You've run out of options for hip pain, and you're facing a possible hip replacement. Once your doctor has determined that you're a good candidate for surgery — based on your medical history, images of your hip, steps you've taken to reduce pain (such as weight loss and low-impact exercise programs), and how pain has affected your daily function — you'll need to ask lots of questions.
"This is not a time to be shy. Be aggressive and get answers. The doctor expects that," says Dr. Scott Martin, an associate professor of orthopedic surgery at Harvard Medical School and medical editor of the Harvard Medical School Guide "Total Hip Replacement."
Here are some categories and questions to get you started.
Ask if your surgeon is board-certified in orthopedic surgery, has had fellowship training (more training is better than less) and performs a lot of hip replacements. "If they're primary joint surgeons, they should do hundreds of hip replacements per year," Dr. Martin advises.
Anatomy of a hip replacement
The hip joint consists of a ball and socket. The ball is the top part of the thighbone (femur). It angles inward and rests in the socket, or acetabulum, which is part of your pelvis bone.
As you age, cartilage that lines the socket and top of the femur tends to wear out. That leaves the bones to rub against each other as you move, causing pain.
During hip replacement surgery, the surgeon removes the femoral head and "neck" of the thighbone and replaces it with a metal or ceramic ball. The ball has a long stem that fits inside the femur.
To replace the damaged socket, the surgeon scrapes away the old cartilage in the pelvis and installs a metal cup with a plastic liner.
The surgeon may use a bone glue (called cement) to help keep the new parts in place. In certain people, healthy bone will very quickly grow into and tightly grasp the artificial ball and socket; cement is unnecessary.
What will your doctor do to minimize the common risks of hip replacement? The main risks include a 10% to 15% chance for a blood clot and 1% chance for either a heart attack during surgery or infection afterward. "We try to get people up and walking as soon as possible, and we send 90% to 95% of people home the next day as long as they have visiting nurses and physical therapy set up. That helps. We also prescribe a daily aspirin for three weeks to reduce blood clots instead of a prescription blood thinner, which can cause bleeding," Dr. Martin says.
Type of prosthetic
Get details about the type of artificial hip your surgeon wants to implant. "The gold standard is a titanium cup with a high-density polyethylene (plastic) liner; a titanium stem; and a ball made of chrome, cobalt, and nickel," Dr. Martin says. "Ceramic parts are good in younger people, but they tend to squeak and leave lots of debris if the ceramic cracks."
Ask how much pain you should anticipate. "Don't let anyone kid you; it's still a big incision, we're cutting bone, and you have to expect a certain amount of pain. But pain medicines work well," Dr. Martin says.
Find out about the types of pain medications your doctor will prescribe, too. Dr. Martin says prescription opioids such as oxycodone are typically necessary for just a few days. After that, he says it's enough to alternate between acetaminophen (Tylenol) and nonsteroidal anti-inflammatory drugs such as ibuprofen (Advil).
Preparing for surgery
Ask what you can do to get ready for surgery. "I recommend a light strengthening program, which helps in recovery. And if you can lose weight it will help your overall physical condition," Dr. Martin says. "I also advise getting prepared mentally. Ask what you can expect each step of the way. Recovery is easier when you know what's going to happen."
There are several paths to get to the hip joint, through the front (anterior), side (lateral), or back (posterior) of the hip. Find out which approach your surgeon will use, so you'll understand the procedure, but don't worry which way is best. "The anterior approach is called 'muscle preserving,' because there is less muscle tissue to separate than with a posterior approach. Early studies were showing less pain this way," Dr. Martin says. "But now we know there is no difference in pain at two weeks out. So the approach should be based on the surgeon's preference and training."
Your return home
Well before surgery, ask if you'll need to make changes at home to accommodate your recovery. Dr. Martin recommends getting a raised toilet seat, to make it easier to get up and down. You can find the seats at big-box stores, pharmacies, and medical supply stores. Dr. Martin also advises that you have permanent grab bars installed in your shower and bathroom, and that you secure loose railings along staircases.
It will also help to ask how long you can expect to have nurses and physical therapists coming to your home, how long your health insurance, usually Medicare, pays for them, and how much additional assistance from family you might need.
You'll need to know about rehabilitation options. Will you need to spend any time at an inpatient facility? Will a physical therapist be coming to your home each week for a few months? Will you be going to outpatient physical therapy, and for how long? Ask your surgeon's office to coordinate those services.
Getting back to your life
The whole point of a hip replacement is to be able to move without pain and be active, so ask how long it should take to reach that stage. While the pain improves within a few days, returning to normal activity "can take anywhere from four to 12 weeks, depending on your health and the activity," Dr. Martin says. Ask specifically about when you are likely to return to exercising, having sex, going to work, going to the store, and engaging in other activity that's important to you.
Ask your surgeon how long you can expect your new hip to last. "If you're 50 or older, we think you can get 20 to 25 years from a new joint," Dr. Martin says. But that can be affected by your health and your lifestyle. Try to get a good idea of what's ahead.
Can you wait?
A hip replacement is intimidating. It's okay to ask if you can put off surgery, especially during the pandemic. But don't wait too long. "Some people are reluctant to consider surgery. They have a high pain tolerance and they're scared of surgery. But those are the people who decline faster physically and emotionally because they haven't treated the problem," Dr. Martin says. "If you let us do a total hip replacement, you'll get your life back."