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What I Learned About Total Hip Replacement, Avascular Necrosis, and Core Decompression

This is the story of a family member who had avascular necrosis in both hips, leading to a total bilateral hip replacement.

X-ray of right hip replacement

X-ray of right hip replacement

Diagnosis: Avascular Necrosis of the Hip

At age 42, a family member, "Joe," was diagnosed with avascular necrosis in both hips. After an unsuccessful attempt at core decompression, he had a total bilateral hip replacement. It was a year-long journey, but today his hips are as good as new, and he is pain-free.

Joe first became aware of the problem last August when he thought he had pulled a muscle riding on a jet ski. After three weeks, the pain had not diminished, and his other hip started to hurt. At that point, he met with his doctor who referred him to an orthopedic specialist. An x-ray showed minor arthritis, but the more detailed MRI confirmed the diagnosis of avascular necrosis.

Femoral head affected by avascular necrosis and removed during hip replacement surgery

Femoral head affected by avascular necrosis and removed during hip replacement surgery

What is Avascular Necrosis?

Avascular necrosis (AVN) of the hip occurs when the blood supply is cut off from the femoral head, resulting in deterioration of the bone. If the condition is not treated, the femoral head will eventually collapse. AVN is very painful and can be treated with core decompression or hip replacement.

AVN can be caused by a bone or joint injury, but also by an unexpected degenerative condition. You are more susceptible to AVN if you:

  • are a male over the age of 30
  • are overweight
  • have a family history
  • drink alcohol excessively
  • have had chemotherapy
  • have taken large doses of steroids

Core Decompression

For Joe's treatment, the doctor recommended core decompression for both hips. This surgical procedure involved drilling a small hole into the femoral head, scraping out the damaged tissue, and replacing it with a synthetic bone graft. The goal was for the drilling to relieve the pressure in the bone and to trigger a revitalization of blood vessels. Joe was advised that the surgery had a 65-70% success rate, which though not a sure thing, sounded like the best plan.

The week before Christmas, he had the surgery on one hip, and then a week later had the other side done. Each procedure was out-patient surgery and recovery time was short. He went home with crutches and the incision pain was minimal. The small incisions were closed with staples that were removed two weeks later. Joe was pain free for almost two months, but then his condition continued to deteriorate. The core depression did not work.

Bilateral Hip Replacement

Joe's condition rapidly deteriorated and both femoral heads began to collapse. He could still walk but was in a great deal of pain as he hobbled around. He continued to take pain medication until he was advised to have a double hip replacement. There needed to be separate surgeries for each hip, at least 6–8 weeks apart. The time in between gives the patient the chance to rehabilitate the new hip.

Joe's most damaged hip was replaced in June. The surgery, which only lasted about 45 minutes, went very well with no complications. Recovery time was about two hours. He stayed in the hospital two nights and was released with a walker. After one week, the incision pain was almost gone. Walking was still difficult, though, since the other hip was in bad shape.

Two months later, he had the second hip replacement. The surgery lasted a little longer, about 1 1/2 hours, because it took longer to match the exact size replacement that would make his legs the same length. Recovery room time was two hours again, and he stayed another two nights in the hospital.

Medical Equipment and Supplies for Hip Replacement Recovery

If you have a hip replacement, these are some types of medical equipment that may be used during your recovery:

  • walker
  • wheelchair if both hips are replaced at once
  • portable raised toilet with side handles
  • pressurized leg wraps
  • anti-embolism stocking (prevents blood clots)
  • electronic thermal pack system (keeps incision area cool to reduce swelling)
  • handheld rope machine to help you put on your socks
  • plastic urinal to use at night
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Hip Replacement Recovery

After each hip replacement surgery, recovery was very quick. The day after surgery, a physical therapist had Joe walking around the hospital corridors with a walker. Once home, he had an in-home physical therapist that gave him specific exercises to perform. After about ten days, he was able to travel to his physical therapy appointments. There, the therapists usually massaged his incision area to loosen knots and then worked on exercises to increase his mobility.

