Transcription:
When to Consider a Hip Replacement

Melanie Cole (Host): What symptoms would lead you to consider a hip replacement? What is the surgery and recovery process like? My guest is Dr. Thomas Brown. He’s a board certified orthopedic surgeon with UVA Orthopedics, and he specializes in hip and knee replacements. Welcome to the show, Dr. Brown. What are some symptoms that people would feel pain? What are some of the most common symptoms that would lead patients to even consider a hip replacement?

Dr. Thomas Brown (Guest): Good morning, Melanie. I think the most common symptom is pain that you experience in the front of the hip that may radiate down towards the knee. Sometimes the hip pain can be confused for back pain, but that’s really more on the backside, where people experience pain that’s radiating from their back. The other symptom that’s constant with hip replacement is stiffness. People that have difficulty putting their socks and shoes on, having a hard time getting down to the toes, that may suggest that their hip joint is now getting a little bit stiff and losing range of motion.

Melanie: So Dr. Brown, what question should patients ask their doctor when they’re considering a hip replacement?

Dr. Brown: I think the two most important ones are, number one, the frequency in which the orthopedic surgeon performs the procedure. I think that’s like any other procedure; the more you do it, the more proficient you become at it. So I think the literature shows that surgeons that perform more than 50 hip replacements per year are pretty good at it, so I think that’s probably a good place to start with your surgeon. Secondly would be what type of approach is used or different ways of getting into the hip joint, whether from the posterior or from the backside of the hip or from the lateral approach or, more recently, a direct anterior approach, which facilitates recovery a bit.

Melanie: Tell us a little bit about hip replacement. People are afraid, Dr. Brown, of getting a new hip, and as someone who has done their rehab so many times, I can tell you and tell them that this is one of the least recovery time, right? Tell us a little bit about the surgery and recovery time.

Dr. Brown: Yeah. Obviously, it’s a big operation, and people are understandably anxious about it, but it’s probably one of the most successful operations performed to alleviate pain and restore function.

Melanie: That’s what I’m saying.

Dr. Brown: I think probably one of the biggest regrets patients have is waiting before they have their surgery after they actually decide to proceed. But again, the recovery is fairly quick. We try to get people up, out of bed, on the day of surgery to do some walking, and normally, you’re able to put full weight on your new hip right away. The stay in the hospital can be as short as overnight to 2 or 3 days, depending on the circumstances and what type of condition people are in before the surgery. But the recovery and the pain relief is really quite striking and quite dramatic early on. People would often wake up from the surgery, and the deep pain they had from their arthritic hip is gone.

Melanie: How long does the surgery take?

Dr. Brown: Depending on the size of the patient and the complexity of the arthritis and the reconstruction required, it can be anywhere from 1 to 2 hours for a primary hip replacement.

Melanie: When people are experiencing this before, do you recommend, Dr. Brown, that they do some prehab before they’re going to get their new hip? Do you want them doing anything? People assume that once they’ve got a new hip, everything else is all perfect. Do you want them doing some things to the muscles that are going to surround that new hip?

Dr. Brown: That’s a great point. I think that the stronger and more fit you are coming into the operation, the easier recovery will be. I think that’s important that patients understand that even with an arthritic hip, you can still try to be active. And if you are experiencing pain prior to surgery, you’re not really causing any damage, but it’s good to strengthen the muscles beforehand, which actually will improve and speed up your recovery after the surgery.

Melanie: Now, are there some people who are not candidates for this type of surgery?

Dr. Brown: There are certain medical conditions that would prohibit performing hip replacement. And normally, we try to exhaust all non-operative treatment options for patients before resorting to hip replacement surgery, and that would include some physical therapy, some medications, and occasionally, an injection into the joint itself may provide some temporary relief for pain.

Melanie: People experience pain from osteoarthritis, from rheumatoid arthritis when they’re walking, when they’re moving, but what about if they’ve got that pain that continues while resting? Is that one of those kind of red flags that would send them to see you?

Dr. Brown: Yeah, I think usually that’s one of the factors that will finally make people decide it’s time to proceed with surgery when they cannot escape from the pain. I think everyone will start to curtail their activity, park the car closer to the grocery store, take the elevator instead of the stairs, and so forth, and do fewer things around the house. But once the pain permeates their rest and sleep time, then it’s hard to escape. I think that will be one of the deciding factors to consider having their hip replaced.

Melanie: Dr. Brown, what about weight loss? Do you encourage weight loss before this surgery or even afterward? Is somebody’s weight a factor in whether their hip gets degraded or not?

Dr. Brown: Absolutely. I think from a surgical standpoint, the lighter a patient comes in, the safer the entire experience is—from the anesthetic standpoint, from the surgical standpoint, the risks are lower if you come in at an ideal body weight. So that certainly is an important thing to consider before embarking on a joint replacement. From a standpoint of trying to avoid or postpone surgery, certainly, the lighter you are, the more stress you place on your hip joint. Just walking down the street, your hip is experiencing four to five times your body weight with every step you take, especially when you’re going up or down stairs. So even a modest weight loss of 5 or 10 pounds will have a big impact on the amount of force that the arthritic hip joint experiences, and that sometimes can make a difference in allowing people to put up with it for a longer period of time.

Melanie: How long do the hip replacement -- are they a lifetime thing? They last? When can people resume that normal activity—walking? What should they be doing?

Dr. Brown: Durability of the replacements is getting better all the time. I think historically, it was 10 to 15 years, but we have really very, very good techniques of fixing the prosthesis to the bone, which involves biologic fixation, where the bone actually grows into the metal and becomes a part of you, and that’s very durable. And also, the bearing surfaces—that’s what rubs upon what surface rub together—and we normally use either a metal or a ceramic ball with a hard plastic or polyethylene liner. There’s every indication that these may last for 2 or 3 decades. As far as when you can resume activity, it depends on the type of approaches used for the surgery. For certain techniques, it requires a short period of time where you are avoiding certain motions to allow the surgical approach to heal itself back up. Other approaches require a little bit sooner return to activity with fewer restrictions. But within three months’ time, people are back to doing most activities.

Melanie: Dr. Brown, tell the listeners why they should come to UVA for a hip replacement.

Dr. Brown: Well, as I mentioned before, I think experience and numbers are important, and I have two other highly qualified fellowship-trained joint replacement surgeons that work with me. We perform over 1,200 joint replacements annually here at the university. We’re one of the few centers in this area that is certified by the J-Co Certification Agency for Joint Replacement, and we also tackle many of the problems that occur, referred in from around the state for revision surgery. So we’re very careful dealing with almost any issue that arises, and we have a great staff, and I feel that we can get patients a very good opportunity to resume normal activity and alleviate their pain.

Melanie: Dr. Brown, in just the last minute or so that we have left, give patients your best advice for those considering a hip replacement, and maybe even what their families can do to get them ready for this.

Dr. Brown: I think probably the best piece of advice I can give is to learn more about the procedure. Do some reading. The Internet is a dangerous place to get information in terms of whether that’s going to be accurate or not, but I think there are good agencies such as the American Academy of Orthopedic Surgeons and also the American Association of the Hip and Knee Surgeons, the Arthritis Organization. All these entities have very good information for patients to learn more about joint replacement. And then discuss it with your family, and most importantly, discuss it with your primary care physician and orthopedic surgeon as to whether or not they feel that they are an appropriate candidate for surgery and if not, what things they can do in preparation for surgery to make the whole experiences safe as possible.

Melanie: Thank you so much, Dr. Thomas Brown. You’re listening to UVA Health Systems Radio. For more information, you can go to uvahealth.com. This is Melanie Cole. Thanks for listening.