Transcription:
How Do I Know I Need a Hip Replacement

Caitlin Whyte (Host): Welcome to Live Greater, a Health and Wellness podcast brought to you by the University of Maryland Medical System. We put knowledge and care within reach, so you have everything you need to live your life to the fullest. This episode is sponsored by the University of Maryland Joint Network. UM Joint Network Surgeons are experts in total hip and knee replacements. Held to the highest standards of care, UM Joint Network Surgeons produce better outcomes for patients compared to national averages, including lower infection rates and faster recovery times. The UM Joint Network home to Maryland's leading joint replacement surgeons. Today, we are talking about some signs you need a hip replacement with Dr. Theodore Manson an Associate Professor of Orthopedics at the University of Maryland. So, Doctor, tell us some of the first signs that you might need a hip replacement.

Dr. Manson: One of the first signs that you may need a hip replacement is, is pain in the hip. And when most people think about the hip and before I went to medical school, when I thought about the hip, I thought more about the side of the hip as being the hip joint and where the pain would be, when in actuality, people that have hip arthritis, they have pain in their groin. And so it's deep down in their groin is where you get pain when you have hip arthritis. And that may be the first sign that something is amiss and you may need to see a physician about it and get an x-ray.

Host:  Is there anywhere else besides the groin that someone might feel pain? 

Dr. Manson: Yeah, most of the time it's groin pain, but sometimes you can get pain over the side of the hip or in your buttock. Although buttock pain is usually caused by problems with your lower back, sciatica. Um, and so most of the time it's groin pain that is due to hip arthritis. 

Host:  Now, what is the average age for this pain for a hip replacement?

Dr. Manson: Most people who have hip arthritis and you know, progress to needing a hip replacement are in their fifties or older. Most of the hip replacements in the US are performed in people between 60 and 80 years of age. But there's some you know, teenagers who have rheumatoid diseases, auto immune diseases that have bad hip arthritis that occurs earlier. There were some people that have had either athletic or motor vehicle accidents, that have post-traumatic arthritis, arthritis that happens because of a previous hip injury. And so it can happen at any time. But most people are older than 50.

Host:  Besides feeling pain in those areas, what are some other ways I would know if I have a hip problem?

Dr. Manson: Well, other ways you might know if you start to get a leg length discrepancy. And so if you start to feel like, hey, my one leg is, feels like it's shorter than the other, that could be due to hip arthritis because you know, the hip is a ball and socket joint. And as you lose cartilage inside the ball and socket joint, that right hip can shorten or the left hip can shorten relative to the other leg. And so you may notice that one leg is longer or shorter than the other. You may notice that your foot starts to turn out. People with hip arthritis get contractures in there and sort of the characteristic contracture that people get is one that points their foot out to the side. So, they walk, it's kind of walking more like a duck on the side that has hip arthritis. And if you, so if you notice that the, you know, your hip is contracting with the foot pointing out to the side more that may be another sign of arthritis.

Host: So after all of these all of these symptoms, when, should I talk to my doctor about hip replacement surgery?

Dr. Manson: Well, I think that, you know, you always want to consider conservative treatments first before you consider a surgery. And so the first step would be to see someone to get an x-ray and most of the time hip arthritis is diagnosed on regular x-rays. So you want to see either your primary care doctor, if they're comfortable seeing you for orthopedic problems or see an orthopedic surgeon to get a hip x-ray and then that can lead you to the diagnosis of hip arthritis.

And if you have hip arthritis, almost all the time, you can, if you can deal with it by taking anti-inflammatory pills or by modifying your activity, then there's no rush to getting, you know, any sort of surgery done. Almost all the time, if you have hip arthritis, uh, you're not doing any damage to the hip that we can't fix later by waiting. So, for instance, if you wanted to wait until you're older, wait until you're retired, wait until after, you know, a specific wedding or trip, you know, to get hip surgery; there's no problem with waiting. 

Host: : Now how common are hip replacements?

Dr. Manson: They're becoming more common because I think the technology has improved and the surgery has improved so that people are less apprehensive about getting a hip replacement. I think the last numbers that I saw, there are around 400,000 hip replacements performed every year in the United States. And I think that's probably going up because of the number of you know, baby boomers who were you know, born in the late forties through the 1960s who are now coming into the age where, you know, hip replacement is, you know, a common operation for that age group.

Host: : So, what happens during a hip replacement surgery? What's the process?

Dr. Manson: So, hip replacement surgery is replacing both the ball and the socket of the hip. And so you replace both the ball and socket joint. And basically you remove the ball part of the ball and socket and replace that with a titanium stem that goes down inside the femur bone. And then you have a metal titanium socket that lines where the old hip socket was. What actually rubs together, there's usually a high strength ceramic ball that rubs against a high strength polymer liner of the socket. And so the titanium parts that meet up with the bone are lined with other materials, which are very low friction. The head ball is made out of a ceramic and the liner of the socket is made out of a polymer called polyethylene.

Host: : Are there any complications that may occur with this kind of surgery?

Dr. Manson: Yeah, there are. And so, you know, with hip replacement surgery, the main complications that can occur are infection, dislocation, and a difference in leg length. And so infection can happen, you know, even in very well done surgeries. And if you get an infection around a joint replacement, it, you need another surgery to fix that and they can be serious. Fortunately infection is very rare, unless people, you know, have severe immune compromise, such as severe diabetes or other, you know, conditions that make them less likely to fight off bacteria.

