How Bilateral Hip Replacements Changed My Life
A State of Denial
The changes were so gradual that I don’t even know when they began. I had been having hip and leg pain off and on for at least ten years. I tired easily when walking, and it had become difficult to sit or stand for any length of time. My gait had changed. People kept telling me I might need a hip replacement. “Nonsense,” I thought. There has to be a solution to this, and I would look into it soon.
In the back of mind, however, I knew surgery really might be in my future, and that prospect frightened me. For years, I had downplayed the problem to healthcare providers during regular exams, assuring them that I only had minor joint pain, probably age related. I had had one hip X-rayed a number of years earlier, and at that time, it had apparently shown just some mild, age-appropriate degenerative joint disease (or DJD). “That’s all it is,” I told myself. I was sure I could find a way to deal with the discomfort, and that it was probably normal. At one point, however, I did decide I was ready for a new X-ray or something. The doctor I saw at that time diagnosed a tendon problem and gave me some exercises. Nothing was said about X-rays. I went home and tried the exercises, which seemed to help a bit for a while, and another few years went by.
It's Becoming a Problem
We traveled to Europe twice in those years, and I tried to put aside any concerns about my mobility. I managed to ambulate through airports; historic sites in Ireland, England, and Germany; and in Paris I gritted my teeth and walked down the Champs Elysees. I was sure it would be okay.
For a long time I seemed to have good days and bad days, but gradually my symptoms became worse and worse. Back home in the States, I had come to dread a trip to Walmart or a grocery store—mentally measuring the distance from the parking lot to the door, followed by the daunting expanse of floor inside the store. My husband suggested one of the electric carts available at the entrance, but I was afraid I might run someone down with one of those. I did begin to use a cane, rather self-consciously, or I pushed a shopping cart if one was available.
We moved to a new community, and I needed a new primary doctor. I made an appointment for just a routine new-patient exam more than a month in advance, and I waited. I had noticed that I could no longer cross one leg over the other. Sleep had become a serious issue, as the pain was generally most noticeable at night when I tried to find a comfortable sleep position. In addition, I developed a sensation of general malaise, or unwellness, especially in the mornings, when I would experience near-nausea and such lethargy that I had to sit with a cup of coffee for an hour before I felt able to eat breakfast. I began to live for that appointment.
The day finally came. I explained all my symptoms to my new doctor, who listened sympathetically. She first ordered a set of bilateral hip X-rays. The results of those were devastating to me. I had advanced bilateral (both sides) osteoarthritis, with all sorts of other possibilities listed, including aseptic necrosis (bone death) of the femoral head and pigmented villonodular synovitis (an abnormal condition of the synovium, or lining between the tendons and joints). None of that sounded good.
The doctor said it looked to her as if the only answer would be hip replacements. So this was it. I fought back tears. “It’s only going to get worse otherwise,” she said.
Next, she referred me to an orthopedic specialist for further evaluation.
The specialist did a quick physical exam, including range of motion of my hip joints. “Oh yeah,” he said confidently. “Uh-oh,” I thought. He said he would refer me to the orthopedic surgeon, who came highly recommended. He said he believed I could be scheduled for surgery within the month. I swallowed hard. “That soon?” I whimpered.
“You could be running around by summer,” he said jovially. An image floated through my mind. There I was, skipping effortlessly through a flower-filled meadow, free of pain. Nevermind that I was 62 by that time, and that running would never be a real option again with hip replacements—still, the picture was enticing. And I knew I had to do something. It really was time.
Finally, I met with the orthopedic surgeon, who assured me he could do both my hips in one surgical procedure. “You’re not very big or tall,” he said, “and you’re otherwise in pretty good health.” Combining both hip replacements into one procedure would mean I would have to undergo the anesthesia, surgery, and the recovery only once, and it would also be potentially less costly.
Not only was I surprised that I could have both hips done in one surgery, but also that this would be done under spinal anesthesia, so I wouldn’t be totally “out.” That idea appealed to me.
It turned out that my condition was congenital (present since birth), that my hip joints had never been properly seated (dysplasia), and that this had led to severe degenerative arthritis. Essentially, my hips had worn out.
Who Needs Total Hip Replacement?
If possible, most surgeons like to reserve the option of hip replacement surgery (also known as arthroplasty) for patients over 60, mainly to reduce the likelihood of the patient outliving the prosthesis and needing to undergo the surgery again. Obviously this is not always a choice, given that every situation is different. Something like a bad fracture could also necessitate replacement surgery.
