When am I ready for Total Hip Replacement ?

Patients often ask me, “When am I ready to have my total hip replacement ?” The answer to that question may be different for each patient. Years ago, before hip replacement was available, patient’s lived with their arthritic hips “forever”. I suspect there was much pain and limping going on in those days. Aspirin was the most common pain medicine used. The psychological aspects of pain tolerance are interesting to consider. If you know there is nothing else available to help you, then you tend to tolerate it better and “live with it”.  Now that we know total hips work quite well in the majority of patients, most patients want to get rid of their pain as soon as possible.  In fact, since the anterior hip replacements have become more popular, more patients are asking for the surgery at an earlier age.  This is because the recovery process appears to be faster and less painful for the anterior approach in most patients.  The posterior approach, was the “gold standard” in hip replacement for many years. Results were good in most cases, but the recovery process was longer, because more muscles are cut to get into the hip joint from behind. There are also more “precautions” necessary after the posterior approach, because it is easier to dislocate the joint posteriorly after the posterior capsule ligaments have been cut. The idea of sleeping on your back, with a wedge pillow between your legs for 3 months was not a “happy or easy period” for many posterior hip replacement patients to get through.  Also taking time off from work was difficult for many younger patients. While the final result from hip replacement is good from either approach, it does appear that the early recovery process is easier and faster for most patients after an anterior approach total hip. The anterior approach uses an anatomical plane to enter the hip joint that “spreads muscles apart”, but does not need to cut them.  This leads to less pain and a more stable joint, as those muscles act like big rubber bands to hold the hip in place. Complications can and do occur with both the anterior and posterior approaches. Your surgeon will explain these during the “informed consent” process. Some complications may even be higher with the anterior approach.., these may include bone fractures and implant position issues, related to the “tighter window” the surgeon has to work through to get the job done. I am also seeing a higher incidence of anterior soft-tissue tendonitis, and some cases of numbness or tingling in the anterior lateral skin.  This is related to some stretching of branches of the lateral femoral cutaneous nerve, which is very close to the anterior incision. Very large patients, or very muscular ones with large thighs, may be better treated with a posterior approach because of some increased difficulty getting to the joint from the front.  The skin edges on the anterior incision can also get irritated, and the wound often crosses the groin crease. This can lead to some mechanical rubbing of the fresh incision, which means more compulsive wound care is needed post op.  Even with some drawbacks, the average patient is usually a good candidate for the anterior approach. Net, net…the risks and benefits of each procedure usually weigh in favor of the anterior approach for the average sized individual. So the answer to the opening question is, if your pain is significant and unrelenting, you are ready for your hip replacement when you have learned all of the risks, potential benefits, and alternatives to the procedure you and your surgeon choose. There is no specific time for any given patient,…pain and disability varies greatly amongst individuals. Maybe there is no standard answer, but you should go see a qualified orthopedic surgeon to discuss your options before you decide.

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