Ask the Doctors

Dear Doctor: I'm 55 years old and a former marathon runner. Now my right hip hurts all the time, not only when I walk but also when I'm lying down. I can't even sleep on my right side any more. I was told I need a hip replacement. What does that entail?

Dear Reader: You've described several of the signs and symptoms that make discussing the option of a hip replacement with your doctor a good idea. The goal of the procedure is to address chronic hip pain, increase mobility, return patients to normal activities and restore quality of life. But before you go booking an O.R., let's talk about the operation, as well as possible alternatives.

Hip replacement is a surgical procedure that replaces the diseased or damaged portions of the hip joint with an artificial joint, known as the prosthesis. An estimated 332,000 individuals undergo hip replacement surgery in the United States each year. The surgery is most common among people with osteoarthritis, a degenerative disease that causes joint cartilage to wear away over time. The hip joint becomes rough and ragged, and the ensuing friction causes both pain and stiffness. Rheumatoid arthritis, injury and fractures can also cause sufficient damage to merit a full replacement of the hip joint.

After documenting your symptoms, your doctor will order imaging tests, beginning with an X-ray, to get a detailed image of your hip joint. He or she will be looking for changes to the bone, signs of narrowing of the joint space and the formation of bone spurs. In some cases, an MRI or a CT scan may be ordered as well.

Before focusing on hip replacement as a solution, we help our patients explore other options for dealing with the pain and lack of mobility. These include physical therapy, walking aids, cortisone shots or medications, and pain and/or anti-inflammatory medications. Some people try supplements like glucosamine and chondroitin for pain relief. These and any other nutritional or herbal supplements should always be reported to your physician to guard against possible drug interactions.

Hip replacement surgery takes about one to two hours to perform. An orthopedic surgeon removes the diseased and damaged bone and cartilage and an artificial hip is implanted in its place. A prosthetic socket is implanted into the pelvic bone, and a prosthetic ball replaces the rounded top of the femur. Patients are often surprised when they're asked to sit up and even take a few steps with a walker the day after surgery, which is to deal with the increased risk of blood clots.

After the surgery, patients must work with a physical therapist to rehabilitate the hip. They are given stretching, flexing and strengthening exercises, which they must continue to do on their own to assure the best recovery and results. They must also watch for potential complications like blood clots, infection, dislocation and a discrepancy in leg length.

Full recovery after hip replacement surgery takes three to six months. For the best chance of success, be scrupulous about rehab, and don't try to do too much.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)

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