Excruciating hip pain isn't just confined to elderly grandparents as these three can testify...Sunday, March 19th, 2017, 2:49 pm
Former Top Gear star Jeremy Clarkson needs his doing. Fitness queen Jane Fonda had one replaced – and still goes mountain climbing.
Even pop diva Lady Gaga, known for her outlandish outfits, had to cancel a string of tour dates due to problems with hers. I’m talking about hips.
And these celebrities – whose ages range from 29 to 77 – are not alone.
Nearly 90,000 Britons undergo an operation each year to replace one or both hips with an artificial joint.
And numbers continue to rise every year, especially in those under 60. Whatever its cause, the crippling pain of dodgy hips makes life miserable. And as a consultant surgeon who has performed more than 1,000 of these procedures in the past five years, I know all too well just how transformative it is.
Yet so often people put off having it. Of course, surgery is never the first line treatment. But it also shouldn’t be feared, even by those who are young.
And, with the right attitude and a hefty dose of self-care, the joy of life after hip replacement will make the agony and immobility of the years that preceded it a distant memory.
If you’re heading for a new hip, or expect to be soon, here we separate the fact from the fiction…
OUCH! WHY DOES MY HIP HURT?
The vast majority of hip pain is caused by osteoarthritis, which is responsible for nine out of ten hip replacements.
The condition causes cartilage – the spongy tissue that cushions joints – to deteriorate so the bones rub together, causing pain and reduced movement.
Oestoarthritis is age-related but, as I said, hip problems are not just the preserve of the elderly, and it’s not uncommon for me to operate on patients in their 40s, 30s or younger. The youngest person I’ve operated on was just 17.
One reason is that we are getting better at spotting conditions earlier, such as dysplastic hips, an abnormality in the shape of the hip joint from birth.
Also, patients these days are less likely to suffer in silence compared to the 1960s when the procedure was pioneered, and so seek help at a younger age.
Other causes of hip problems include a fracture from a fall or an infection of the joint, such as septic arthritis.
If you feel a burning sensation in the side of your hip, it could be bursitis, an inflammation and swelling of a bursa, a fluid-filled sac which acts as a cushion between the tendons and bones.
Paracetamol, ibuprofen and ice packs should ease pain and swelling, but see your GP if pain persists after two weeks.
GETTING BETTER IS UP TO YOU
A hip replacement is given to reduce pain or problems with everyday activities. It’s a miraculous medical achievement, with potentially incredible results.
But if your pain is mild to moderate, and X-rays are showing the damage is not too great, then you may be better off taking painkillers and using a mobility aid, such as a walking stick, to increase stability.
Try this for six months. If symptoms improve, then great, you’ve avoided surgery. If on the other hand you see no improvement, then we go down the surgery route. You certainly aren’t going to be at a disadvantage by delaying surgery for a few months or even a couple of years as the progression of the disease is usually so slow.
But more than anything, I want you to stop thinking it’s all up to your doctor to fix.
It’s disappointing when I operate on patients who are very overweight or are smokers, and who’ve failed to take the advice to turn their lifestyle around. These are the ones who are harming their chances of successful operation and won’t bounce back as quickly.
Exercise and a good diet is key to success. I operated on a woman of 104 because she kept herself in good shape with regular walking and gardening. The operation was a resounding success.
Exercise – at least two hours a week – helps to strengthen the muscles that support your joints and weight loss can make all the difference and even prevent the need for surgery in the first place.
Stick to half-hour sessions of low-impact, non-weightbearing cardiovascular exercise three times a week, such as cycling, swimming or using the cross trainer at the gym.
Running and aerobics are a no-no (sorry Jane Fonda) as constantly landing on the hip joint can make matters worse. You want to be out of breath, not flat out.
Diet, too, plays a big part, as the obesity crisis facing the NHS is impacting on hip replacements. A nine-year study of 2,100 people revealed obese patients had a fourfold incidence of infection, and twice as many dislocations after a hip replacement compared to people of a healthy weight.
HOW GOOD IS MY SURGEON?
For many people, the pain might be too much to bear. So surgery is the best option.
Your first port of call will be your GP, who will refer you to a musculoskeletal clinic for further assessment. If a hip replacement is deemed necessary, you’ll be referred to a hospital where you will meet an orthopaedic surgeon.
Many hospitals now run ‘hip schools’. If they do, go to one. These are short courses designed to give patients a chance to meet staff who will be caring for them and talk through the operation and recovery period. You’ll also get a chance to meet people who have already had a hip replacement to find out how they coped with it.
One question everyone asks is: ‘Who is the best man for the job?’
The good news is there are thousands and almost all of us work for the NHS. The National Joint Register has a database of more than 2,000 orthopaedic surgeons in England.
Each surgeon has a profile that lists where they work and how many hip replacements they have performed in the last three years, and gives information on the type of hip replacement used.
The profile also gives details of death rates within 90 days of the surgery being performed and how that compares with the national average.
Ask your surgeon questions before your operation if you aren’t getting the information you want. Yes, this can be a scary prospect. But this is your body! I promise, we won’t be offended – any good doctor will want you to feel confident.
If you are not satisfied with your surgeon, you can return to your GP and ask to be referred to someone else.
GETTING READY FOR THE BIG DAY
Ideally, you shouldn’t wait more than 18 weeks between referral time and having your operation.
Get yourself in the best shape you can beforehand to help speed up recovery time: that means the kind of exercise I’ve mentioned above, and stopping smoking, as nicotine restricts blood flow and interferes with wound healing.
We know that patients do lie about their smoking habits. I have this to say to them: please quit before the operation. If you don’t, you’re very likely to suffer complications, meaning continued pain and more immobility.
The whole procedure, done under general or spinal anaesthetic, usually lasts an hour and a half.
As with any surgical procedure, there is a small risk of complication, such as heart attack, stroke or blood clots, but overall the risks involved in joint replacement surgery are very low.
Other rare problems include dislocation, fracture and nerve damage, but the benefits far outweigh the risks. Your surgeon will explain all of these risks before you sign a surgery consent form.
PREPARATION IS KEY TO RECOVERY
Ten years ago, it was common for patients to stay in hospital for up to ten days after a hip replacement. Now we aim for five days maximum – and some can people even leave on the same day.
Expect pain, but it will feel different. I’ve had patients crying tears of joy when they come round after surgery because although they can feel soreness associated with the surgery, that underlying pain triggered by moving is gone.
Prepare by having everything you need on the same floor within easy reach, such as your computer, phone and so on. Have a friend or relative to help around the house when you get home.
You might need a raised toilet seat to make going to the loo easier, and get a chair with arm rests so you can get in and out of it easily.
Six weeks is about the amount of time you’ll need to get back to your old self. Before that, there should be no work, driving, swimming (or baths) or long-haul flights.
HOW LONG WILL MY NEW HIP LAST?
Over time, some implants wear out, become loose and occasionally break. Signs the joint has become loose include pain or a feeling that it is unstable, and you may need a further operation.
Look after it and you and your new hip will be together for years to come. You should expect it to last for at least 15 years.
Don’t wrap yourself up in cotton wool, but stick to activities that won’t put your new hip under undue pressure.
Sudden, jerky movement or twisting your hip could put undue stress on the joint. l Zameer Shah is a consultant orthopaedic and trauma surgeon at Guy’s & St. Thomas’ Hospital NHS Trust and a senior honorary clinical lecturer at Kings College London.
For more information on hip pain, please click here.
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