For two weeks after each surgery, Joe took pain medication and a blood thinner to prevent blood clots. He had difficulty getting comfortable at night in a sleeping position, because his bed was too firm and the sofa was not much better. Finally, he found that sleeping on an air mattress worked best.

After ten days, he had a follow-up appointment with his doctor which included x-rays. There were not any staples to remove this time, because surgical glue had been used for the 8 inch incision. The next follow-up appointment was at six weeks.

Putting on socks can be very difficult if you have avascular necrosis of the hip or are recovering from hip replacement surgery.  This rope tool makes the task easy and painless.

Putting on socks can be very difficult if you have avascular necrosis of the hip or are recovering from hip replacement surgery. This rope tool makes the task easy and painless.

Medical Equipment for Hip Replacement Recovery

At home, Joe used a walker for about a week. Stairs were a challenge, as was sitting on a commode. The hospital sent him home with a raised portable toilet that could stand alone or be stationed right above a regular commode. After one week, Joe, was able to manage the regular toilet.

Another piece of equipment that was very beneficial was the pressurized leg wrap and ice pack system (VascuTherm). This machine was used in the hospital, and then it was sent home with Joe for about three weeks. While he was in the hospital bed, the machine was connected to leg wraps that inflated and deflated around the calves. This process kept the blood circulating and prevented blood clots. Once home, the machine was hooked up to a localized thermal pack that cooled and helped a lot with swelling of the incision site.

After the first hip replacement, Joe had difficulty putting on socks. He mentioned that to a nurse on the second hospital stay and she sent him home with a neat rope gadget that allowed him to put socks on himself. The sock is attached to a flat plastic piece and then ropes allow you to lower the sock down to foot level. Pull the ropes up and the sock slides on. See photo above.

Life After Hip Replacement

Joe now has no pain and is able to walk normally. He does not have 100% mobility in his hips, meaning that he cannot bend and squat as easily as before. He was advised that these new hips should last about 30 years, which is a big improvement to what was being used a few years ago. The ceramic femoral head and high-quality plastic lining contribute to the predicted long life.

This content is accurate and true to the best of the author’s knowledge and does not substitute for diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed health professional. Drugs, supplements, and natural remedies may have dangerous side effects. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.

Comments on March 11, 2018:

I want a treatment from gud doctor can survive me,I had 12surgery of my rgt hip due to AVN n infection by Psedonomous.Aregeonia,pl suggest any specialist to cure ,even had two stage

Charlotte101 on September 08, 2017:

Just about to get my hip replacement on the urgent list as I have osteonecrosis I have had hip pain for 10 years but they couldn't work out why but after developing this necrosis finally I am getting a new hip found out today and should be in by Christmas in so happy

SeanO on August 20, 2017:

I'm 28, and I've had hip problems in the past. Just last year I was told my labrum was torn, I had a bilateral impingement and the ligaments in my rhip were detached from the bone. No surgery was sought out as I was being medically separated from the military. Well seven weeks ago while walking I got a horrible pain in my rhip and almost fell. It was constantly awful but I went to work on it for a few weeks before seeing a doctor. When I finally went in I was made aware that the joint had collapsed and I would have to have a THR. My surgery was Aug 16 good, good present as my bday is the 22nd. My incision appears to be a little longer than 8" and it has been very painfull but as the days go by I get a little better. I was able to walk one foot after the other (with a walker) for the first time today 4 days after surgery. I'm sure I have a long way to go but for now I just appreciate being able to lay in bed and now be in so much pain I can't even eyes. Good luck to you all and I wish you the best

Ramakrishna on August 12, 2017:

I have been taken the core decompression . I am unable to check is it successful or not . How do ee know the surgery results. What are the precautions i have to take post surgery. Can i bent my leg while sitting on chair

JV on June 25, 2017:

Had a THR 8 months ago. Recovery was much better than excepted. I was back to my normal routine in three months. Back to playing tennis (doubles), in 5 months. Soreness and mild inflammation around the incision site when I overdue it but nothing like I felt before I had surgery. I used ice and heat as a way of therapy and helps a lot.

