Advice about timing of my hip replacement?
March 16, 2021 6:33 PM Subscribe
I was recently diagnosed with severe arthritis in my hip and was told I will need a replacement. Things aren’t bad now, but life will change in the not-so-distant future such that recovery would be more logistically difficult. MeFites who have hip replacement, what would you suggest I do?
As of right now, things aren’t bad: somewhat limited range of motion, occasional dull aches. I am doing “prehab” to strengthen legs/core/glutes and am losing weight to lighten the load. Not walking a ton in lockdown mode, but stairs are manageable and I get a ton of cardio on a great stationary bike with no issues. Based on how I feel and function right now, I am not in a rush to solve this problem with surgery. I’m 51.
That said, based on other factors in my life, fall of 2022 might be a good time to have the operation and go through the full year of recovery. I live in a first floor apartment and my youngest child will still be living at home as a senior in high school. Depending on my kid during recovery feels kind of unfair; I would expect to have support and help from other people too, but if I had the operation in this timeframe, I would have someone living with me through the worst of it.
In fall of 2023, for a bunch of reasons, I will move from to a second floor apartment when my child moves out to start college. The idea of recovering in a living situation with a flight of stairs, when I’m living by myself, makes me nervous. In theory I could find a temporary living situation in an accessible apartment for the first month after surgery. (I did this for three weeks in a great Air B&B with my older child after he had knee surgery... though I was his live in support...)
YANMD, but maybe you can think about the trajectory of your own hip arthritis/replacement and tell me what you think. Get it over with this fall? Hold out (potentially for years?) and hope for the best? I’d prefer to hear from people who’ve gone through hip replacement or closely supported someone else who did.
As of right now, things aren’t bad: somewhat limited range of motion, occasional dull aches. I am doing “prehab” to strengthen legs/core/glutes and am losing weight to lighten the load. Not walking a ton in lockdown mode, but stairs are manageable and I get a ton of cardio on a great stationary bike with no issues. Based on how I feel and function right now, I am not in a rush to solve this problem with surgery. I’m 51.
That said, based on other factors in my life, fall of 2022 might be a good time to have the operation and go through the full year of recovery. I live in a first floor apartment and my youngest child will still be living at home as a senior in high school. Depending on my kid during recovery feels kind of unfair; I would expect to have support and help from other people too, but if I had the operation in this timeframe, I would have someone living with me through the worst of it.
In fall of 2023, for a bunch of reasons, I will move from to a second floor apartment when my child moves out to start college. The idea of recovering in a living situation with a flight of stairs, when I’m living by myself, makes me nervous. In theory I could find a temporary living situation in an accessible apartment for the first month after surgery. (I did this for three weeks in a great Air B&B with my older child after he had knee surgery... though I was his live in support...)
YANMD, but maybe you can think about the trajectory of your own hip arthritis/replacement and tell me what you think. Get it over with this fall? Hold out (potentially for years?) and hope for the best? I’d prefer to hear from people who’ve gone through hip replacement or closely supported someone else who did.
My husband had his hips replaced. He was a former dancer who had fucked his body and got both his hips replaced over a couple of years. He did do a hip at a time. I think the thing that motivated him was the doctor telling him it was time.
That said, he recovered very quickly, and lived a long life with dual hip replacements. So I think you might be a little anxious about it.
posted by Marie Mon Dieu at 7:27 PM on March 16, 2021 [1 favorite]
That said, he recovered very quickly, and lived a long life with dual hip replacements. So I think you might be a little anxious about it.
posted by Marie Mon Dieu at 7:27 PM on March 16, 2021 [1 favorite]
Do you have rheumatoid arthritis or osteroarthritis? I have osteoarthritis - if yours is rheumatoid this advice does not apply.
About 8 years ago I was referred to an orthopedic surgeon to discuss a hip replacement or two. My xrays show very severe degeneration, and have for more than a decade. The honest surgeon told me that I was too early in my symptoms, and should wait until I had consistent pain that limited my activities, but not until I felt debilitated. He told me "you will know when it's time. Xrays don't tell the story, your pain will tell you when it is time". Good advice. I have delayed surgery and instead have opted for physical therapy when one or the other hip acts up. This has been very, very helpful and actually eliminated most pain.
