When Is It Time to See an Orthopedic Surgeon About Hip Joint Pain?

What are the Reasons for Getting a Total Hip Replacement?

 

What are the signs that I need or I’m ready for a total hip replacement?

This is a complex question because we are all individuals with unique goals, tolerances, fears, and desires, so “it depends….” The situation is often not black or white. I’ve listed below the common indications or triggers patients share with me.  These are “green lights” to move forward with considering hip replacement, still recognizing that one size does not fit all.

1. Hip pain that has a substantial, negative impact on your life is the most common reason to opt for total hip replacement surgery. It is a powerful and predictable way to relieve hip pain.
2. Hip pain most commonly develops from hip arthritis. The cartilage space between the femoral head and the socket (acetabulum) wears away, resulting in the bones rubbing together and causing pain. Another cause of unbearable pain is hip fracture. There are other reasons as well, but these are the most common.
3. When I’m trying to gauge how disabled someone is from their hip pain, I often inquire if it awakens them from sleep at night. Being awakened repeatedly or unable to fall asleep because of hip pain leads to sleep deprivation, which can lead to depression and irritability. It’s hard to be happy, active and productive if you’re chronically tired.
4. People with advanced hip arthritis often experience what we call “startup pain” which increases as they first stand up from a seated position.
5. Hip pain that increases with activity or walking and limits your ability to be active is also significant. Many patients report that the pain abates if they sit or rest. They can walk again, but only for a limited distance. Those who love walking and exercise say that limiting their activity is diminishing their quality of life.
6. As a joint becomes more arthritic, frequently, the range of motion becomes more restricted. Many patients complain of difficulty tying their shoes or inability to lift their legs to get dressed.
7. Patients of all ages speak of being embarrassed by the need to use ambulatory aids such as walkers or canes and express their strong desire not to use them.
8. Occasionally the joint becomes so stiff that it essentially doesn’t move (ankyloses). In this situation, hip pain may diminish or be absent because the joint is not moving and the bones aren’t rubbing together. This lack of movement results in awkward body mechanics and a limp. Other joints and the back often become painful.
9. Sometimes the decision to replace your hip is due to the discomfort you are experiencing in other areas of your body, such as your lower thigh or knee. This is known as referred pain. Some people with advanced hip disease have only referred pain and no pain in their hip. Nonetheless, it is pain.
10. Many patients who develop an arthritic hip also have lower back arthritis with back pain and get relief from their back pain after a hip replacement because their body mechanics and the fluidity of their gait improves after hip replacement.
11. Some people proceed with a hip replacement because they are feeling frustrated and down, not being able to participate in activities they enjoy such as golf, pickle ball, hiking or dancing. Others say they are embarrassed and frustrated that they’re not keeping up.
12. Others complain that they are gaining weight and can no longer exercise and walk, which is something they take pride in.
13. Some proceed with hip replacement out of fear that they will fall, break a hip and lose their independence.
14. The necessity of total hip replacement becomes clear when conservative treatments such as NSAIDS, therapy, injections, ice and heat are no longer relieving your discomfort or allowing you to actively live the life you love.

Most of us who are 50+ are not total strangers to pain. If we exercise vigorously one day, we might experience some uncomfortable stiffness the next day, but that’s typically not a bad thing for our overall fitness, as long as it progressively gets better and finally resolves. If exercise is not part of our daily regimen, doing even basic household chores can become strenuous enough to make our joints ache. While severe pain requires prompt medical attention, moderate soreness is usually not a reason for worry and typically responds to a regimen of heat, ice, over-the-counter anti-inflammatories and rest . The challenge is determining if and when it’s time to be concerned. The broad answer is if the joint pain is not getting better and possibly worse.

What should I do if I have hip pain?

Most people who develop hip pain start with a visit to the primary care physician who is familiar with their healthcare history. Hip pain can have a variety of causes, including from injuries and from different forms of arthritis. The pain can be coming from inside the hip joint (intra-articular i.e., degenerative arthritis) or from outside the hip joint (extra-articular i.e. bursitis). For many patients, the discomfort they’re feeling in the region of their hip may actually be coming from another source such as their lower back or a hernia. That’s why the first step is getting a diagnosis and learning the right pain management and treatment options for you. Based on the x-rays and your description of your pain and limitations, your primary care physician may get an X-ray and initiate conservative treatment. They may also refer you to an orthopedic surgeon who, as I do, specializes in total hip and knee replacement. Other patients may benefit from examination by a rheumatologist or another type of specialist.

Many hip issues can and should initially be treated with a conservative regimen, which includes NSAIDS, therapy, injections, ice and heat.  A hip replacement becomes appropriate and many times life-changing when the problem is a worn out or damaged hip joint and conservative treatment has not produced adequate results. When a total hip replacement is performed for the right reasons and expertly, there is a very high degree and percentage of success. Our ability to perform hip replacement has wonderfully improved over my 30-year career. I routinely see a faster recovery with less pain and a much earlier discharge home and return to work or other activities. Modern prostheses last longer and the operation is done with less blood loss and tissue dissection. Historical hip restrictions are no longer necessary. It’s been a remarkable and wonderful journey. Hip replacement has been called the “surgery of the century.” What is particularly remarkable is that the deep hip pain so many patients have before their surgery disappears almost immediately after their surgery.

 

What is the best age to get a total hip replacement?

There is not a good answer to this question. Historically patients have been encouraged to delay their surgery for as long as they can due to fears their prosthesis would not last very long. Thank goodness, this has changed in a wonderful way. While traditionally, patients were told their prosthesis may last only 10 years, modern-day prostheses and bearing surfaces can last well more than 20 years. We are seeing many hip and knee patients with these modern prostheses still functioning perfectly and with minimal signs of wear after more than 20 years. What has also improved wonderfully over my career is our ability to revise or re-do a hip replacement when is has worn and failed.

The general recommendation is still to delay surgery as long as reasonable, especially if you are under 50. The strong trend I see in today’s world, unlike in past generations, is that folks are no longer willing to accept suffering and feel restricted when an operation can reliably relieve their pain and improve their quality of life. Another strong trend that I’ve seen over my career is that people in their 80s and 90s are seeking surgery as frequently as folks in their 30s and 40s. Nobody wants to live with pain and not be active and independent. People are choosing surgery because they have a choice.

The most rewarding part of my “job” is when patients return after their hip or knee replacement and tell me that I’ve “given them their life back.” For me, there is nothing more powerful or fulfilling than that.

About Dr. William Leone and The Leone Center for Orthopedic Care at Holy Cross Health

William A. Leone, MD, FACS, one of the nation’s top orthopedic surgeons, has operated on thousands of people from all over the world with hip and knee conditions. He takes pride in solving even the most complex hip and knee problems and is gratified by the profoundly positive effect the surgeries he has performed have had on the lives of so many patients.

The Leone Center for Orthopedic Care at Holy Cross Health is located at 1000 NE 56th Street in Fort Lauderdale. For more information or to schedule a consultation, please call 954-489-4575 or visit holycrossleonecenter.com.