Dislocation is where that hip pops out of joint. It's also very rare. I think that in most high, you know, volume hip centers, places where they do a lot of hip replacements, that, that's well less than 1%, but again, it's something that, you know, if you have a dislocation, it's, you know, the hip pops out of joint and usually they have to put you to sleep and put the hip back in. So, sort of concerning and you know, frightening for a lot of patients, but it's fortunately a rare complication. Last complication is leg length discrepancy, where you end up with two legs that aren't the same length. And that's pretty rare nowadays, too. We have all sorts of ways to optimize your leg lengths to get them close to as close as possible to being equal. I don't think you can ever get people laser line equal, but you can get them very close so that the patients don't notice any difference. And it's only by, you know, measuring the legs with really you know, accurate tools that you would ever notice any difference in between the two legs.

Host: : Now what's the recovery process look like after a hip replacement surgery? How long is it?

Dr. Manson: So, you know, to overview the most surgery and it varies by what hospital and practice you go with. But most of the time a hip replacement takes about an hour. The surgery takes about an hour. You're up and walking after the surgery. And in most hospitals and surgery centers, in Maryland, you're up and walking the day of the surgery and you get physical therapy and they do everything that you need to do, including usually climbing stairs and those types of things and helping you practice getting in and out of the car.

Most patients from a hip replacement standpoint, can go home the same day. Depending on your other medical conditions, they may want to keep you overnight in the hospital or get you to even a rehabilitation hospital. But I think that most hip replacement patients nowadays are able to go home the same day. After you go home, most of the time, you don't need a lot of physical therapy after the surgery, it's mainly walking. Mainly, you know, just getting back to your activities of daily living. For people that are doing office work, we say, hey, if you're doing work around the office, we usually have you going back to work around four to six weeks after the surgery.

For folks that are doing more heavy lifting, you know, so my folks are doing construction and those types of things, we usually say, you should wait about three months before you go back to doing heavy lifting or jobs where you're doing repetitive lifting or climbing. People always asked, well, when can I go back to working out?

Well, you can do anything upper body as soon as you want after the hip replacement. We usually say, hey, wait, six weeks after the hip replacement before doing lower body exercises, just so that you don't develop tendonitis around the hip.

Host:  So, getting ready for my surgery, is there anything I need to do to prepare beforehand?

Dr. Manson: Before surgery, we have patients do what they call prehabilitation, which is physical therapy prior to surgery. And so hip replacement is a little bit different than other types of orthopedic surgery that we tend to, we tend to have patients do most of their physical therapy prior to the surgery rather than after. And so what that does is that gets you ready for tips and tricks that you're going to need to navigate in and out of a car, around your house, up and down the stairs so that you're not worried about having to try and learn all that stuff right after the surgery. you learn it before the surgery, so that you're prepared and ready to go.

Other things, if you have health conditions such as diabetes, you definitely want to make sure that your diabetes is under control. And so if you have diabetes, we generally look for blood sugars that are lower than 150 and 160 consistently when you're testing them and a hemoglobin A1C, that's less than around eight or so. And these numbers, you know, are up for debate. But basically you want to try and control diabetes as best as you can prior to surgery. Likewise, any other medical conditions, you'd want to have optimized prior to surgery. 

Host:  So, how would you go about choosing an orthopedic surgeon for your area?

Dr. Manson: I think you look in your area and the best sources of information about you know, who to see for your hip pain are people in healthcare. So, if you know nurses that work in the local hospital or medical practices that you can ask nurses, you can ask your primary care doctor, nurse practitioners, physician assistants. They usually know locally who's, you know, will take good care of you with regards to a hip replacement.

Overall, you know, when I'm looking for family members who are in other cities where I don't know, uh, who does hip replacements there, I'll first ask other doctors, then I would look and if I were looking for a replacement surgeon, I'd look for somebody who had done additional training in joint replacement surgery. So, after their orthopedic residency, they did additional training in joint replacement surgery. And I think that people tend to get hung up a lot on whether, you know, what technology is used in hip replacements, what approach or people use to get to the hip. And I think that's less important than finding someone that does a lot of hip replacements.

And that's usually defined as greater than about 50 hip replacements per year that you get along with. And so I would not go with, you know, a particular surgeon because they use a specific technology. And I wouldn't go with somebody who I didn't like their bedside manner. I think that there's enough people that, you know, you need to find someone that you can get along with that you know, does you know, a fair amount of hip replacements. It's no secret that just like anything else, you're good at what you do a lot of. And so I think that that's, you know, a general way that I go about it if I were finding a hip replacement surgeon.

Host:  One last question here, what should you not do before a hip replacement surgery?

Dr. Manson: Well, I think that the biggest thing you don't want to do before hip replacement surgery is you wouldn't want to have any cortisone shots into the hip right before the hip replacement surgery. So, in orthopedics, we use cortisone shots into joints to treat arthritis and it treats the symptoms of the arthritis fairly frequently. We give lots of shots into knees and shoulders and you know, feet and hands and those types of things. What we found over the years is the cortisone shots are not particularly effective for hip arthritis. And so we don't give them near as much as we used to.

And if you do get a cortisone shot, you really shouldn't get it deep down into the hip within about three months prior to the hip replacement, because you can actually raise the risk of infection around the time of hip replacement. If you need a cortisone shot in your shoulder or your knee the day before the hip replacement surgery, that's fine. It's just, you don't want to get into the hip joint that you're having replaced within about three months prior to surgery.

Host:  Well, that wraps up our episode. Thank you for your time and for this information, Dr. Manson. Find more shows just like this one at umms.org/podcast. And thank you for listening to Live Greater, the Health and Wellness podcast brought to you by the University of Maryland Medical System. We look forward to you joining us again.