Ask the Expert: Dr. Mark Figgie, Orthopedic Surgeon, Answers Your Questions on the Benefits and Risks of Hip Replacement Surgery
by Dr. Mark 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.
Comments
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?
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
Interesting. For sure you really made a great work on the research plus the effort that you have made.
We’re glad you found this interesting. Thanks so much!
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.?
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.
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.
Thanks for your comment, Robert. We’ll share with Dr. Figgie. Glad to hear you’re doing well.
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.
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.