Osteoarthritis is the most frequent reason for hip replacement, causing degeneration of the cartilage between the joints. The end result can be a "bone-on-bone" situation which can be alleviated by replacement with a prosthetic joint.
Hip Replacement Process
By the time I went into surgery, I had accepted the idea and was even a little bit excited about it. I was sedated enough to sleep for most of the procedure, but the anesthesiologist awoke me after the left side was finished so that I could turn to the other side. "How bad was it?" I asked drowsily. "It was pretty bad," he said with a grin. I nodded off again.
During the procedure, the diseased femoral head (see diagrams) was removed and a prosthetic stem was placed, after drilling down into the femoral shaft. The acetabulum was reamed out to allow for placement of a prosthetic acetabular cup and liner. Then an appropriately sized prosthetic femoral head was placed. In my case this was done on both sides.
Physical Therapy and Post-Surgery Exercises
Following surgery, I remained in the hospital for a few days. As soon as possible, I was taken to physical therapy. Using a gait belt attached to my waist, the therapist and I practiced walking in the hallway. I performed simple exercises, including ascending and descending a three-step staircase structure.
Although many patients are scheduled for follow-up outpatient therapy, it appeared that I probably would not need it, and I was sent home with a list of exercises to do on my own. Of course, I was told to call if I felt that I needed additional assistance, but it turned out that I did not.
Precautions Following Hip Surgery
Most patients require about four to eight weeks to return to normal activity levels following total hip replacement. During the healing process some of my instructions included:
- Avoid turning my feet inward.
- Avoid crossing my legs.
- Grip the arms of my chair or walker when rising.
- Avoid bending from the waist.
Of course, the initial precautions following surgery complicated such things as walking, dressing, and showering. I bought an inexpensive walker, as well as a “grabber,” a “sock donner,” a "dressing stick," and a long-handled shower sponge. These were all very helpful during the several weeks that I needed to recover some freedom of movement. Items like these, by RMS and other companies, are often sold as a "hip kit" bundle by medical supply outlets and elsewhere.
A Note About Blood Transfusion
Before my surgery, I had read articles suggesting that a patient consider “banking” his or her own blood in case of need for transfusion. My medical professionals did not suggest that to me, perhaps because of my age and/or the short period of preparation time before my surgery, and it didn't occur to me to ask about it. Always an optimist, I had assumed that I would be unlikely to need transfusion.
Right after my surgery, however, I experienced a rapid drop in blood pressure and, indeed, required a transfusion. I was chagrined, but I had no choice. Hospital personnel assured me the blood was tested in all sorts of ways, but at that time I wished I had prepared for this eventuality. This was, by the way, the only real complication I had following surgery, and it turned out fine.
Since that time, I’ve discovered that there are different schools of thought regarding self (or autologous) blood donation and transfusion. Some say that the blood loss from the donation can lead to a state of anemia, making the patient more likely than not to require a blood transfusion.
The suitability of autologous blood donation obviously varies from case to case and is something that can only be determined by the patient and provider.
Exercise and Weight Maintenance
After I had fully recovered from my hip surgery, I continued to focus on maintaining a healthy diet and a reasonable level of exercise. Although I was never overweight, I had lost a few pounds and wanted to keep it that way. Obviously, weight control and fitness are beneficial in any case, but they are especially important for someone with prosthetic hip joints.
The first couple of weeks were no picnic, but I stuck with my exercises and focused on the future. Post-surgical pain was not as significant as the inconvenience of ambulating with a walker and the other necessary precautions. Each day brought additional improvement, though, and it wasn't long before I was able to retire my walker. The surgery took place in early April and I was, indeed, "running around by summer."
It actually took a little longer than I expected to regain a smooth, normal gait. Over the years, I had developed an odd, swinging gait as a means of overcoming the stiffness and pain while walking. But with a bit of time and practice that problem resolved itself.
Certain restrictions will always apply, such as refraining from lifting heavy weights and otherwise placing undue stress on my hip joints, but this is a small price to pay. My reward is the increased mobility and improved sleep that I feel have added years to my life. And my newfound energy has definitely been an added bonus! I am very fortunate to have had this option available to me. Choosing to undergo hip replacement surgery not only changed my life, it almost feels as if it saved my life. And I don't regret it for a moment.