Ask the Doctors - My physician says I need a hip replacement. Now what?


Dear Doctors: I’m 55 years old and a former marathon runner. Now my right hip hurts all the time, not only when I walk but also when I’m lying down. I can’t even sleep on my right side any more. I was told I need a hip replacement. What does that entail?

You’ve described several of the signs and symptoms that make discussing the option of a hip replacement with your doctor a good idea. The goal of the procedure is to address chronic hip pain, increase mobility, return patients to normal activities, and restore quality of life. But before you go booking an O.R., let’s talk about the operation, as well as possible alternatives.

Hip replacement is a surgical procedure that replaces the diseased or damaged portions of the hip joint with an artificial joint, known as the prosthesis. An estimated 332,000 individuals undergo hip replacement surgery in the U.S. each year. The surgery is most common among people with osteoarthritis, a degenerative disease that causes joint cartilage to wear away over time. The hip joint becomes rough and ragged and the ensuing friction causes both pain and stiffness. Rheumatoid arthritis, injury, and fractures can also cause sufficient damage to merit a full replacement of the hip joint.

After documenting your symptoms, your doctor will order imaging tests, beginning with an X-ray, to get a detailed image of your hip joint. He or she will be looking for changes to the bone, signs of narrowing of the joint space, and the formation of bone spurs. In some cases, an MRI or a CT scan may be ordered as well.

Before focusing on hip replacement as a solution, we help our patients explore other options for dealing with the pain and lack of mobility. These include physical therapy, walking aids, cortisone shots or medications, and pain and/or anti-inflammatory medications. Some people try supplements like glucosamine and chondroitin for pain relief. These, and any nutritional or herbal supplements, should always be reported to your physician to guard against possible drug interactions.

Hip replacement surgery takes about one to two hours to perform. An orthopedic surgeon removes the diseased and damaged bone and cartilage and an artificial hip is implanted in its place. A prosthetic socket is implanted into the pelvic bone, and a prosthetic ball replaces the rounded top of the femur. Patients are often surprised when they’re asked to sit up and even take a few steps with a walker the day after surgery, which is to deal with the increased risk of blood clots.

After the surgery, patients must work with a physical therapist to rehabilitate the hip. They are given stretching, flexing and strengthening exercises, which they must continue to do on their own to assure the best recovery and results. They must also watch for potential complications like blood clots, infection, dislocation, and a discrepancy in leg length.

Full recovery after hip replacement surgery takes from three to six months. For the best chance of success, be scrupulous about rehab, and don’t try to do too much.

Eve Glazier, MD., MBA, and Elizabeth Ko, MD., are internists at UCLA Health. Dr. Glazier is an associate professor of medicine; Dr. Ko is an assistant professor of medicine.

Ask the Doctors is a syndicated column first published by UExpress syndicate.