Hip pain slowing you down from enjoying life’s activities? Many people experience hip pain associated with arthritis as they age. So we decided to sit down with joint replacement surgeon Dr. Laura Matsen Ko and get the scoop on how to tell it’s time for a replacement, and what your patient journey will look like if you’re considering the procedure.
What is the right time to have a hip replacement?
Hip replacement surgery is considered when hip arthritis pain and stiffness keep you from enjoying your usual activities (such as golfing, hiking, walking, working out, dancing, climbing stairs)
Common movements that may increase your arthritic hip painLifting your leg in and out of car
Getting up/down from a chairPutting on socks/shoesGoing up or down stairsPicking up an object from the ground or getting up off from the groundProlonged walkingOccasionally people feel a radiation of pain down to their knee. If the pain radiates past the knee, your pain may be coming from your back
Other signs it may be time for a hip replacement
You’ve noticed your affected leg to have less flexibility or to be shorter than your other sideYou feel deep groin aching with prolonged activityThe hip seems to catchYou have started to use a cane when you leave the house
Because hip replacement is an elective procedure, you should be in your best state of health and fitness before proceeding – optimal health makes the surgery safer and speeds up recovery.
Why did you get hip arthritis?Your hip pain results from a degenerative process in which your hip has lost its normal smooth cartilage, so that now the irregular surfaces of your hip ball and socket rub on each other. In many cases, I cannot pin down the exact cause of a person’s arthritis, but heredity, injury and heavy use can increase the chances of your joints wearing out.
What can you do to optimize the chances of a good outcome?
Visit your primary care physician to ensure you are in the best possible health. I am reluctant to perform elective surgery on individuals who are significantly overweight, those who are smoking and those who are on major narcotic medication because these factors interfere with a smooth and safe recovery.Optimize your fitness- Get some aerobic exercise every day, choosing activities that are comfortable for you: water exercises, elliptical, stationary cycling, and upper body workoutsMake sure you have a good plan for support when you leave the hospital (for example, who will keep an eye on you and help you get around?)
What approach do you use?
I prefer the anterior approach because it avoids cutting the muscles around the hip and offers accelerated recovery. With this technique, I can optimize stability and obtain x-ray images that help assure the implants are in the desired position.Your incision will be on the front/side of your hip about 4 inches long.
How long does surgery take?
The actual surgery takes around an hour. You will be in the surgical suite a bit longer while the anesthesiologist cares for you before and after the procedure.After surgery, you will spend an hour or so in the recovery room and then be transported up to your room where you can meet up with your family and friends.
What happens in total hip replacement surgery?
Prior to the procedure I plan in appropriate size and position of the implants for the individual patient.At surgery, I remove the arthritic ball (femoral head) and ream the arthritic cup (pelvic acetabulum) so that a smooth cup implant can be secured in position. I place a short stem inside the thigh bone (femur) to which the new ball is attached.
How many nights will you spend in the hospital?
My patients usually spend one night in the hospital.Patients are discharged when they are ready to go home with a friend or family member.
What is recovery like?
My goal is to help you get up and around as quickly as we can after surgery and to minimize the need for pain medications that could slow your progress. I find that the sooner patients are on their feet and are off narcotic medications, the better they feel.While in the hospital, a physical therapist will help you get up a few hours after surgery. You will be encouraged to put full weight on your leg, initially using a cane, crutches or a walker for stability. You will be taught to climb stairs prior to leaving the hospital.My patients are usually back to gentle exercising by 2 weeks (walking and gentle spinning on a stationary cycle). You will progress your activity as your comfort allows. At a month after surgery, my patients generally start activities such as elliptical, easy golf, gentle yoga, longer walks, and swimming.The vast majority of my patients do not require formal physical therapy after the procedure.
When will you be able to return to work?
Desk workers usually return to work around two weeks. More active occupations may require a bit more time for recovery.I will work with you individually to set expectations for your timeline.
What are the risks of surgery?
Healthy patients have less than a 1% risk of major complications. The risk is increased if the patient is not in good health – in such cases I work with my medical colleagues to develop a plan for minimizing the risk before surgery.According to the published literature, the two most common complications of hip replacement are infection (sometimes requiring further surgery) and blood clots (usually treated with strong blood thinners such as Coumadin). I minimize the risk of infection with prophylactic antibiotics and careful surgical technique. I minimize the chances of blood clots by encouraging circulating-stimulating activity immediately after surgery and by using blood thinners when there is an increased risk.There are also risks of leg length inequality, dislocation, implant loosening and wear, but these are very low with the anterior approach.
When can you drive?
Most patients feel comfortable driving around three weeks after surgery. You should not be taking any narcotic pain medicines if you are going to drive.First try your driving in an empty lot or on a quiet road to ensure you feel physically and mentally up to driving.
How long will your new hip last?
The track record with the implants I use is excellent.At 15 years, at least 97% of patients are happy with their hip and have not required a revision procedure.
These are my answers to commonly asked questions. Feel free to make an appointment and I can answer any further questions you may have!
Dr. Laura Matsen Ko
Joint Replacement Surgeon
To learn more about Dr. Matsen Ko, you can visit her page here.
Or visit her website at www.seattlejointsurgeons.com