Hip Replacement

Hip replacement is a major surgery that must be considered carefully.

Here, Dr. Wickline shares his advice for patients who are wondering if hip replacement is the right option.

If you decide that hip replacement is the right path for you and would like to follow Dr. Wickline’s proven protocols during your recovery, the Less Swelling Less Pain Hip Replacement book is available for purchase. 

Dr. Wickline’s plan has helped thousands of patients recover from hip replacement surgery with less pain, less swelling, and reduced need for narcotics. These protocols have also helped many people save money on physical therapy co-pays and increased patient satisfaction post-surgery.

What Is a Bad Hip?

What are the usual symptoms of a “bad hip”?

The vast majority of patients who are considering hip replacement surgery have pain in the groin crease and frequently have pain that radiates down the front of the thigh which can include the knee. Some patients however, have no groin pain and complain only of severe knee pain and difficulty bearing weight. Most patients complain of significant difficulty putting on their sock and shoe due to limited hip motion. They also complain of difficulty getting in and out of a car, frequently needing to use the arms to lift the leg up into the car.

What is hip arthritis?

Most commonly, hip arthritis refers to osteoarthritis (OA). Osteoarthritis is a degenerative, “wear and tear” disease process where cartilage wears away in the joint causing pain and disability.  This degenerative change occurs naturally with aging. 

In some ways the cartilage in your hip socket is like the tread on a tire.  Some tires are 100,000 mile tires and you never need to replace them. Other tires are only 60,000 miles, and you may have to replace them if you want to keep driving that car.  

Things to Consider Before Hip Replacement Surgery

Is hip replacement surgery right for you? Dr. Wickline shares this advice with patients considering hip replacement surgery:

1. Hip replacement is meant for individuals who have pain at least 5 days out of 7 per week. Your arthritis should be bad enough that you have significantly changed and modified your lifestyle. You should dread the stairs, long lines, and large department stores or grocery stores. Most patients cannot put on their own sock and shoe or have significant difficulty doing so. They have trouble getting in and out of a car.

2. There are multiple ways to access the hip socket during surgery. Two of the most common are anterior approach and posterior approach. Anterior approach means that the incision and the work is done from the front of the hip and can often be performed without cutting the muscle. It is often touted as having less pain and moderately quicker recovery in the first 3 to 6 weeks after surgery compared to the posterior approach. However, there is at least a 20% risk for a permanent numb spot on the outside of the thigh due to the incision placement.
   
   The posterior approach involves an incision which does require some muscle cutting. It has been the workhorse approach for many decades and is still used by about 40% of surgeons. Generally, there is no numb spot with this approach, but there has been an increased risk for dislocation as compared to the anterior approach. Many surgeons do require specific precautions after surgery for a period of time.
   
   Either approach can be performed in an outpatient setting with success.¹

3. A reasonable expectation for hip replacement is a 90% reduction in your pain as compared to before surgery. While some patients ultimately report they are completely pain-free and have forgotten about their joint issues, most patients still have some minor complaints or irritation.²

4. Young, highly active individuals with high demands may have less satisfaction with hip replacement than other patients. Frequently, this is due to having unrealistic expectations.³

5. Some hip replacement patients occasionally experience a clicking sound or a squeak after surgery, permanently.

6. Some patients experience mid-thigh discomfort for up to 2 years after surgery as the thighbone learns to accommodate the implant. There is no fix for this other than time.

7. Approximately 1 out of 500 patients will not achieve bone ingrowth into the implant.  Ultimately, this may need further surgery to get the results you are looking for.

8. The literature suggests it takes at least 10 to 12 weeks to achieve reasonable function.  This is a long recovery. Many patients are able to have reasonable function as early as 3 or 4 weeks. However, those patients need to remember that some of the healing processes cannot be rushed. Overdoing things too soon due to early success may lead to problems. Patients need to be mindful that it takes a full 12 weeks for the bone to fully grow into the implant and recovery is generally maximized at 1 year.

9. For most patients, hip replacement should improve your ability to walk distances, shop, climb stairs, and chase your grandchildren. No surgeon can make you 18 again. A realistic assessment of what hip replacement can give you improves the odds that you will be happy with your surgery.

