Knowing when to have a total hip replacement?

Not a hip, but a knee with me; I’m 59.

Whilst I wasn’t taking painkillers all day, it has got to the stage where I find difficulty walking normally for more than a mile, cycling hurts and I’m unable to go sailing or skiing. My job is pretty stressful and exercise was my way of managing this stress. I took the decision that my quality of life, both mentally and physically, was of utmost importance to me and my family right now. I have an operation for (hopefully) a partial knee replacement tomorrow afternoon – I say hopefully as there may be a chance I will need a total knee replacement.

Partial knee replacements seem to have greater longevity than hips – apparently 80% are still functional after 20 years (I’ve not delved into the stats to understand age distribution though).

All the best to the OP and other posters – joint pain is no fun.

OP not so much telling you to be more active, but reassuring you that you’re ok to be more active if you want to.

Lots of people with wear and tear type arthritis reduce their activity because of the pain, and that’s what they think that they need to do, often because they’ve been told to by healthcare professionals. Often it’s the reduction in activity that makes them unhappy, over and above any pain that they’re in. In some cases, reassurance that they’re not making things worse for themselves by being active, even if it causes pain, can be helpful to them in delaying or reducing the need for a joint replacement.

Kramer – sorry re read my last post and it may have come across wrong, the last comment wasnt aimed at you.

indeed my consultant said to try and keep running and exercising. Again its just the dwindling reduction in exercise tolerance that is mentally difficult to cope with. As above I have a stressful job (desk based), and out side of work spend a lot of time ferrying my son too and from football training and matches, exercise was the me time bit that helped me recharge and I used to fit this in with my sons training sessions, but I now struggle to jog let alone run 2 miles, and its painful to start with and painful after.

Surprised by the people who feel that this is a depressing thread , I found it very uplifting to know that a condition which has left generations of hard working people crippled by agonising pain in their later years can be cured by what is nowadays a simple and quickly recovered from operation. I read alot about the work of the pioneer of hip replacements a very clever and far sighted man , was he Prof Woodward based in Birmingham , we have much to thank him for ?

Professor Charnley.

That’s the fella, what a man.

jamesco – it’s depressing for me, as my hip replacement was in my 50’s, meaning I may have to have another before I’m elderly and being a woman, this may not be possible. The thought of not being able to walk or enjoy outdoor past times, after years of working is worrying.
If I was elderly and had had some life, then It would be a godsend.
Yes I’ll be forever grateful that I have some form of active life now, but most of the posters on this thread are not even old.

I hesitated to post yesterday as though my story is about hip pain, it is purely anecdotal and not about wear and tear / arthritic pain in later life, but it’s in keeping with some comments above so here goes:

I had a hip problem as a youngster, about 10 years old, that at first made it impossible to walk. Called Perthes disease if you care to google, it involves necrosis of the head of the femur. The prognosis at the time was a hip replacement by the age of 30, along with strict rules to avoid impact sport (running, football). Well, I didn’t like running or footbal anyway so I loved my sick note for PE. But I did develop a love of cycling. And I credit the relatively low-impact, high movement, and muscle/tendon strength developed by lots of cycling for helping me recover beyond expectations. I’m 38 now and still on my biological hip. Hurts occasionally, but can do long walks. Saw a consultant to check it out last year and I probably will be getting a replacement at some point in later life, possibly one of those injections first. But bottom line, in my experience, cycling has saved my hip and when I’m in good cycling health my hip feels stronger rather than “looser”. YMMV.

Sorry to hear that Bunnyhop ,but I like you was considered too young for a THR but it’s been a revelation and I am optimistic that the massive leaps in modern health care and surgery will mean that one or maybe even two revisions could be a distinct possibility, I looked at it from the point that I could easily be dead before I got any relief, chin up, best wishes.

Will reply properly but i had mine done at 31..

Happy to have a proper chat over it

Also an orthopaedic surgeon (not spine).

Overall hip replacement is an amazingly successful operation.

