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Why Hip Replacement is the Best Surgery in Medicine

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Posted at 11:23 AM, Sep 22, 2015
and last updated 2015-09-23 12:29:25-04

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The following article is sponsored by University of Utah Health Care.

By Natalie Dicou

Deborah Shank was barely opening her eyes after receiving total hip replacement surgery, and the pain that had wracked her body for years was already gone. Just like that.

“Most patients wake up from surgery — and despite the surgical pain that people experience, which is sort of a muscular pain — that deep-seated, bone-on-bone, grinding, toothache, sharp, stabbing pain that they’ve been living with is gone,” said Christopher Pelt, M.D., an orthopedic surgeon with University of Utah Health Care. “It’s one of the best surgeries in medicine as far as restoring quality of life.”

Within hours of anesthesia wearing off, patients who may have required a wheelchair to get around prior to surgery are typically up and walking, using a crutch or cane for support.

“I never went to the cane — I went straight to my hiking sticks because that’s very pure for me, and it works, and I can get a cadence going,” said Shank, 63, an avid hiker, kayaker and long-distance runner who lives in Moab.

Not much slows down Shank, who has an extremely high pain tolerance. When she severely broke her collarbone, she said she hardly flinched when a doctor pressed against the injury during an exam. By the time she felt she was in enough pain to have her hip replaced, there were black spots on the ball at the top of her femur, the cartilage was essentially gone, and one of her legs was a half-inch shorter — and yet she was still out there on the red rock trails.

“I could still hike but there were times when it became too painful, and there were times when I didn’t know how I was going to get back home,” said Shank, who had stopped being able to kayak because she couldn’t rotate her hips with all the bone spurs. “I started to realize that, if it continued like this, I wouldn’t be able to be active. And that’s my life: moving.”

Like most people who undergo hip replacement surgery, Shank had osteoarthritis in her hip joint, a wear-and-tear issue that worsens over time and causes pain in the groin, lower back and buttock area.

“Osteoarthritis occurs when we lose the smooth cartilage cap that lines the end of the bones that help our joints move freely and easily,” Pelt said. “When that cartilage cap wears down, the bone grinds like sandpaper in the joint.”

Many patients are born with a predisposition for wearing out their hips early. Some might develop osteoarthritis because of hip dysplasia, in which the socket is too shallow and creates stress on the cartilage. Others lose cartilage over time because they have hip impingement, which results in the ball and socket bumping into each other. Still others, a small minority, had a hip injury that led to arthritis. Implanting a new joint with metal, plastic, or ceramic components produces life-changing results for these patients.

“A few years down the line, you may forget you even had it done — the pain relief can be that good,” Pelt said.

Those years leading up to the surgery, however, can be a long road of searching for answers. Hip replacement doesn’t become an option until more conservative treatments — such as anti-inflammatory medications, physical therapy and joint injections — fail to alleviate the pain.

It’s best to avoid getting the surgery too early because, just like car bearings that need to be replaced, the artificial bearings used in hip replacements don’t last forever, meaning that a middle-aged patient who undergoes the surgery may someday require a major revision, Pelt said. At the same time, he pointed out, you don’t want to wait so long that the pain interferes with your ability to live your life and do the activities you enjoy, such as skiing, tennis or even smiling, which one patient said she’d lost the ability to do. It’s best to find that sweet spot in the middle, and that’s a much easier task than it was even earlier in this century.

“In the 1990s and early 2000s, we would tell patients that hip replacement would last 10-15 years, but in the mid 2000s, the technology really improved, and the technological advancements in the materials we now implant have led to massive improvements in the outcomes for our patients,” Pelt said, noting we don’t know how long the surgery currently lasts but he predicts 30 years or longer.

The surgery itself takes about an hour and a half. Most patients stay overnight, and Pelt encourages them to go home the next day to recover where they’ll heal best in their own environment surrounded by people who love them, rather than to a rehab facility. Within two weeks of recovery, patients can do most household activities. Within six weeks, they are out shopping. And at the three-month mark, they are able to start getting back to playing tennis and skiing.

“It didn’t take me long to bounce back — a week ago, I’d already been out walking six miles,” said Shank six weeks after Pelt replaced her right hip. (She had the surgery on her left hip in November of last year).

“When I came up for my six-week appointment, I had to give him a big hug and told him ‘Thank you for changing my life,’” said Shank, who will explore Costa Rican hiking trails this winter among other upcoming outdoor plans. “It really is that big a deal.”

For people interested in hip replacement, Shank said it’s important to go into it motivated, including being willing to work closely with a physical therapist.

“Be in the best shape you can be in ahead of time,” she said. “Even if you can’t go far, walk a little or ride a bicycle and try to get a little stronger. The better you go into it, the better you are going to come out of it.”

Would you like more information about hip replacement surgery? Call the University Orthopaedic Center at 801-587-7109.