10. It takes at least 6 weeks, if not 12 weeks, to get your sleep pattern back to normal after hip replacement surgery.

11. Remember, I personally have 50% cartilage loss in my hip and I am not currently having hip replacement. This cartilage loss causes me pain sometimes and it makes me modify my activities but it is not pain that is terrible or incapacitating. It is only a little harder to put on my sock on the arthritic hip side compared to the other hip. Therefore, it is too soon for me to have surgery.

12. On the other hand, waiting until you are 85+ years old to then decide to have a hip replacement is also not a great idea. Having surgery at this age has a higher risk of complications.

13. Most hip arthritis patients have some associated arthritis in the lower spine. In my experience as well as others, some patients can do very well for the first 3 to 4 weeks and then suddenly have trouble putting weight on the operative leg or the other leg. This is almost always due to the spine acting up.
    
    Let your surgeon know if this happens, and they may want to check out the hip. Be prepared, however, if the hip x-rays are normal to consider the spine as the source of the pain and expect some changes in medications and sometimes even a referral to a pain management doctor for a steroid injection in the spine if things do not improve with time.
    
    In my experience, sudden increased pain at 3-4 weeks occurs in about 1 out of 12 patients, and 1 out of 50 need referral to a pain management specialist. I recommend that your surgeon obtain spine films BEFORE hip replacement so that you and your surgeon are aware of the potential spine issues that could develop.

14. Be advised that previous surgery to the hip increases risk both during and after surgery.  Patients typically experience a slower recovery because the tissue has scar buildup from the previous surgeries. You will need to have a bit more patience and work a bit harder than those who have not had previous hip surgery.

15. Patients who have had hip replacement surgery are able to obtain MRI and CT scans of other body parts in the future with no problem. MRI and CT scans of the operative joint, however, are frequently of limited value due to the metal interfering with the imaging study.

16. Patients who have low albumin, are overweight, have thyroid disease, have depression or anxiety, are chronically using narcotics, are on blood thinning medications, or have multiple other medical diagnoses are all at some increased risk of complication compared to a patient who has none of these things. This is why optimization is SO important.

Swelling After Hip Replacement Surgery

Swelling – the first and most common culprit for postoperative pain.

This is perhaps the most important topic you need to understand to recover from your hip replacement surgery more quickly and have fewer complications

Have you ever twisted your ankle as a kid playing soccer, tennis, or volleyball? Most of us have.

Most of us have learned through these experiences that we should not walk a mile the next day or the next week and it frequently doesn’t seem normal for a couple of months or more. You’ve learned to stay off it, limit how much weight you put on it. 

If you sprained your ankle badly today, would you do a 90 minute walk tomorrow on that same ankle? Obviously, no.

This is no different for how you need to behave after hip replacement. However, I have many patients say “I have finally made the difficult decision to move forward with surgery now, so I want to heal as fast as possible by doing extra exercises before and after surgery.” I can tell you that this mindset almost always backfires. Think about the ankle sprain and the question you just answered. You know that you need to control the swelling to get that ankle pain to decrease and get back to your active lifestyle.

Therefore, I need you to follow my plan with no additional strengthening or extra walking the first two weeks post op. If you do, you’ll very likely reach post-op milestones weeks or months before other patients following outdated protocols. You will also likely have less pain than what other patients have to endure. I have already published proof of this, so please see our website for peer reviewed articles. 

If you have a watch that monitors your steps, our data shows that more than 750 steps per day in the first week seems to be associated with more pain, a greater need for pain pills, and more difficulty getting back to normal activity. 

This is important to me (and personal). My wife has been treated for cancer and has high risk for permanent swelling/lymphoedema. Any major surgery on the lower leg can cause permanent swelling (secondary lymphoedema). Most surgeons assume there is no way to improve post-op swelling. I disagree. I want to decrease the post op swelling and the risk of permanent lower leg swelling. I’ve teamed up with Dr Mark Merlin, a vascular surgeon who nearly lost his leg in a bad trauma. He is one of the world’s leading researchers on lymphoedema and is a consultant for NASA as astronauts get lymphoedema-like symptoms in space.

About the Less Swelling Less Pain Total Hip Book

The Less Swelling Less Pain Total Hip guide is designed to walk you through everything you need to know before and after your hip replacement surgery to optimize for your recovery. These are the same protocols that Dr. Wickline shares with his own patients ahead of hip replacement surgery.

In this book, you will learn what to expect leading up to, during, and after your hip replacement, including:

• How to prepare for recovery
• Optimizing your nutrition ahead of surgery
• A step-by-step plan for your recovery
• And much more