Five Things I Learned Leading Up to My Total Hip Replacement
By Betsy Miller
Hi, I’m Betsy Miller. I’m the author of The Parents’ Guide to Hip Dysplasia and an IHDI Advisory Committee member. I was diagnosed with bilateral hip dysplasia (DDH) in infancy. When I was a baby I was treated with traction, closed reductions, a cast, and a brace, none of which I remember.
I do want to let you know that I’m not a doctor. I’m writing this based on my personal experience. If you’re looking for medical guidance for your own hip dysplasia treatment, you should see an orthopedist who is experienced in treating hips.
It wasn’t until I was 56 that I had hip surgery as an adult—a total hip replacement on my left side. Here are some things I discovered along the way that might help others who have hip dysplasia.
1. When I Was a Baby My Hips Were Fixed, But Not Completely
I grew up knowing that I had DDH and that my hips had been fixed. As an adult, I experienced hip pain in my late 30’s, so I went to see an orthopedist who specialized in hips. That’s when I found out that I have residual hip dysplasia, which came as a shock. My hip sockets are shallow, and I have quite a lot of femoral anteversion (the tops of my thigh bones are at an odd angle). My doctor said my hip pain was due to inflammation.
This situation can happen even for people who are treated in early childhood. I am pretty sure that both of my hips were dislocated at birth. The treatment that I got was essential and made a huge positive difference throughout my childhood, in which I was happy and unaffected by hip trouble.
As an adult in my late 30’s, my doctor said I still had a lot of cartilage in my hip joints—which was a good thing. I didn’t have any labral tears—also a good thing. With hip dysplasia, the hip joint cartilage tends to wear out faster than otherwise would be the case, and there’s an increased risk of tears in the labrum—a rim of cartilage that surrounds the hip joint.
2. Taking It Easy Helped My Hips
My doctor and I talked about ways to tweak my lifestyle. I needed to avoid high-impact activities and pay attention to how much standing and walking I did on hard surfaces. I looked for ways to exercise that were easier on my hips, like using a stationary bicycle.
We also talked about pain management options and hip surgeries—PAO and THR. Since my left hip was more severe than my right hip, the doctor’s best guess was that my left hip would last 5-15 years, and my right hip would last longer than the left. He said it wasn’t possible to predict exactly how things would go because each person with hip dysplasia is unique. Still, he let me know that I had time to figure out what would work for me. I didn’t need to rush into surgery.
3. A PAO Would Have Been Difficult with My Bone Structure
PAO (peri-acetabular osteotomy) is surgery in which an orthopedic doctor cuts the hip bone and realigns the hip joint. For certain people with hip dysplasia, having this surgery before their cartilage wears out can be beneficial and make it less likely that a total hip replacement will be needed.
I had plenty of cartilage, and I was young enough to have a PAO, but the way my hip joints fit together presented an extra challenge. Realigning the hip socket side would not have been enough. The angle of my thigh bone would also have had to be adjusted. (My orthopedist described this as “congruency issues.” )
At that time, PAO was a less established surgery and fewer doctors performed it than is the case today. My doctor didn’t do PAO surgeries himself, but he was willing to refer me for a consult with a doctor outside of my medical group if I wanted to learn more.
4. Quality of Life Affects When to Have Surgery
I decided to wait and see. At first, that was a scary choice. I had connected to online hip dysplasia support groups where many people who had PAO surgery posted about how it helped them.
I was worried that I’d miss the window of opportunity for a PAO and then my cartilage would wear out and I’d immediately need a THR. At the same time, I was learning that there are different degrees of hip dysplasia, and what helps some people may not apply to everyone.
Fortunately, within six months, my lifestyle changes were working—my hips were much better. Once my hips had calmed down, I could do pretty much everything I wanted to in daily life. I’m a technical writer, so I didn’t have to do a lot of standing or walking at my job. I could walk up to three miles on a soft trail—not every day, but I could still go for a hike on the weekend if I wanted. I could walk about a mile on hard surfaces like sidewalks.
For these reasons, I opted not to pursue a PAO even though I knew that meant I’d likely need total hip replacement surgery at some point in the future.
5. There May Be Special Considerations for THR If You Have Hip Dysplasia
When I seriously started looking in to getting a THR, my left hip had been pretty bad for about a year and a half. My left hip was painful most of the time, with flare-ups and caused me to always keep an eye out for a place to sit down if I needed to. This was limiting my mobility. My right hip didn’t bother me at all because I wasn’t standing or walking enough for it to reach the point where it hurt.
I had my hips x-rayed, which showed bone changes on my left side even though I still had cartilage in my joint space. I made appointments to be seen by a couple of different orthopedists. (I had moved to a different city and by now my original doctor had retired.)
I chose a doctor who had lot of experience with hip replacement surgeries, including for people with hip dysplasia. Before the surgery, he ordered cat scans of my hips in addition to the x-rays. My surgery would be more complicated than someone without DDH. He estimated that my operation would take 20 minutes longer than it would if I didn’t have hip dysplasia.
I was happy that my doctor was able to use an anterior approach (from the front versus the back) for my hip replacement surgery. The recovery time for an anterior approach is typically shorter. Getting a hip replaced is major surgery, and it does take time to recover from it. I’m glad I got the surgery. It was the right time, and it improved my quality of life. It’s now 18 months after my THR, and I’m still having some trouble with a tendon in the front of my left hip, so I’m currently working with a physical therapist to see if it can be resolved.
Author: Betsy Miller
Betsy Miller is the author of many of the articles on the IHDI website and the book The Parents’ Guide to Hip Dysplasia, along with several other children’s health books. Miller was treated for hip dysplasia when she was a baby (bilateral closed reduction) and recently had a hip replacement. She has been active in the IHDI since the year that it was founded.
Author site https://betsymillerbooks.weebly.com/