I've upped my pain medication regimen to include both aspirin and acetaminophen at intervals throughout every day as a routine - I'm allergic to ibuprofen but not aspirin. Staying on top of the pain has made an incredible difference. Inflammation is your enemy, and preventing inflammation will delay deterioration of your joints. I will wait until my hips are more consistently painful because I think that although hip replacements are typically wonderful, occasionally they aren't, and I know a couple of people who have not had great outcomes. I also had a boss who had an early replacement and needed another about 20 years later, and I'd prefer not to do this too early.
On the other hand, you don't want to wait until you are really debilitated. I think there is a sweet spot, but only you will know it. And I agree that an anterior approach is an option every potential patient should consider. It "spares" cutting large muscles and leads to quicker rehab.
posted by citygirl at 7:34 PM on March 16, 2021 [1 favorite]
About 8 years ago I was referred to an orthopedic surgeon to discuss a hip replacement or two. My xrays show very severe degeneration, and have for more than a decade. The honest surgeon told me that I was too early in my symptoms, and should wait until I had consistent pain that limited my activities, but not until I felt debilitated. He told me "you will know when it's time. Xrays don't tell the story, your pain will tell you when it is time". Good advice. I have delayed surgery and instead have opted for physical therapy when one or the other hip acts up. This has been very, very helpful and actually eliminated most pain.
I've upped my pain medication regimen to include both aspirin and acetaminophen at intervals throughout every day as a routine - I'm allergic to ibuprofen but not aspirin. Staying on top of the pain has made an incredible difference. Inflammation is your enemy, and preventing inflammation will delay deterioration of your joints. I will wait until my hips are more consistently painful because I think that although hip replacements are typically wonderful, occasionally they aren't, and I know a couple of people who have not had great outcomes. I also had a boss who had an early replacement and needed another about 20 years later, and I'd prefer not to do this too early.
On the other hand, you don't want to wait until you are really debilitated. I think there is a sweet spot, but only you will know it. And I agree that an anterior approach is an option every potential patient should consider. It "spares" cutting large muscles and leads to quicker rehab.
posted by citygirl at 7:34 PM on March 16, 2021 [1 favorite]
Good for you for the prehab. That's brilliant. Between that and being diligent with your physio afterwards, you'll be back to normal in a few months. My mum had a hip replaced in her late 80s, and came through it like a trooper, literally couldn't tell which one had been done.
You'll have a rehab facility in between the hospital and home as well, I hope.
If it's not bothering you unduly (and perhaps even less with your exercising?) you might want to put it off. You don't want to outlive your new hip. A friend really wanted his hips done in his 50s, and the doctor was quite reluctant. Your doc can advise you, though; things may have changed somewhat since then (~ 15 years ago).
posted by kate4914 at 7:42 PM on March 16, 2021 [1 favorite]
You'll have a rehab facility in between the hospital and home as well, I hope.
If it's not bothering you unduly (and perhaps even less with your exercising?) you might want to put it off. You don't want to outlive your new hip. A friend really wanted his hips done in his 50s, and the doctor was quite reluctant. Your doc can advise you, though; things may have changed somewhat since then (~ 15 years ago).
posted by kate4914 at 7:42 PM on March 16, 2021 [1 favorite]
I had a hip replacement at age 53 for osteoarthritis. I'd suggest waiting until the pain gets bad before you do it - it could be a year, it could be 5-10 years. There's no way of telling just from x-rays, statistics, or your doctor's gut feeling - you'll know when your pain falls of a cliff, that's when the bone-on-bone part starts. The worst part of the recovery will be the first week or two; you'll be partially disabled (e.g., needing a chair to shower, using a cane) for about 6-8 weeks and then functional with limitations for a couple months after that. You'll probably be fine with stairs any time other than those first couple of weeks. You'll get tired easily. It is super nice to have someone around but it doesn't have to be your kid, and it doesn't have to be 24 hours - just get a rotation of friends to come in for a couple hours a day to keep you company, because you will get bored.
posted by matildaben at 8:28 PM on March 16, 2021 [2 favorites]
posted by matildaben at 8:28 PM on March 16, 2021 [2 favorites]
Best answer: I haven't had a hip replacement but work in orthopaedic research, and we look at hip replacement outcomes.
