Ask the Expert: Dr. Mark Figgie, Orthopedic Surgeon, Answers Your Questions on the Benefits and Risks of Hip Replacement Surgery

by Dr. Mark Figgie
Dr. Figgie

Q1. What are some of the biggest mistakes patients make when starting physical therapy after total hip replacement?
One of the biggest mistakes patients make is that they try to do too much too soon and then get too sore to exercise. Usually, we recommend walking as the best form of exercise in the early postoperative period.

Q2. I heard my recovery time will be shorter if I undergo a mini anterior hip replacement surgery instead of the more traditional posterior method. Is that true, and is the mini surgery an alternative for anyone who has to have their hip replaced?
The studies show that the difference in recovery for a mini-anterior hip incision and a mini-posterior incision is minimal after the first three days. Not everyone is a candidate for the anterior approach and there are pros and cons regarding the anterior approach that should be discussed with your physician.

Q3. I have osteoarthritis in both hips and was wondering if it’s possible to undergo a double hip replacement or if the procedures need to occur separately.
It is possible to have both hips done the same day, but not everyone is able to do this. We have strict criteria for patients considering bilateral hip replacement, and they need to be cleared by a cardiologist and anesthesiologist before surgery.

Q4. My mother is 82, and her doctor has recommended total hip replacement. She’s generally in good health otherwise. What are the risks and alternatives to her having surgery?
The major risks for surgery are infection, dislocation, blood clot, and leg length discrepancy. Healthy patients should tolerate surgery in spite of their age, especially when the surgery is performed with regional anesthesia. HSS has one of the lowest infection risks in the country. Alternatives to surgery include medications or injections which can mask the pain but not cure the arthritis.

Q5. What are the alternatives to hip replacement surgery? Are there some cases where replacement surgery is the only option?
Alternatives to surgery include medications or injections which can mask the pain but not cure the arthritis. Physical therapy is usually not helpful in late stage arthritis. Arthroscopic procedures may be helpful in impingement and labral tears but usually don’t help with arthritis. Often, hip replacement is the best option for improvement in quality of life for the patient.

Dr. Mark P. Figgie is an orthopedic surgeon at Hospital for Special Surgery and Chief of the Surgical Arthritis Service. He is one of the leading experts in joint replacement for inflammatory arthritis and performs more than 500 surgeries a year. His training in engineering and biomechanics has helped him become instrumental in the design of implants for elbows, knees, and hips, including the design of custom implants.

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The information provided in this blog by HSS and our affiliated physicians is for general informational and educational purposes, and should not be considered medical advice for any individual problem you may have. This information is not a substitute for the professional judgment of a qualified health care provider who is familiar with the unique facts about your condition and medical history. You should always consult your health care provider prior to starting any new treatment, or terminating or changing any ongoing treatment. Every post on this blog is the opinion of the author and may not reflect the official position of HSS. Please contact us if we can be helpful in answering any questions or to arrange for a visit or consult.

Comments

Josie Ong Yiu says:

Dear dr. Mark Figgie, I had bilateral hip replacement both done in LA, I live in the Philippines. My latest one was a revision of my left hip done in 2008 by Dr. William Long of Dorr Arthitis Insitute. I now have pain in left buttocks and groin which started 3 weeks ago, I took Arcoxia 120mg once a day with Dolcet(tramadol) one table 3 times a day for one week, but the pain only lessened, took another pain medication with myonal (muscle relaxant) and neurontin 300mg one capsule 3 times a day. I went to see my physiatrist and neurologist , they said it”s Sciatica. I am now undergoing physical therapy which include lumbar traction, physis and cryotherapy. What do you think is this pain?

HSS on the Move says:

Dr. Figgie says, “Sciatica is an inflammation of the sciatic nerve – it may be unrelated to the hip surgery and could be caused by a herniated disc in the back. You might get an MRI of your back and follow up with the neurologist.” If you would like to come see a physician here at HSS, click through to our International Center at http://www.hss.edu/international-center.asp

12BET says:

Interesting. For sure you really made a great work on the research plus the effort that you have made.

HSS on the Move says:

We’re glad you found this interesting. Thanks so much!

