Differences associated with THR

Let's talk about differences....not just in my two hip replacements but in total hip replacement in general.

Before I begin with some technical/medical differences I want to remind everyone - this is your journey!!! I belong to a  Facebook group "Hip Replacement group for Active people" and I often read posts of members disappointed that they are not "where another member is" in their recovery.  There are also posts asking where they should be at a certain point in recovery. 

I find this group to be very helpful and as a matter of fact the posts I read prior to my first hip replacement in September 2020 alleviated some of my worry about the surgery. 

At times I am very hard on myself, especially in reference to fitness. I tend to overdo. After my first replacement I found myself comparing to others and this took a toll on me emotionally and could have had a negative affect on my recovery. I took time to reflect on my experience as a Group Exercise Instructor and Personal Trainer and realized the advice that I would give to clients is what I need to practice. The advice is - You can't compare yourself to others. You are unique. We all have a different starting point. We all have a different journey. Be motivated by the journey of others to be committed to yours but do not feel the need to compete. Listen to your body and to the advice of your surgeon and physical therapist (hopefully you have been referred for PT). Be "OK" with doing less if you are a "fitness fanatic"; trust me, it is OK and you will get back anything you think you lost! Be patient.

And ...on to some more differences.....

The need to have hip replacement varies from person to person. Here are some of the medical conditions that are most common for hip replacement.

Avascular necrosis is a disease that results from the temporary or permanent loss of blood supply to the bone. When blood supply is cut off, the bone tissue dies and the bone collapses. If avascular necrosis happens near a joint, the joint surface may collapse.

Hip dysplasia is the medical term for a hip socket that doesn't fully cover the ball portion of the upper thighbone. This allows the hip joint to become partially or completely dislocated. Most people with hip dysplasia are born with the condition.

Osteoarthritis is the most common form of arthritis. It is a chronic degenerative joint disease that affects mostly middle-aged and older adults. Osteoarthritis causes the breakdown of joint cartilage.

I have been diagnosed with seronegative rheumatoid arthritis. I always struggle with this diagnosis as I do not have the RA factor in my blood. However, physical exam, x-rays and the condition of my knees and hips indicate that this is an accurate diagnosis. The inflammation in my joints increased osteoarthritis leading to my replacements.

Once there is a diagnosis for replacement need the next difference is in surgical approach.

Here are the three most common approaches used by surgeons.

Anterior Replacement: With anterior hip replacement, the surgeon makes a small incision near the front of the hip to allow for removal of damaged bone and cartilage, and implantation of an artificial hip without damaging surrounding muscle and tendons. The anterior approach avoids cutting major muscles as there are fewer muscles at the front of the hip. This approach to hip replacement tends to provide the surgeon with a more limited view of the hip joint during surgery, making the surgery technically challenging,

With this approach there may be wound healing issues. In addition, obese or very muscular people may not be good candidates.

Posterior approach: The posterior approach to total hip replacement is the most commonly used method and allows the surgeon excellent visibility of the joint, more precise placement of implants and is minimally invasive. In posterior hip replacement, the surgeon makes the hip incision at the back of the hip close to the buttocks. The incision is placed so the abductor muscles, the major walking muscles, are not cut.

With this approach some surgeons place 90 degree precautions for up to 6 weeks. These guidelines include not bending or flexing the hip past 90 degrees, no crossing of legs, and no rotating the operated leg inward.

Lateral approach: The lateral approach to the hip is a commonly used approach and involves splitting of both the gluteus medius and often vastus lateralis  muscles. Lateral (side) approach uses an incision at the side of the hip. 

The advantage of this surgical method is the balance of having a versatile incision that can be used to correct deformities and insert specialized implants with lower dislocation rates following surgery than what is observed with posterior approaches.

The disadvantage of the direct lateral approach is that the abductor muscles of the hip joint have to be cut for surgical access to the hip. These muscles may heal, but impaired healing can cause a persistent limp when walking.

There are new surgical techniques being introduced to hip replacement: Mako robotic assisted, Super Path, etc. 

There are advantages and challenges to all approaches. Not one approach fits every patient or every surgeon. I believe that the most deciding point is your trust in your surgeon rather than the approach used.

Both if my hip replacements have been done by the same surgeon (he also did my knee replacement). My surgeon uses the Striker Mako-Robotic Assisted; Posterior approach. I have had successful outcomes (so far; so good in my recent surgery 4/21/22) with this approach. I totally trust my surgeon!

Recovery difference as also to be addressed. We are all different. Obviously we are not all the same age at the time hip replacement is necessary. Some wait until the deterioration of the hip limits mobility and activity considerably. Some have minimal effect to mobility however x-ray and/or MRI indicate the need for surgery sooner rather than later. Our fitness level and medical history may affect recovery.

I have to remind myself, constantly, that slow and steady wins. I have a very "over achiever" personality, especially in working out. I have already been cautioned by my physical therapist to cut back on my walking distance; more indoor cycling (being cautious to not break precautions). I am trying really hard to practice this advice. This is challenging due to the differences in my recovery between this surgery and the first hip. With this surgery I have minimal pain. I had more bruising which is gone and more swelling which I still have under the scar (making me a touch nervous so I am monitoring). I did not have the same need for assistive devices in this surgery - may be more of a curse! In my first surgery I had more pain and needed the cane longer. My scar looked better and there was less swelling. I think my activity level is comparable - walking, upper body strength, PT sessions, elliptical. I am on the bike sooner this time.

We are all excited that the "hip pain" is GONE! This may "trick" us into doing many of the things that we had been previously avoiding - often too soon. We have to remember that we had major surgery, flesh opening, bone cutting, joint removal! We have to embrace the medical process of healing, soft tissues has to heal, muscles need strengthening, gait training (if needed). We may not even realize the affect of our activities on soft tissue so it is important to take to your PT or surgeon regarding it. 

Don't compare yourself to others! Reminder: "we are different"!