Key things to factor into your thinking – a hip replacement doesn’t give you a normal hip again, it gives you an almost normal one that doesn’t hurt. Running/impact sport will lead to accelerated wear as its just a bearing surface and the more you load it…

It’s really just very effective pain relief – so if the pain can be controlled with tablet pain relief that is better than operation pain relief. When tablet pain relief no longer works a hip replacement is a good operation.

A small (very small) number of patients have disastrous and life changing complications and end up worse than they were – it’s small, and it’s less likely in a young fit patient but it can happen. A really important thing to think about is ‘could I handle it psychologically if I had a really bad outcome’ Hard to work that out but you meet a small number of patients who are very very regretful about having had surgery and than can be very hard for them to deal with.

This isn’t meant to be off putting, more about the stuff to have wrestled with!

Latest research I’ve seen says they are lasting more like 25 years which is great.

I forgot to mention, but my BIL had a 3D computer printed titanium hip replacement which was custom designed for a perfect fit of the old one. What I didn’t say is that he had the entire operation under local anaesthesia (spinal block) because as a single parent, the children (who’s mother had recently died), were worried about losing their father. Outcome has been great for all concerned.

We are massively over-engineered so it is possible to compensate for a worn joint by ensuring good control over it – working on balance, strength (including optimal recruitment patterns) & flexibility.
Modifying the loads on the joint can also have a huge effect – weight, activity & foot-ware choice.
Eventually you run out of the ability to compensate, are in constant /regular pain, your sleep is affected & your world effectively becomes a lot smaller. It is at that point, in my opinion, that a joint replacement becomes a sensible choice.
I had a new knee at 59. The initial problem was a poorly treated meniscal tear in my 20’s, not helped by continuing to play squash, going windsurfing & snowboarding. Shock loading the joint was the major issue for a long time. Initially sorbothane insoles/ springy soled shoes were enough, then I gave up squash, then slalom sailing, then wave sailing & snowboarding. Instead I did more yoga, cycling, surfing & paddle boarding. When things started to deteriorate more rapidly I contacted the surgeon that had been monitoring my knee & agreed to have it replaced. There was a 6 month wait, during which things got rapidly worse.
The new joint is great, I have virtually no discomfort in normal activities & I sleep well. It is not however the same as the original when it was in good condition, just a lot better than the old one by the time it was replaced. I was diligent with my rehab & went for my first surf 3 1/2 months after the surgery. High impact sports are now off my agenda, not because they are impossible but because I believe that they will use up the life of the replacement faster & I get enough enjoyment from the lower impact activities I now do.

I believe that the same would be true for a hip in terms of managing the joint. There is one important difference: in order to get anywhere one leg has to be behind you. In a normal gait this is mainly hip extension. Extension is often lost relatively early on an OA hip, resulting in over use of the lumbar spine. If you have reduced hip extension & a degenerate low back I would be tempted to have the hip replaced sooner rather than later.

If you have the op & can afford it private specialist rehab will be money well spent. NHS physio is woefully underfunded &, largely as a result of this, the expected level of function is well below optimal.

What I didn’t say is that he had the entire operation under local anaesthesia (spinal block)

As I understand it that’s pretty much standard practice now. It makes sense that the risk of a full GA and its aftereffects means that spinal block is preferable

Mine was done under spinal block. It was also explained that they could add a longer lasting analgesic effect so it took longer to wear off, increasing post-op comfort. They offered me a sedative so I could sleep through the op. Not something I was going to refuse!

Full replacement done 3 years ago.
Saw the surgeon who told me I should not be walking
Had it done 2 weeks later.
When it is bad it is horrendous and painkillers are pointless. I was at that stage. And it was the best thing I have had done.
Currently waiting for my right one doing. Not as bad but still constant pain. Cycling keeps the pain at bay. Non weight bearing.

Also got a fused ankle and had a reconstructed knee. Which will need sorting somehow soon.

Osteoarthritis is a bas5tard.