Thomas j DUNLEAVY says:

My brother has severe osteoarthritis of his hip. he has just been cleared of MSCR infection. How soon can he have hip replacement surgery. I am doing fine. Did your son make Med school.Brotherblives in florida and is a real medical novice.Thaanks, Tom
PS can you recommend good sureons in northern fl.?

HSS on the Move says:

Hi Tom, We’re sorry to hear about your brother’s troubles. We reached out to one of our physicians, but unfortunately without more information about your brother’s medical history and an examination, he can’t make a judgment on when he should have surgery. He should discuss his concerns about timing with a physician. For assistance please contact our Physician Referral Service at +1.877.606.1555 or https://www.hss.edu/secure/prs-appointment-request.asp?pageid=6463. To locate a physician in Florida, go to the American Academy of Orthopedic Surgeon’s website – http://www7.aaos.org/member/directory/directory.aspx. Wishing your brother the best.

Robert kuzianik says:

It would be too great a task finding the proper words to thank you for my new knees. Not only can I walk, I can run. I”ve moved to the top of my class-b level paddleball. The pain that lives in my body has now moved to my elbow. I thank God that I am alive at the same time that people like you, Dylan, u2 are. I consider myself blessed. Thank you, Dr. Mark P. Figgie.

HSS on the Move says:

Thanks for your comment, Robert. We’ll share with Dr. Figgie. Glad to hear you’re doing well.

Jack Gilman says:

I may need a hip replacement, but I was rejected already by one surgeon because I have psoriasis. He felt it was too high a risk factor to do the surgery.

I would like to know if this will prevent my getting a replacement.

HSS on the Move says:

Dear Jack, Thanks for reaching out. Orthopedic surgeon Dr. Charles Cornell says, “Psoriasis is generally not a real risk factor. If there are active lesions in the region of the incision we might pretreat them with UV light or try a short course of Enbrel to help the lesions resolve first. We operate and perform total hip replacement on many patients with psoriasis without a real increase risk of infection.” Please consult with your physician about this and any other concerns. If you’d like to make an appointment with an HSS physician, please contact our Physician Referral Service at +1.877.606.1555 or https://www.hss.edu/secure/prs-appointment-request.asp?pageid=6463.

gloria blatt says:

I have a painful knee, that has to be replaced/

I have lymphedema in that leg, and it is quite swollen.
What are my chances of getting a knee replacement
in that leg successfully?

HSS on the Move says:

Hi Gloria, sorry to hear you”re in pain. It would be best to consult with a physician in-person to determine appropriate treatment. If you’d like to make an appointment with an HSS physician, please contact the Physician Referral Service at +1.877.606.1555 or https://www.hss.edu/secure/prs-appointment-request.asp?pageid=6463

Billy says:

I’ve been diagnosed with a complex rotator cuff tear. Specifically, the MRI showed: “1. Complete tear with approximately 3.8 cm retraction of the supraspinatus tendon with moderate atrophy of the supraspinatus muscle. 2. Near complete tear of the anterior and mid fibers of the infraspinatus tendon in the background of severe tendinosis and moderate atrophy of the infraspinatus muscle. 3. Mild to moderate tendinosis of the superior fibers of the intact subscapularis tendon. 4. Moderate tendinosis of the intact intra-articular portion of the long head of the biceps tendon.”

The tear likely stems from a head on collision just over two years ago. The surgeon who examined me and reviewed the MRI report felt that I should have the surgery immediately – as in yesterday. Although I’m not in any pain currently (I have had two relapses since the accident and there is reduced strength in the affected arm), he felt that the longer I wait, the more chance that the major tear could not be repaired or that it wouldn’t hold and could result in a re-tear. I guess because of the muscle attrophy, he was worried it could receed more and not respond well to surgery.

Here’s the question – since surgery would put me out of commission (I use my arms for work), how detrimental is it to wait until the end of March for surgery? He’d like to do it middle of November (first availability), but if I wait until March, my schedule is about 9 million times free-er and its just easier for me. But my fear is waiting could lead to a higher degree of irreparable damage….although I also think since it’s been over 2 years, what is 4 months. Thoughts?

