How do you know when you need a hip replacement?

Cindysphinx

G.O.A.T.
I'm 60, and my hip has been an issue for a while (7+years). It seems pretty good with most things (stairs), but the inward and outward rotation are compromised and it always feels tight. I play doubles exclusively.

So for those who have had a hip replacement, how did you know when it was time? I have known a couple of people who had hip replacements, and they seemed quite compromised in their tennis movement before the surgery. I don't feel that way and don't feel like my hip is preventing me from playing. But I played doubles yesterday and tweaked it, so today it is sore. I don't take NSAIDs for it (although I take them about once a week when overall stiffness becomes too much).

Is there any reason to get a hip replacement sooner rather than later? My doctors say to get it whenever I feel like I should, which isn't especially helpful.
 

travlerajm

G.O.A.T.
Thirty years, ago, I majored in biomechanics, and the topic of hip replacement surgery outcomes filled the bulk of my Biomechanics 501 curriculum.

A couple take-home points:

1. Once you get a surgery, the lifespan of the implant is finite - typically about 15 years. If you get the surgery now, you will likely need another when you are in your mid 70s. And your body’s ability to tolerate the invasive surgery when you are that age will be much lower, with much higher risk of life-threatening complications such as infection. Given this, I’d suggest waiting until you are in your late 60s so that the bionic hip can last until your early 80s (close to your life expectancy).

2. The reason hip joints don’t last forever is because the interface between the bone and the metal requires the stress to be loaded within a narrow range in order for the adhesion to be stable. Too much localized stress causes the bone to resorb. Too little stress causes the bone to resorb also. It’s my understanding that hip replacement surgery has not advanced very much in the past 30 years, and that these surgeries still have short usable lifespans.

The first point is personal for me, as my grandfather passed away at age 78 when he slipped in the bath tub and fractured his hip. He did not survive the ensuing hip replacement procedure.
 

SteveI

Legend
Thirty years, ago, I majored in biomechanics, and the topic of hip replacement surgery outcomes filled the bulk of my Biomechanics 501 curriculum.

A couple take-home points:

1. Once you get a surgery, the lifespan of the implant is finite - typically about 15 years. If you get the surgery now, you will likely need another when you are in your mid 70s. And your body’s ability to tolerate the invasive surgery when you are that age will be much lower, with much higher risk of life-threatening complications such as infection. Given this, I’d suggest waiting until you are in your late 60s so that the bionic hip can last until your early 80s (close to your life expectancy).

2. The reason hip joints don’t last forever is because the interface between the bone and the metal requires the stress to be loaded within a narrow range in order for the adhesion to be stable. Too much localized stress causes the bone to resorb. Too little stress causes the bone to resorb also. It’s my understanding that hip replacement surgery has not advanced very much in the past 30 years, and that these surgeries still have short usable lifespans.

The first point is personal for me, as my grandfather passed away at age 78 when he slipped in the bath tub and fractured his hip. He did not survive the ensuing hip replacement procedure.
^^^^^

All of this above. Sums it all up
 

Harry_Wild

Talk Tennis Guru
Yes, the order you are, the more you are prone to getting a serious infection from an operation. Years from now, that may not be the case since surgery is progressing toward robotics based surgery and AI is now making considerable progress.
 

ollinger

G.O.A.T.
Yes, the order you are, the more you are prone to getting a serious infection from an operation. Years from now, that may not be the case since surgery is progressing toward robotics based surgery and AI is now making considerable progress.
Robotics offer some advantages but they're not necessarily cleaner, and most surgical infections begin with the patient's own bacterial flora
 

Rubens

Hall of Fame
I find phrases such as "whenever you feel like you should" or "depends on the degree of symptoms" not very helpful.

Let's make it clear(er). If you experience pain while carrying essential activities of daily living (ADL's), AND have failed other treatments such as NSAIDs, physical therapy and steroid injections, or cannot tolerate such treatments, then most would agree that it is time to replace the hip. Unfortunately tennis is not considered an essential ADL. There is no guarantee that your tennis would be any less painful after the replacement. In fact there is no guarantee that your new hip will feel better even for ADL's, but most would agree that it's a risk worth taking if your symptoms are at the point that fits the description at the beginning of this paragraph. Not sure you're quite there yet.
 