This is a timely thread. I have severe osteoarthritis in my right hip.
I was first diagnosed with it back in 2015 at 53 years old & at that time my mobility wasn’t too restricted & pain management was successful until last year.
Over the last 10 months or so, well, It’s been getting worse & I’ve been putting up with the pain & decreased mobility until a couple of months ago, so after a doctors appointment & x rays, once my x ray results were in I was booked in for an appointment with the orthopaedic dept at the hospital last Wednesday. So, after 4 more x rays & a long chat with the consultant I’m scheduled for a total hip replacement. Consent form for the op signed, so I’m just awaiting a date.

seb84
Full Member
Latest research I’ve seen says they are lasting more like 25 years which is great.

Andy Murray had the same resurfacing op as me and I read that if he continues to play top level tennis then his hip would be expected to last for 7 years . Given the massive stresses that playing top level tennis puts on the hip then I would hope that mine will last at least 3 times as long which would mean that I would be into my 80s so mine will hopefully see me out . I cycle and swim but don’t run as that hurts my knee and I am trying to minimise the impact on my hip as well so the only real damage is caused by walking but I expect that to be fairly minimal .

Bit of a further update.

After a nice holiday in Greece, my other hip has now joined in with sympathy and I have a labral tear in that (self diagnosed) its not half as bad as the right one was but still pretty uncomfortable. I kind of knew it was coming as I had all the same warning signs.

My right hip was already giving me more hassle prior to the left joining in, but now thats getting even worse. What it has shown me though is that I did have quite a lot of chronic pain as the ‘sharp’ pain in the left hip is actually quite a pleasant change from the chronic pain in the right. I didnt realise quite how chronic pain leaves you feeling tired and almost like with a constant headache.

Exercise is now reduce to a waddle down the road walking the dog with occasional shooting pains like someone is sticking a red hot poker up my arse !

I rang the consultant secretary last week and luckily I got a call yesterday from Outpatients to say they have a cancellation this week. Will see what the outcome is the orginal Xray’s and MRI showed the left hip to be in a worse position that the right hip (the one that had the original tear)

I thought hip replacements were lasting 40+ years now?  the thing with the lifespan of the hip replacements is that they have not been around that long and its only in recent years we have seen younger and younger folk having them so there are not that many hip replacements around that are more than 25 years old rather than them not lasting more than 25 years.  NOt my field tho but thats what I thought

An ex colleague of mine – a physiotherapist had one in her 40s.

Only 3 months to go for me now, can’t wait, it’s proper knackered now, painkillers stopped doing anything a few months ago, i’ve been down for a replacement for years, stated i should try and keep going as i was in my early 40s, but 2 years ago it was done and put on the list, prioritised about a year ago after it got worse, will be a different world if i can actually start doing stuff again!

Unfortunately my trapped nerve has also come back this week, so my entire left side isn’t having a good time just now 😂

As for the wear and tear, the surgeon told me recently they expect them to last a lot longer than the stated lifetime, as above, they’ve only been seeing data from replacement hips for a short time, and have changed materials and procedures as well, they’ll always be pessimistic with the predictions, think he stated the only ones he’s had to replace were due to incidents and accidents requiring surgery.

I thought hip replacements were lasting 40+ years now?

Thats an interesting one that. Just had a quick look at some more recent research.

From the Lancet

Among more than 60,000 people who had a hip replacement, only 4.4% required revision surgery in the first 10 years after surgery, but by the 20-year mark, 15% required revision.

Among nearly 55,000 people who had a knee replacement, only 3.9% required revision surgery within 10 years of surgery; by 20 years, 10.3% required revision.

Age did matter. Of those over 70 having hip or knee replacement, the lifetime risk of having a second operation on the replaced joint was about 5%. But this risk was much greater in younger individuals, especially for men. Up to 35% of men in their early 50s required a second operation.

Stating the obvious. If you do very little they will last longer. So for me my chances of needing a revision would look to be relatively high compared to the statistical norm of those who have thr.

Also the other side of it – fit younger folk would have stronger muscles that stabilise the joint more and they are more likely to do their physio?