In general, people who are worse off (ie have a higher level of pain and lower function) going in to hip replacement surgery do better than people who have surgery when they are not in a lot of pain and/or have few restrictions in function. We assess patient-reported pain and function outcomes just prior to surgery and again 6 months post-surgery; a 'better' outcome means less pain and greater function.
As posters have said above, patients typically weight bear on their new hip on the day of surgery.
Have you completed the Oxford Hip Score? You can open a sample questionnaire on the right-hand side of the linked page. Score each question from 0 (no pain, best function) to 4 (worst pain, worst function) for a total out of 48. My score is 48 (no problems whatsoever). The median score pre-surgery is around 15 points; that might give you an idea where you are. By 6-months post-op the median score is 45.
posted by lulu68 at 11:39 PM on March 16, 2021 [4 favorites]
In general, people who are worse off (ie have a higher level of pain and lower function) going in to hip replacement surgery do better than people who have surgery when they are not in a lot of pain and/or have few restrictions in function. We assess patient-reported pain and function outcomes just prior to surgery and again 6 months post-surgery; a 'better' outcome means less pain and greater function.
As posters have said above, patients typically weight bear on their new hip on the day of surgery.
Have you completed the Oxford Hip Score? You can open a sample questionnaire on the right-hand side of the linked page. Score each question from 0 (no pain, best function) to 4 (worst pain, worst function) for a total out of 48. My score is 48 (no problems whatsoever). The median score pre-surgery is around 15 points; that might give you an idea where you are. By 6-months post-op the median score is 45.
posted by lulu68 at 11:39 PM on March 16, 2021 [4 favorites]
Response by poster: Hi all. Thanks so much for sharing your perspectives—this is so helpful. Yes, I absolutely am anxious about this!
To follow up on questions: I’ve got osteoarthritis. About the one year timeline comment—I was aware that folks generally walk the same day and most functional limitations diminish in a few months. However I read a comment once from an orthopedist that recovery continues over the longer term, with changes continuing to happen at the one year mark. I think there might be an idea lodged in my head that the move upstairs is going to be a big deal, and if I made the jump early, at the year mark I’d be recovered enough to take on that big project.
posted by Sublimity at 9:42 AM on March 17, 2021
To follow up on questions: I’ve got osteoarthritis. About the one year timeline comment—I was aware that folks generally walk the same day and most functional limitations diminish in a few months. However I read a comment once from an orthopedist that recovery continues over the longer term, with changes continuing to happen at the one year mark. I think there might be an idea lodged in my head that the move upstairs is going to be a big deal, and if I made the jump early, at the year mark I’d be recovered enough to take on that big project.
posted by Sublimity at 9:42 AM on March 17, 2021
I am in my 40's and I have had both hips replaced now - second one about 7 months ago. I think that this sounds like a good timeline. I am very mobile now but stairs are still awkward for me 7 months later. Carrying things on stairs is hard. I try to avoid that. I would definitely worry about being on the second floor a year or less after surgery if I lived alone. I don't think you'll be a huge burden on your child. I really needed intense help for about a week after surgery but that's about it.
Several people above have given good advice about waiting longer but I can't speak to that. I didn't find out what exactly the problem was until I was almost incapacitated. You can memail me if you need more info!
posted by bijou243 at 2:15 PM on March 17, 2021 [1 favorite]
Several people above have given good advice about waiting longer but I can't speak to that. I didn't find out what exactly the problem was until I was almost incapacitated. You can memail me if you need more info!
posted by bijou243 at 2:15 PM on March 17, 2021 [1 favorite]
Score each question from 0 (no pain, best function) to 4 (worst pain, worst function) for a total out of 48. My score is 48 (no problems whatsoever).
This sounded backwards, and reading the scoring system document confirms:
"Score each question from 0 to 4 with 4 being the best outcome."
posted by HiroProtagonist at 7:56 PM on March 17, 2021 [2 favorites]
This sounded backwards, and reading the scoring system document confirms:
"Score each question from 0 to 4 with 4 being the best outcome."
posted by HiroProtagonist at 7:56 PM on March 17, 2021 [2 favorites]
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