Question
Hip Replacement on both sides

I am a 45 year old male facing the prospect of hip replacement on both sides due to advanced osteoarthritis. I have been in pain for over five years and this last year has been the worst.

The doctors I have seen will not give me a straight out recommendation to go ahead with the surgery. They all seem to want to skirt that answer at all costs leaving me with 'if you think it is time then it is time'.

My X-rays show advanced arthritis and necrosis. The cartilage is gone, the bones are rubbing together and I have been steadily losing mobility. While it may appear the answer is obvious I have many doubts and fears about proceeding.

I know the surgery and recovery will be painful and slow but that is the least of my concerns. What concerns me most is what I keep reading and hearing about other mobility loss after the surgery for fear of popping the new hip out of the socket (or breaking it).

The materials I have read say you should gain mobility but then go on to list a number of motions you will not be able to perform. Many of which would be difficult to live without.

Some of my concerns are these:
It is torturous for me to tie my shoes right now but at least I can do it. If I have the surgery, the pictures I have seen make it look like I will not be able to tie my shoes then either without some kind of aid.

If your knees can not be higher than your waist will I be able to use my recliner chair?

I have a motorcycle now - will I have to give it up?

I can get a toilet seat extension to raise up the seat height for my house but what about having to use a toilet somewhere else that is going to force your knees to be higher than your waist?

The pictures I have seen of motions not to perform make it look like if you twist your hips the wrong way - for example moving an item on an upper shelf from left to right - the hip can pop out.

I just don't know enough at this point to make the decision to go ahead with the surgery. Any help you could provide or any sites you could point me to that could give me a better idea of what my mobility will be like when it is done would be greatly appreciated.

Thank you.
Jerry-


Answer
Dear Jerry

I feel so badly that you are in such pain.  Bone pain is terrible and I also have necrosis and that is a disease that does not get better.  The reason the surgeons leave it up to the patient is because THR surgery is still considered elective surgery.  My rule of thumb is that if your illness is impacting your life to such a degree that you are in such bad pain and are finding you have more limitations than not, look into having the surgery.

Dislocation is a possibility, but less so as long as you keep to your precautions.  Don't bend over a 90 degree angle, don't play contact sports, don't twist your body harshly and don't cross the midline of the body. You can't bend to the floor from a sitting position as that will put you over the 90 degree limit.  You will ALWAYS have to get up from the chair, and bend to the floor to pick something up from a standing position with your knees facing outward.  As long as your knees face outward you can bend further than a 90 degree angle.  The doctors just don't want you going over 90 degrees in a position where your chest is in your lap.

These things will become second nature to you in recovery so don't let those limitations put you off for the surgery.

You will be able to tie your shoes on your own, but not by bending.  You will have to cross your legs in the number four position to tie your shoes and put on your socks.  I have never heard of the knees not being higher than your body.  I was pregnant with hip replacements and my son was breech and I had to lie on the floor with my legs up on a bed to entice my son to turn in the womb.  I had no problems.

I use a recliner all the time and I have had four revisions.

Can't answer to the motorcycle question.  My thought is that it's dangerous, but not a threat to the stability of the hip.  I rode on the back of one when I was younger with replacements.

As far as dislocations go, the risk of dislocation is higher at the beginning of your surgery.  As you heal, the risk lowers.  If you do for some reason dislocate, you are at risk for more dislocations.

I had my first set put in at 14.  If I did not have the surgery, my pelvis would have collapsed.  I had avascular necrosis of both hips due to prednisone use for a kidney transplant.  With the surgery I was able to lead a normal life, I finished college and graduate school, got married, toured Europe and had two healthy boys.  I have dislocated in the past with one hip (a few revisions ago) but it was because the hip was failing and because it needed a revision.

You definitely will not be able to do activities, but look at your life now?  What activities are you not doing anymore anyway?  At 45 you are too young to be as limited as you are.  I say, find a good surgeon and go for the surgery.  

Sharon