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Hip Pain. Total Hip Replacement at Age 44. Protocol & Recovery.

For those landing here after a Google search for “total hip replacement”, this is for you: a "guide" of sorts. Our goal is to educate and demystify the surgical process, especially for younger, active, patients. 
  • Patient Age: 44
  • Health going into surgery: Excellent. Daily Bikram yoga practice, lift weights 1-2x a week; and ride a stationary bicycle each day. Thin. Strong upper body. 
  • When did pain start: 10 years ago.
  • Why wait? In the 12 months leading up to surgery, pain became significantly worse and range of motion increasingly limited. Sleep was disrupted; achy pain in legs every day; walking became painful; often limped. The mental space the pain was taking up became too large, and quality of life was an issue. Pain maintenance became a challenge and very time consuming.
  • Pain management in 3 months before surgery: 1 or 2 Advil each day was enough. Also took a supplement proven to help with with arthritic joint pain. Sometimes NyQuil at night to sleep "harder."
  • Other forms of therapy before surgery: Chiropractic care, massage, ART (Active Release Technique) and acupuncture.  Early on, chiropractic care helped with hip alignment issues, and it provided significant pain relief. Later ART helped with ongoing pain management and range of motion preservation via targeted stretches and foam rolling. Acupuncture had no effect. 
  • Diagnostic Process: X-rays from 6 years prior provided a base of comparison for new X-rays.  New X-rays revealed significant degenerative changes and the possibility of Avascular Necrosis (AVN). An MRI was ordered as well as a CT Scan with contrast. Keep in mind that the radiologist will note everything. This does not mean it is the diagnosis, but rather the possible "set" of scenarios. 
  • Bottom Line:  No Avascular Necrosis; torn labrums; multiple cysts. Left hip worse.  Severe osteoarthritis, “hips of a 80 to 90 year old.” Part of cause was genetic, "shallow acetabulums", a cause of hip dysplasia. Total hip replacement is only curative option. Cysts are common in situations of severe arthritis. Don't panic at the initial findings.
  • Surgical Plan: Replace worse hip now and the other later. "Later" ended up being 3 months later.
  • Implant Materials: Ceramic head with polyethylene liner; titanium post. These were the recommended materials. Keep in mind that sometimes a different head may be chosen based on weight. This site gives you a decent rundown of the various materials. Your surgeon should be up on the latest research and have clear reasons for the recommended implant materials. 

  • Method: Posterior, minimally invasive, which means they did NOT cut the muscle.  Recovery time is proven to be as fast or faster than the “new” anterior approach. Bottom line is that the surgeon prefers this method.  In his words “he’s very good” at it. Agree. The press on the anterior approach can be misleading. Often the recovery time comparisons are NOT to the "less invasive" approach. Be careful when researching. Much information is "marketing" driven. Ask questions. 
  • Anesthesia: Spinal block with local anesthesia. NO general. Highly recommend this approach. There is research that suggests avoiding general anesthesia is better for your health and recovery.  (The article is a MUST read if you are contemplating hip or knee surgery.) Local feels good going in (via IV), and you are awake immediately after surgery. Avoiding general means no throat tube, shivering, nausea, etc.  The shot in the spine for the block is not painful. The spinal block numbing lasts 3 hours; plenty of time for surgery. The benefit of being awake fast is that you can get up and around. Yes, after surgery, expect to get up that same day. It lessens the risk of blood clots and promotes healing. An epidural takes longer to wear off versus the local and spinal combo. 