Dartagnan64

G.O.A.T.
Ugh. There’s never a good time for something like this.
First thing is to make sure you are as healthy as you can be. Excessive weight and diabetes are a big issue with recovery and longevity of a hip replacement. Second is it's probably better to manage conservatively as long as possible because as others have said, artificial hips have a finite lifespan and while revisions are possible, they don't always heal as well. Third, don't do it to play better tennis. It will only provide less pain. The loss of proprioception from the procedure can be a killer for active sports and most people's tennis declines considerably after joint replacement.
 

SystemicAnomaly

Bionic Poster
@Cindysphinx

In my case, an x-ray of my pelvis / hips made it pretty obvious that the left hip is in dire need of a total replacement. Avascular necrosis. Top of the femur is pretty busted up and not even sitting in the socket. Significant arthritis on the left side but not the right side. An MRI provided some additional details on whether or not an infection was present in the hip joint.

Has a total replacement been suggested for you? Partial replacement or hip resurfacing? This is less invasive than a total replacement.

If given a choice between an anterior procedure or a posterior one, usually best to go with the former. A posterior replacement is much more susceptible to a dislocation. It might also require a bit more recovery / rehab time. In my case I do not have a choice -- I'm stuck with getting a posterior procedure cuz of the nature of my hip issue.

Hopefully that will happen early next year. I need to get more dental work out of the way -- to reduce the risk of likely inflammation which could wreak havoc with a replaced hip. I also need considerable more physical therapy to reduce / minimize a scoliosis of the spine prior to the hip surgery. My fear is that aggressive PT for the scoliosis might increase the likelihood of a hip dislocation. So I'm trying to get that scoliosis PT done prior to the hip surgery

 

SystemicAnomaly

Bionic Poster
According to WebMD:
95% of hip replacements last at least 10 years, about 75% last 15 to 20 years & just over half last 25 years or more. To help keep your artificial hip in good shape longer, stay active but avoid high-impact activities & stay at a healthy weight
 

mmk

Hall of Fame
My wife had her right hip replaced the first time when she was 36 due to Legg Calve Perthes disease. It had to be re-done when she was 44, due to the plastic interface having been irradiated to disinfect it. Unfortunately that caused the plastic to break down. The surgeon who determined she needed it re-done (revised) said that her pelvis had been thinned out from the plastic, and that he wasn't good enough to do the revision. He referred her to Dr. Brian Evans at Georgetown, who is considered one of the best orthos in the nation. He had to pack freeze-dried bone material into her pelvis to have enough bone to do the operation. The revision has held for 20 years, and still good. Cindy, IIRC you are in the DC area, if you can get in with Dr. Evans, he is great.
 

Shroud

G.O.A.T.
I'm 60, and my hip has been an issue for a while (7+years). It seems pretty good with most things (stairs), but the inward and outward rotation are compromised and it always feels tight. I play doubles exclusively.

So for those who have had a hip replacement, how did you know when it was time? I have known a couple of people who had hip replacements, and they seemed quite compromised in their tennis movement before the surgery. I don't feel that way and don't feel like my hip is preventing me from playing. But I played doubles yesterday and tweaked it, so today it is sore. I don't take NSAIDs for it (although I take them about once a week when overall stiffness becomes too much).

Is there any reason to get a hip replacement sooner rather than later? My doctors say to get it whenever I feel like I should, which isn't especially helpful.
Your single handed forehand sucking is a good indicator. :)
 

Cindysphinx

G.O.A.T.
My wife had her right hip replaced the first time when she was 36 due to Legg Calve Perthes disease. It had to be re-done when she was 44, due to the plastic interface having been irradiated to disinfect it. Unfortunately that caused the plastic to break down. The surgeon who determined she needed it re-done (revised) said that her pelvis had been thinned out from the plastic, and that he wasn't good enough to do the revision. He referred her to Dr. Brian Evans at Georgetown, who is considered one of the best orthos in the nation. He had to pack freeze-dried bone material into her pelvis to have enough bone to do the operation. The revision has held for 20 years, and still good. Cindy, IIRC you are in the DC area, if you can get in with Dr. Evans, he is great.
Wow. Brian Evans? That's the doctor I saw most recently. I guess I'm in good hands, then.