My guess and thats all it is is a lot of those who require revision are sedentary – but thats a lay guess

My mum had both her hips done in the same year.  She was 84 at the time – but a very fit 84yr old and she did her exercises diligently both pre and post op.  She is miffed that 4 miles walking is about her limit!  That will be in the top few % of recoveries.  I have also seen folk of a similar age not do their physio, be sedentary and can barely walk to the kitchen a year post op

So an update on my hips!

It doesnt seam like 10 months since I last posted !

I did get an appointment, but it was only to see a Junior who arranged for me to have an injection in to my hip. Months past and finally got the appointment. However by this point because I had done zero exercise symptoms had pretty much gone away.

Actually turning down the injection, then did prompt a phone call from the consultant which resulted in re x-ray of my hips. This showed degeneration in both hips, but not severe enough to warrant hip replacement.

For the last 6 months I have been relatively pain free. Obviously I have pretty much torn away most of the labrum in both hips of the last 2-3 years and now its a nice steady process of bone on bone grinding until it gets to the point of being operated on.

I was told early doors that my hips were too far gone for any tear surgery, but boy its been a very very unpleasant period of time the random shoots of pain or the prolonged periods of soreness. Speaking to people who’s hips have gone, they said the tear pain is very different to the actual arthritic ‘replacement’ pain so obviously I have that joy to come too 🙂

I’m 11yrs in at 42..

Currently riding in cromie.  My hips still great.

My weight general fitness not so much.

I know I’ll need a revision as i had it so young but thats a future me problem.

Mine was due to a fracture at 25.  I had 6 yrs of painkillers injections physio. I had one physio ask how i managed to walk up stairs.

I lived on painkillers  to manage. They didnt help the pain but allowed me to push on renovating my house.  Was bloody awful.  The replacement was like a brand new life.

WRT to revisions, revisions are almost never as good as the first one and don’t tend to last as long. Revision revisions and you really start to get into complexity of the operation and diminishing returns.

My ex-FiL had his first hip done 2 years ago at 74. Had increasing pain for 10+ years, physio and medical folks thought it was his knees again, he is on his 4th knee though, 2 on each side. First one in his early 30s latest about 12 years ago. The additional damage to the hip due to not identifying the problem in time meant his recovery was, and is, very slow. He’ll likely never get to better than 75% of a healthy hip. As an additional ballache, the other hip is now past due, but it’s also high risk due to the issues they found with the first one (porosity, micro fractures and an amount of necrosis), and they won’t operate again until the first one reaches a certain level…

So regular visits to the hospital and when it flares up he’s pretty much stuck between the living room, kitchen and spare bed (can’t do stairs).

Get it done before it’s critical.

On the plus side, i was told i’d need a new knee before 30 after a massive smash in my late teens. I’m now in my 50’s and it’s only just started mild twinging now. Do the physio!

naproxen, (anti-inflammatories even taken with food upset my stomach)

Are you not prescribed Omeprazol? I’m on Naproxen for my knee, and which is now also effective for my thumb joints, and my right hip has become very painful over the last few months, to the extent that getting my socks on has been difficult! Omeprazol was prescribed at the same time, however I don’t seem to have issues with Naproxen, ‘cos I’ve run out of the Omeprazol a few times and not noticed any difference. Friends of mine just can’t get on with it at all though.
I’ve been putting off making an appointment with my doctor, I do also have co-codamol/Zapain for my knee, but I’ve avoided taking it regularly, mainly because I could get away without having to take it, but Voltarol and Co-codamol are starting to become a regular part of my routine!
I’m 70 next month, btw.

Yeah, you usually get issued with Omeprazole or Lansoprazole depending on what’s best with naproxen.

Had my hip replaced last October, pain has disappeared, it’s a long road to recovery, but getting there, the hip joint is 100%, but it’s the muscle wastage over the years and building up the strength again that’s taking the time now, so gym twice a week to stretch and strengthen as well as stretching daily, was able to go back to activities in January/February and have had no issues cycling, golfing, etc.

My days of enduro are over though, so no booking BPW or Wind Hill, wheels on ground from now on.