HSS on the Move says:

Hi Billy, thank you for your question. Dr. Lawrence Gulotta, Orthopedic Surgeon, says: “Rotator cuff tears can be difficult to treat since two patients with similar MRI findings may have very different symptoms and require very different treatments. It is difficult to assess and offer advice without interviewing, examining and reviewing images for a given patient, hence it is difficult for me to directly answer your question.

In general, most rotator cuff tears do not heal with time. In fact, most get bigger the longer you wait. The bigger the tear is, and the more retracted and atrophied it is, the more difficult it is to repair. If a patient is relatively active, and uses their arms for recreation or employment, then it is generally accepted that early repair offers the best chance to have the most normal shoulder possible. Once the tear becomes chronic (such as over two years, as in your case), then I spend a lot of time with my patients trying to determine what their main complaint is – whether it be pain or loss of strength. In chronic situations, rotator cuff repair surgery is very effective at alleviating pain, but less effective at improving strength. If pain is the main complaint, then I think most patients are very happy with the results of surgery and I would recommend proceeding with it. If weakness is the main complaint, then I would offer surgery only to those patients who are relatively young and have little arthritis on their x-rays, and little rotator cuff atrophy on their MRI.” If you are interested in receiving care at HSS, please call our Physician Referral Service at 877-606-1555.

john smith says:

i am confuse i dont know if i should do anterior or posterior hip replacement.im 6ft3inches tall and 239 pounds my thigh is thin and not musular.which is better for long term with less longterm restrictions.i was told that anterio you cant horse back riding .I was told they dont cut the back muscles only split the back muscles when they told the posterio please repply

HSS on the Move says:

Hi John, thanks for reaching out. To learn more information about anterior and posterior hip replacements, visit http://www.hss.edu/conditions_anterior-hip-replacement-overview.asp (anterior) and http://www.hss.edu/professional-conditions_posterior-soft-tissue-repair-primary-total-hip-arthroplasty.asp (posterior). It is best to consult with your treating physician in order to help decide on the best course of treatment.

Robert McDermott says:

I had my right hip resurfaced in 2007. I never got full strength back and two years later was back to walking with a limp and living in pain and discomford. My hip fells almost as bad as it did before I had the surgery. I want to have revision surgery, but I am afraid to go through that again and not get better results.

HSS on the Move says:

Hi Robert, thank you for your question. Dr. Mark Figgie, Orthopedic Surgeon, says: “There are several reasons why you could have weakness and pain after a surface replacement. Your hip should be carefully evaluated to determine why you are having problems in order to ensure the proper course of treatment. Revision surgery can be successful in many situations but may not be the answer in every situation.” It is best to consult with your treating physician. If you are interested in receiving care at HSS, please reach out to our Physician Referral Service at 877-606-1555 for assistance.

Jackie says:

I had a total hip in 1997. Over the last month my hip has started squeaking. With it also comes pain and I can feel the hip shifting freely. I had a ct scan and it was determined the liner in the cup is gone. 2 questions 1. Where did it go and 2. How is this fixed?

HSS on the Move says:

Hi Jackie, thank you for reaching out. It is best that you consult a physician in-person. If you are interested in receiving care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.

John Venhous says:

Just discovered a hard growth at the outside bottom of the L/tebia at the juncture with the ankle. It was not there a week ago. No pain or redness. Any idea what it is. I will set up a visit to my Doctor ASAP.

HSS on the Move says:

Hi John, thank you for reaching out. Dr. Joseph Lane, Orthopedic Surgeon, says: “It is most likely benign and could be a benign ganglion. I suggest an MRI with STIR to examine the mass. The test should resolve any of your issues.” It is best to consult with your treating physician. If you are interested in receiving care at HSS, please call our Physician Referral Service at 877-606-1555 for further assistance.

samantha says:

I need to have total hip replacement and I was looking up on the anterior approach which seems good except I have substantial hip muscle atrophy? so my question is can this proceedure still be down on atrophied muscles?? thank you

HSS on the Move says:

Hi Samantha, thank you for reaching out. According to Dr. Michael Alexiades, Orthopedic Surgeon, “it is possible that it can be done.” It is best to consult with your treating physician. If you are interested in receiving care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.