And he said . . . wait for it . . . "Well, it's up to you to decide when you can't tolerate it anymore." Hence my asking you folks how you knew.

Oh, and based on my jacked up Xrays, he seemed quite surprised that I could still play doubles. But he said Xrays don't tell the whole story.

I guess not.
 

SteveI

Legend
Wow. Brian Evans? That's the doctor I saw most recently. I guess I'm in good hands, then.

And he said . . . wait for it . . . "Well, it's up to you to decide when you can't tolerate it anymore." Hence my asking you folks how you knew.

Oh, and based on my jacked up Xrays, he seemed quite surprised that I could still play doubles. But he said Xrays don't tell the whole story.

I guess not.
Hi Cindy:

I will give you my second hand information. I have a tennis partner with a bad hip also and he explored all his options with best doctors in WNY and I traveled with him to HSS in NYC also. Every doctor said the same thing... "And he said . . . wait for it . . . "Well, it's up to you to decide when you can't tolerate it anymore.""

It sounds to me based on other local players here you are still doing quite well and can still play and function in life.

I hope you can play for many more years. I have been managing two repaired knees and two disk issues in my lower back for a while now. Good luck..
 

Cindysphinx

G.O.A.T.
Thanks, @SteveI. I guess I'll soldier on.

Sorry about the knees and back. I had two meniscus surgeries on my left knee, so I know how debilitating knee issues can be. Much worse than hip issues, IME.
 

mmk

Hall of Fame
Wow. Brian Evans? That's the doctor I saw most recently. I guess I'm in good hands, then.

And he said . . . wait for it . . . "Well, it's up to you to decide when you can't tolerate it anymore." Hence my asking you folks how you knew.

Oh, and based on my jacked up Xrays, he seemed quite surprised that I could still play doubles. But he said Xrays don't tell the whole story.

I guess not.
So my wife has had her right hip replaced & revised, both knees replaced and revised (revisions by Dr. Evans) and both shoulder replaced. At 36 she couldn't walk without excruciating pain, and that is when she had her right hip replaced the first time. She'd been having problems since she was 13 and the quack her parents sent her to x-rayed her left hip instead of her right, even though she told him it was her right, and told her parents she was fine. Basically the blood flow to the top of her femur stopped when she hit puberty. All her other joints are messed up because of how she has had to compensate. If you want to talk with her, send me a PM.
 

Cindysphinx

G.O.A.T.
So my wife has had her right hip replaced & revised, both knees replaced and revised (revisions by Dr. Evans) and both shoulder replaced. At 36 she couldn't walk without excruciating pain, and that is when she had her right hip replaced the first time. She'd been having problems since she was 13 and the quack her parents sent her to x-rayed her left hip instead of her right, even though she told him it was her right, and told her parents she was fine. Basically the blood flow to the top of her femur stopped when she hit puberty. All her other joints are messed up because of how she has had to compensate. If you want to talk with her, send me a PM.
I’m sorry she’s going through all of that. It makes what the rest of us are dealing with sound like a paper cut.
 

antony

Hall of Fame
I imagine the older you are, the longer it takes to heal so I’d recommend it sooner depending on how bad things are
 
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antony

Hall of Fame
Thirty years, ago, I majored in biomechanics, and the topic of hip replacement surgery outcomes filled the bulk of my Biomechanics 501 curriculum.

A couple take-home points:

1. Once you get a surgery, the lifespan of the implant is finite - typically about 15 years. If you get the surgery now, you will likely need another when you are in your mid 70s. And your body’s ability to tolerate the invasive surgery when you are that age will be much lower, with much higher risk of life-threatening complications such as infection. Given this, I’d suggest waiting until you are in your late 60s so that the bionic hip can last until your early 80s (close to your life expectancy).