Swimming, biking and walking sure helps me. Yoga, not so much!

Linda T. on June 23, 2017:

First let me say that I posted wrong date for decompression. Should have been March, 2017,

Went to my orthopedic surgeon today and he did an x-ray that showed the femoral head is starting to collapse. So I am being scheduled for a total hip replacement. Hopefully this will lead to a pain free future.

I want to thank everyone who left the comments on this subject. This site has been quite informative. The medical equipment info was very good. I will have that here before I go to hospital.

Linda T, on June 20, 2017:

I also was told I had AVN of the femoral head. Like p Singh, I had the decompression in January 2017, and everything seemed to be going great. I was doing cycling on my stationary bike with no pain and felt good. I am now 3 months after surgery and for the past month the pain has come back, so this Friday I am seeing the surgeon again to see what can be done.

I realize to some, 3 months post surgery might not be long enough, but I have been putting up with this pain since Jan. 2016 and it just got progressively worse over the year. Really thought I had a pulled groin muscle. Will report back as to what ortho doc tells me.

p Singh on May 23, 2017:

hi I was diagnosed with AVN bilateral stage 3 approx 10 months back.after 4 months I had core depression surgery on both sides of hip. After 1 month it was like improving like anything. i was doing cycling also.but after 3 months of surgery it started hurting more. now i am taking pain killers etc and the pain persists.what can it be

Joe S on January 18, 2017:

I am 9 months Post Surgery from a Total Hip Replacement on my right side from the same issue.. Avascular necrosis. My hip pain was so intense and after many test and x rays. Having an MRI and results showed that my entire hip joint was dead. I had Avascular Necrosis for a long time and did not know it. This was a huge issue during recovery. I did not realize that my walk and muscles were changing things in my body. My spine angle was leaning to one side. The pain in my hip was beyond anything I could imagine and happen very quickly.

My surgeon used the old method and made the 8 inch incision across my right rear cheek. I would never recommend this procedure to anyone. Post Surgery was the worst experience in my life and this was my 10th Surgery to date. The muscle in my right leg would spasm so much and we're extremely painful. My right leg was very weak and could not hold my weight when walking. Physical therapy was not beneficial for me because of the muscle spasms and I was expected to do squats. My leg could not hold the weight. Having had physical therapy in the past. My wife and I went to the local pool and did my therapy in the pool. I joined the woman's water aerobics class everyday and slowly became mobile. I walked small routes around the neighborhood. I love to golf and would travel to the Range with a walker and club. I slowly walked with a push cart, until I was able to carry my bag.

It's 9 months Post Surgery and I still have muscle spasms and at times problems walking. I still Golf and able to walk. The muscles that were cut and replaced were made weak. Making my progress very slow. The muscles in my leg for so many years were constricting to protect the bone that was dying. Now I have to stretch those muscles, creating a lot of spasms. My journey has been very long and when I talk to people at the gym. Respect that I am at the gym is given. Hope pray no one has my experience.

Mari on November 15, 2016:

Nice article. I initially came here seeking questions about this. My case is fairly different however. Let me start m story.

I was 23 when I had my total right hip replacement. I'm current 29 knocking pretty hard on 30's door. The surgery was done on a Monday and I was out that Saturday. When I showed up to the rehab center, I was the youngest patient there. The docs and nurses that took care of me knew exactly what was up obviously, but I started to hear the ones that weren't taking care of me ask questions as to why someone my age had something so exstensive done to them. I would have readily told them, as this is something I've dealt with all my life. I have Sickle Cell Anemia. And what happened to me is exactly what happened to dear Joe here in the article. AVN is a POSSIBLE side effect from having Sickle Cell since my blood cells are shaped like crescent moons, they don't carry the necessary oxygen needed throughout my body all the time. Sometimes, those cells get sticky and clump together blocking my smaller arteries. For those not in the know, it's a very painful illness. Yes, many a time I've wanted to be tranquilized from the severe pain, I've wanted to die (temporarily until the episode was done so as not to feel anything.)