JoAnne says:

I am 47 years old. I was born without a hip socket. Dr. Arthur Michele did the surgery. He used a piece of my pelvis to graph the bone. I later had surgery because the leg was an inch shorter. I was 10 years old. He put in a plate and pins? Removed them a year later. My leg is a half inch shorter and my pelvis is twisted. I’m 5’1 on the left, 5’2 on the right. I work out everyday with weights, maintain a healthy weight. 120lbs. I can’t really do a lot of walking, sitting or standing anymore, although my legs are strong. I’m also flat footed. My hip is in the front of my pelvis and swells, my knee bothers me and my ankle. I really don’t want to have a hip replacement for this reason. How will I feel afterwards. I’ve been living in this position my whole life. Will It hurt more to be in alignment and will it cause nerve damage? I’m not the typical hip replacement I know that. It’s a chance I’m scared to take…and I don’t want to end up in so much pain someday with out doing anything about it either. My husband had a total knee replacement in 2010, it was done wrong and had to be replaced again in 2011. I do not want that to be me. He’s only 49 now and he can’t do any of the things he used to. I’ve always put up with the pain, I have a high threshold for it. I’ve tried to find people my age with this but haven’t been successful. I know there has to be adults like me somewhere. I don’t want to lose my freedom. I have great muscle tone so when I did see a doctor he said to me you look great. LOL Well thanks but I don’t feel great. My hip isn’t in the same place as regular people so the pain isn’t where other’s have it, and I have strength I just don’t know what I should do. Everyone tells me I will never get an appointment at HSS unless I’m referred by another doctor and have a current MRI I will not go to any doctor. I hope to hear from you. I don’t know where else to turn.

HSS on the Move says:

Hi Joanne, thank you for reaching out. We are happy to assist you in making an appointment at HSS. Please contact our Physician Referral Service at 877-606-1555 for further assistance.

david says:

Sirs or doc i had two orthoscopic knee surgerys both in a 6month period my first sergery i had discmennicus tear and my second i had laterial superfied tear i also have arthoaritis in my knee im still haveing lot of knee pains my knee gives out on me it sensitive to the touch when i walk it hurts when i try to twist my body i sends a really sharp pain down my leg it hurts when i bend it it fills like its going numb im 36 years old am i gona have to kneed tottal knee replacement something has to be done i cant run and do stuff lime that kno more because it hurts so much

HSS on the Move says:

Hi David, it is best to consult with your treating physician who is familiar with your medical history and course of treatment. If you wish to receive care at HSS, please call our Physician Referral Service at 877-606-1555.

Linda Martin says:

I had total knee replacem ent surgery five years ago. I am 65 years old and I would like to use a walking treadmill. Will it harm my knee replacement?

HSS on the Move says:

Hi Linda, thank you for reaching out. It is best for you to consult with your treating physician for a better diagnosis. If you wish to receive care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.

akbar ali shaik says:

Doctor, good morning ,
my wife has to undergo total knee replacement in May 2014 and now she was detected with osteoporosis. can he under the surgery or not
please reply sir, grateful to you

HSS on the Move says:

Hi Akbar, thank you for reaching out. Dr. Linda Russell, Rheumatologist, says: “Having osteoporosis generally does not preclude a joint replacement. It would be wise to normalize a low vitamin D level preoperatively. Medications to treat osteoporosis such as biphosphonates or teriparatide can be continued perioperatively i.e. through the surgical period.” It is best for your wife to consult with her treatin physician. If you are interested in care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.

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Hospital for Special Surgery
April 22, 2014 at 5:34 pm

Did you know that Electromyography (EMG) is a form of electrodiagnostic testing that is used to study nerve and muscle function? Dr. Joseph Feinberg, Physiatrist, says: “There are two parts to EMG testing: a nerve conduction study and a needle exam for muscle testing. Both may result in some discomfort, but are usually well tolerated without the need for medication beforehand. EMG testing usually takes anywhere from 30 to 90 minutes depending on the condition being tested and findings of the study.” For more information on EMG testing, visit http://www.hss.edu/conditions_emg-testing-a-patient-guide.asp.

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