2. The reason hip joints don’t last forever is because the interface between the bone and the metal requires the stress to be loaded within a narrow range in order for the adhesion to be stable. Too much localized stress causes the bone to resorb. Too little stress causes the bone to resorb also. It’s my understanding that hip replacement surgery has not advanced very much in the past 30 years, and that these surgeries still have short usable lifespans.

The first point is personal for me, as my grandfather passed away at age 78 when he slipped in the bath tub and fractured his hip. He did not survive the ensuing hip replacement procedure.
Something to consider is that hip replacements will be better in the future, so it depends how bad your hip is now and how you want you quality of life to be. If it’s not bad now, and you could still get acceptable use out of it, maybe take your time. It is likely they will have improved hip replacement medical methods and technologies as time goes on and maybe if you wait a few years they’ll have ones that last longer enough

If I had mobility problems that affected my quality of life severely, and all other non-surgical options are exhausted, I would get the hip replacement now and hope by the time I need another hip replacement the methods and tech will be improved to make my then older age not that big a deal.


Good luck.

If I can ask, why a chiropractor? I've never seen one (I always run to the orthopedic surgeon).
Have you ever seen a chiropractor since this post?
 
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antony

Hall of Fame
Are you afraid of going to one? Kind of bizarre you’ve been dealing with mobility issues for so long without giving a good one a shot. I’ve had a lot of help from them when I tweak something out of place in my body, and most of the time the relief is immediate.

 
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Don't want to be a kill-joy regarding chiroquackters, but I've had many sessions with many different ones for my hip issue--I got no relief beyond the parking lot--if you do it's likely psychosomatic temporary--it all depends on the charisma of the practitioner--it doesn't hurt if Sharon Stone is seeing the same one. The anterior THR cuts the least amount of tissue. Can go home the same day and doing stairs--hitting balls in a month--like any major trauma or insult to the body six months to a year to forget which side it was on. I couldn't wait for artificial cartilage to be FDA approved for the larger joints, but that may be the future for bone-on-bone stuff--it's been approved for big toes and thumbs--guess u can't kill too many patients working on hands and feet. A company called Cartiva developed it, coincidentally out of Alpharetta, Georgia, new HQ for TW. They were bought out by Wright Medical. I couldn't wait--let u know in a year. Made a few bucks on the stock though--seems promising for the future of joint pain.
 

antony

Hall of Fame
Don't want to be a kill-joy regarding chiroquackters, but I've had many sessions with many different ones for my hip issue--I got no relief beyond the parking lot--if you do it's likely psychosomatic temporary--it all depends on the charisma of the practitioner--it doesn't hurt if Sharon Stone is seeing the same one. The anterior THR cuts the least amount of tissue. Can go home the same day and doing stairs--hitting balls in a month--like any major trauma or insult to the body six months to a year to forget which side it was on. I couldn't wait for artificial cartilage to be FDA approved for the larger joints, but that may be the future for bone-on-bone stuff--it's been approved for big toes and thumbs--guess u can't kill too many patients working on hands and feet. A company called Cartiva developed it, coincidentally out of Alpharetta, Georgia, new HQ for TW. They were bought out by Wright Medical. I couldn't wait--let u know in a year. Made a few bucks on the stock though--seems promising for the future of joint pain.
Well I’ve grown up with them and have had many acute issues that were fixed immediately. Shoulder impingement from bad serving, displaced rib that made it hurt to breathe, sprained ankle, and various back and neck pains. YMMV

There’s always the chance your hip issue is not able to be remedied by a chiro. I have no idea what your problem was, but for those tweaks and pains that Cindy mentioned, I would see the chiro before the doctor. I’d give the chiro a shot too though if it was only the hip thing.

I did not seek a chiropractor out when I fractured my talus. I went to the Steadman Clinic for that. They may be the best orthopedists in the world. I’d actually recommend them to @Cindysphinx (after trying out a chiro because the costs of a chiro is not that much relative to an MD).

many pro athletes use chiropractors and they’re happy to attest to their help. I doubt they get paid to say that. I know I don’t. In fact, many people become chiropractors because they love how much it has helped them. Those are the practitioners i’d want.
 