I tend to stay away from the word 'disease' even though it's part of the label of my illness. But in no means can I tranfer what I have to someone. Even if I were to decide to be "blood buddies" with someone. Because of Sickle Cell, my immune system is weaker. I get viruses and colds, bugs and whatnot much easier than the average person. But medicine is very advanced and what was once a death sentence for me when I was born, people like me now have much longer lifespans. I'm sorry but you did need this bit of info on me to understand a little more.

I healed a lot quicker than I thought and my doc told me it was due to my age. I was their first 23 year old TRH replacement patient. So here I am, 6, almost 7 years later and though I feel MUCH better than before I had it done, there are aches I get in the hip.

If I'm out all day, by the time I get home, I just wanna flop down and sleep, hip throbbing (not untolerably though). Then again, people with SC get tired much easier, rest is a must when our bodies are telling us to even more so for someone like me.

I've always been a side sleeper, right or left, doesn't matter. But the past 2-3 years now, if I lay on my right for too long as I'm not much of a mover in bed anyways, I wake up for feeling sore. Is this normal as time goes on? Also, around the same time, when it's really cold out, it tends to burn slightly. Like when an old scar starts to itch a bit before it rains or when joints act up before bad weather. It's weird.

Most important for me. I'd been wanting to get more strength into my legs anyways and before the whole hip fiasco, I used to be a dancer. I (stupidly, I admit) never asked my docs or surgeons if I'd be able to get back to dancing after a certain amount of time. Does anyone know if one can go back to dancing after such a surgery? I mean, it's been 6/7 years for me. And dance as in ballet.

Sorry so long, but this was latest thing on the subject and just had a few questions. If you stayed this long, thank you for reading. Take care and happy health, everyone.

Kim Kennedy from uk on January 03, 2013:

What a shock to suddenly develop such a fast moving disease. Thank goodness the hip replacement is available, it's amazing how recovery times have improved over the years. Nobody wants a big operation, but it sounds like there were no other options. Can't help smiling when people are glued or stapled back together! I'm glad things worked out well, interesting story.

Sarah Johnson (author) from Charleston, South Carolina on August 29, 2012:

Thanks, teaches12345. While no walk in the park, the procedure was not as bad as I once thought. I also used to associate hip replacement with much older patients. Hopefully this hub will answer questions that a potential patient may have.

Dianna Mendez on August 29, 2012:

Glad to hear that Joe turned out all right from the surgery. This is a bit of information that will help people to understand the procedure. I often hear of friends whose family member has had this surgery. Now I know what they went through. Good post.

Sarah Johnson (author) from Charleston, South Carolina on August 28, 2012:

Thanks, clevercat. I thought the sock gadget was pretty cool. It is amazing how they can do hip replacements now without huge L-shaped incisions and weeks/months of slow recovery.

Rachel Vega from Massachusetts on August 28, 2012:

I'm also glad I checked this one out. It turns out it was quite an absorbing read, especially the parts about the different equipment involved. Great job!

Sarah Johnson (author) from Charleston, South Carolina on August 28, 2012:

Hi, Doc! Yes, I think you are right - the title/subject might sound like something from a boring textbook, but when applied to a real life situation....well, I hope it helps someone who is wondering what to expect.

Glen Nunes from Cape Cod, Massachusetts on August 28, 2012:

Sounds like quite an ordeal for Joe. Fortunately, it looks like the story has a pretty good ending. Using the details of an actual case turns what could have been a pretty dry hub into something quite interesting. Nice job!

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