rider so I figured he would know what riding involves. Good reason to pick a surgeon, huh?

Susan

[Simkie]

Even excellent surgeons have blind spots. They don’t know everything, and they’re not the best for every single patient out there.

Go talk to a few guys. Especially if you’ve GOT several great surgeons nearby. Getting additional opinions isn’t a vote of no confidence in your current guy, it’s just information gathering.

I mean, I read a dozen reviews before spending 20 bucks on Amazon. A few opinions before making an irreversible change to your body isn’t unreasonable.

[Dr_Doolittle]

I do agree with reading reviews, but shopping surgeons requires setting up consults with new surgeons each time, getting new x-rays, etc. – which is a pretty big hassle!

[Simkie]

Nope, you can bring your imaging with you It’s just another appt.

[frugalannie]

Just taking a whack at some of your questions from the initial post. I’m sure that surgical techniques have improved greatly since I took care of my MIL when she had one about 20 years ago, and when I had a partial replacement 10 years ago. But here’s what was true then and probably more true now.

My MIL had soldiered on through pain for years and finally got her (worse) hip done at 78 years. The day after surgery she complained of pain, and after that, she marveled at how little pain there was and she felt great. So the pain is time limited. And they had her up and walking the morning after her surgery. She recovered well and happily.

I had fractured the femoral head and dislocated it (there might, just might have been a fall from a horse involved). Had a significant TBI as well as other injuries that were soft tissue. I still have no recollection of that day, but I remember thinking they hadn’t really done surgery because by the time I came to there wasn’t any pain. Partial hip replacements are supposed to need a redo in 5 years, but mine is still working well. The surgeon on call when I was injured was old school: I have a huge honking scar from the front of my hip joint to the back cutting through all of the muscle. Looks great with a bathing suit on. As to recovery, I used crutches and got up and down stairs within a day or two of my surgery. I didn’t need crutches after a couple of weeks but there was a ton of soft tissue damage surrounding the surgical site which slowed things down. Once I was over my TBI (which took much longer than the hip) I got on and rode. It felt great.

The only thing I had to change was giving up mounting from the ground because I was told not to flex my hip beyond 90 degrees to prevent dislocation of the new femoral head. YMMV.

[Horsegirl_s_Mom]

I’m age 57, had a hip replacement 4 years ago due to “congenital malformation,” which I believe is the same as hip dysplasia. The surgeon did the traditional approach, which is sort of on the side of the hip.

I’m so happy with the results. I was walking with no pain/no trouble by the next day (albeit with a walker for stability for a few weeks). Four years later, I walk 10,000+ steps per day and swim with no pain at all. It’s really wonderful. The surgeon said he did the replacement with an eye toward facilitating a second replacement in 10-20 years, given my relatively young age.

Good luck!

[Dr_Doolittle]

Thank you @frugalannie and @Horsegirl_s_Mom!

Re: steps, we have 10 steps from the parking lot to the main level of our TH, and the main level has two couches (neither of which are comfortable to sleep on and are covered with dog beds!), and a recliner - and then another 12 steps up to the bedrooms. Accursed three story TH

Am I going to be able to negotiate these stairs right after surgery? My husband is a huge guy (6’4" and about 280), and I’m pretty small at 5’3" and 118# - but will he have to carry me?

[Horsegirl_s_Mom]

Based on my recollection, it is very unlikely you’ll be able to navigate a flight of stairs immediately following surgery.

What I recall is that you can go up one (wide) step, because you put your walker up on the step and then use it to help you step up.

However, a flight of stairs requires each leg to bear the full body weight for part of the time… and I don’t think this is possible right after surgery. My Hubby bought a cheap twin bed frame and made a bed for me in the downstairs office, which I used for several weeks post-surgery.