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mad dog1

G.O.A.T.
Don't want to be a kill-joy regarding chiroquackters, but I've had many sessions with many different ones for my hip issue--I got no relief beyond the parking lot--if you do it's likely psychosomatic temporary--it all depends on the charisma of the practitioner--it doesn't hurt if Sharon Stone is seeing the same one. The anterior THR cuts the least amount of tissue. Can go home the same day and doing stairs--hitting balls in a month--like any major trauma or insult to the body six months to a year to forget which side it was on. I couldn't wait for artificial cartilage to be FDA approved for the larger joints, but that may be the future for bone-on-bone stuff--it's been approved for big toes and thumbs--guess u can't kill too many patients working on hands and feet. A company called Cartiva developed it, coincidentally out of Alpharetta, Georgia, new HQ for TW. They were bought out by Wright Medical. I couldn't wait--let u know in a year. Made a few bucks on the stock though--seems promising for the future of joint pain.
Just like there are bad doctors and good doctors, there are bad chiropractors and good ones. Same goes for auto mechanics. Same goes for tennis players.
 

graycrait

Legend
@Cindysphinx , my brother and another friend from our high school tennis team have both had hip replacement surgery. Both have played collegiate tennis and decades of USTA team tennis. They have been ecstatic about the results some 3 yrs each since the surgery, one in the Denver area and the other in the Baltimore/DC area. My bro is 68 and our friend is 64.
 

ttwarrior1

Professional
i needed hip replacement, did quack medicine, it worked and now its my strongest bodypart. Ive made posts, only been trolled. I tried and give up trying to tell
other people what to do to fix it, . message me if u want but not making a post again
 
i needed hip replacement, did quack medicine, it worked and now its my strongest bodypart. Ive made posts, only been trolled. I tried and give up trying to tell
other people what to do to fix it, . message me if u want but not making a post again
Aw come on--who here would troll anyone doing a good deed!?!--could you refer us to your links please? Any good "quack medicine" like reiki or voo-doo?
 

antony

Hall of Fame
i needed hip replacement, did quack medicine, it worked and now its my strongest bodypart. Ive made posts, only been trolled. I tried and give up trying to tell
other people what to do to fix it, . message me if u want but not making a post again
I believe it! I bet a lot of problems that have needed surgery could’ve been prevented with early chiroquacktic intervention because people just were overly skeptical or elitist even and let easy problems to fix get way worse.
 

srvnvly

Hall of Fame
I’m 57 and have had both hips replaced (4/2021,12/2019), and it’s been a good decision for me. I could hardly walk and have been in chronic pain for years. I asked my ortho surgeon about longevity of the hardware and he didn’t give me a definitive timeline, but said, based on my weight, overall health, and quality of the materials, I should not have to worry about them wearing out.
 

cortado

Professional
Thirty years, ago, I majored in biomechanics, and the topic of hip replacement surgery outcomes filled the bulk of my Biomechanics 501 curriculum.

A couple take-home points:

1. Once you get a surgery, the lifespan of the implant is finite - typically about 15 years. If you get the surgery now, you will likely need another when you are in your mid 70s. And your body’s ability to tolerate the invasive surgery when you are that age will be much lower, with much higher risk of life-threatening complications such as infection. Given this, I’d suggest waiting until you are in your late 60s so that the bionic hip can last until your early 80s (close to your life expectancy).

2. The reason hip joints don’t last forever is because the interface between the bone and the metal requires the stress to be loaded within a narrow range in order for the adhesion to be stable. Too much localized stress causes the bone to resorb. Too little stress causes the bone to resorb also. It’s my understanding that hip replacement surgery has not advanced very much in the past 30 years, and that these surgeries still have short usable lifespans.

The first point is personal for me, as my grandfather passed away at age 78 when he slipped in the bath tub and fractured his hip. He did not survive the ensuing hip replacement procedure.
All of the above, but hip resurfacing (what Murray had) has the potential to last longer in theory because you have preserved the femoral neck and just resurfaced the head and socket.
Plus, if your resurfacing does wear out, there is much more femur and femoral neck bone left to work with should it need revising to a full hip replacement.

Either procedure is a big, big deal, has the potential to go horribly wrong, and shouldn't be thought of as 'routine'.
And no fake hip is ever going to be as functional as a real hip.
 

Cindysphinx

G.O.A.T.
Bump!

Well, I am getting the hip replaced, soon.

Since this post, I have had some bad days with this hip. I played four doubles matches in two days at sectionals a few months ago, and it was pretty messed up afterward.

To play a match now, I have to take two Aleeve in the morning and two Tylenol before the match. This is not sustainable.

It throbs at night. I feel it on the Peloton. Ab exercises are uncomfortable.

If I walk for an hour, I’m limping a lot. I’m planning a big, outdoorsy vacation later this year, and I cannot take this bum hip with me. If I do, I will be sitting in the car when others are kayaking.

I’ll let you know how it goes. I hope I can get back to tennis. I will lose my spot on my teams, and I don’t know how I will play well enough to ever earn my way back in.
 

Rosstour

Legend
Bump!

Well, I am getting the hip replaced, soon.

Since this post, I have had some bad days with this hip. I played four doubles matches in two days at sectionals a few months ago, and it was pretty messed up afterward.

To play a match now, I have to take two Aleeve in the morning and two Tylenol before the match. This is not sustainable.

It throbs at night. I feel it on the Peloton. Ab exercises are uncomfortable.

If I walk for an hour, I’m limping a lot. I’m planning a big, outdoorsy vacation later this year, and I cannot take this bum hip with me. If I do, I will be sitting in the car when others are kayaking.

I’ll let you know how it goes. I hope I can get back to tennis. I will lose my spot on my teams, and I don’t know how I will play well enough to ever earn my way back in.
dang. Best of luck. I'm local, and I'm sure others are too, so if you get desperate for help, bump this.
 

Cindysphinx

G.O.A.T.
Oh, one more thing on the question of anterior versus posterior.

I’m using Dr. Evans (boy, howdy, there was a long wait to get on his schedule). He refuses to do the minimally invasive, anterior approach. Said the incision is much smaller, which makes placement less precise, and precise placement is everything. That sounds like a good reason, so we’re going posterior.

And the anesthesia isn’t general? Whaaaat? An epidural plus light anesthesia? I’ll believe it when I see it.
 

travlerajm

G.O.A.T.
Bump!

Well, I am getting the hip replaced, soon.

Since this post, I have had some bad days with this hip. I played four doubles matches in two days at sectionals a few months ago, and it was pretty messed up afterward.

To play a match now, I have to take two Aleeve in the morning and two Tylenol before the match. This is not sustainable.

It throbs at night. I feel it on the Peloton. Ab exercises are uncomfortable.

If I walk for an hour, I’m limping a lot. I’m planning a big, outdoorsy vacation later this year, and I cannot take this bum hip with me. If I do, I will be sitting in the car when others are kayaking.

I’ll let you know how it goes. I hope I can get back to tennis. I will lose my spot on my teams, and I don’t know how I will play well enough to ever earn my way back in.
Best of luck in your recovery with your new and improved bionic hip.
 

FiddlerDog

Hall of Fame
I hope I can get back to tennis. I will lose my spot on my teams, and I don’t know how I will play well enough to ever earn my way back in.
Are you the one who posts trivial ongoing drama about your USTA team?
For you, not playing USTA anymore will be the best thing that ever happened for your tennis.
 

Cindysphinx

G.O.A.T.
Yep, that's me. Nothing going on in my life, no sireee Bob. No family, no career, not much of a reason for being on the planet, really. Except to tell you people about Becky.
 

socallefty

Legend
I have a friend who started playing tennis again about 6-7 weeks after a hip replacement and singles another 3 weeks later. After another year, he lost a lot of weight and is now moving better than I’ve ever seen him. He plays singles against me almost weekly and we are having tighter matches now as he is defending better in addition to his normal net rushing game. He is even thinking of going back to playing hockey again.

So, there is a lot of hope for you to get back to tennis. All the best.
 
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