  • Picking the Surgeon. Do your homework. Talk to someone who is similar to you in terms of age, medical situation and activity level and who has used the surgeon. Scott T Ball was the surgeon selected, and his staff, especially his Senior Physician Assistant, Dustyn Severns, exceeded expectations with respect to knowledge and responsiveness. 
  • Pay Attention to the Team. Do NOT underestimate the value of the team. While the surgeon may do "the deed", keep in mind that you will have appointments and ongoing care from the Team. If you are kept waiting for an unreasonable amount of time; your calls are not returned; you have to wait days to get a reply; scheduling appointments is a challenge; questions are not answered directly...These are all symptoms to a problem.  The UCSD Department of Orthopaedic Surgery gained my confidence with promptness, access and knowledge.  Email was our primary form of communication, which meant very little phone tag. Phone calls are an annoyance. The UCSD team was up on research, new methods, and always straightforward with answers.  After surgery, Dr. Ball was available and made sure certain things happened such as immediate physical therapy and catheter removal. Important. Your surgeon is your advocate and "power broker" in the hospital. Without this advocate, the hospital stay would have been longer, catheter left in, and little movement day of surgery...not to mention sharing a room with three others!
  • Hospital: It does matter. I experienced two hospitals and there were some pretty big hiccups at one of them. BUT, again the top quality surgical team stepped in when most needed to solve problems. The hospital stay was one night and this was by choice and enough.  Check in was at 7:30am and release was the next day was around 4p.  The point is that with such a short “stay”, handling some  “bumps” isn't too hard. More often the hospital stay is two nights; but it does not have to be.
  • Get Moving: I was up and using the bathroom within hours after surgery. The same day of surgery I practiced stairs with a Physical Therapist. Moving promotes healing and lessens the risk of a blood clot. A walker was used while in the hospital. 
  • Insurance: Get it sorted out ahead of time.  The surgeon selected was out-of-network while the hospital was in-network. This combination under a HealthNet PPO meant TWO deductibles and TWO out-of-pocket maximums to satisfy. While this situation is not ideal, I felt very strongly about the choice of surgeon. Looking back, I would not do it differently.  
  • Assistance:  A walker was used while in the hospital. At home, after the first replacement, a cane was enough. Stairs were not a problem. While I used a hospital-issued "granny cane", companies like Top & Derby make stylish ones (see image left)!! For the second surgery, crutches were necessary for two weeks, because of a hairline fracture that occurred during surgery. The crutches were a safety precaution and I used them religiously for 2 weeks.
  • Challenges: Sitting on the toilet and getting in/out of bed were the most challenging. (Accept the raised toilet seat. Most hospitals provide them. It helps.) These challenges lost their intensity after 2 weeks.  In terms of the cane/crutches, there was some negotiation with respect to the duration of using the crutches. Two weeks and then a check-in was our agreement. Typically the first check up after hip replacement surgery is 4 weeks. (This 2-week check-in speaks to the flexibility of the surgical team.) After the first surgery, I saw a doctor after 2 weeks to get approval to return to Bikram Yoga. It was important to ensure that the surgical incision was healing as expected. Precautions were taken for all activities. (Bikram Yoga is not a "flowing" practice and is easily modified for safety.)
  • Activity Level: Within 2-3 days after both surgeries, i was on a stationary bicycle. The resistance was minimal and the time spent in the saddle short (10 minutes building to 30 minutes by the end of week 1). Despite long naps and lots of "horizontal time", I was still on my feet a lot (more than recommended). Even with crutches, I was likely on my feet 6+ hours a day. Ankle swelling was the result. 
  • Recovery Pain:  Pain is expected and each day it will be different. Pain thresholds are individual and the amount of drugs taken will dictate how much pain is felt. After 2 weeks, the pain decreases and by 4 weeks it's a whole new game.
  • Drug Regimen: Understanding exactly what is being prescribed, and why, is important and will help you take control of the recovery process.  For example: I was prescribed: Celebrex, Oxycontin, Oxycodone, and Xralto. Celebrex is not covered by my insurance plan, but is one of the only anti-inflammatories that is safe with a blood thinner (Xralto). I decided to skip it.  The blood thinner is important to prevent clotting and is a non-negotiable. The narcotics are helpful, but the amount prescribed was extreme. For example, 60 tablets of Oxycontin were prescribed with a recommended dosage of one tablet every 12 hours. So that is a month's supply. I only needed ONE week’s supply…14 tablets. However, insurance coverage is per drug name ($70+ co-pay for the drug whether 5 tablets for 50). The same method applies to the quicker acting Oxycodone. My objective was to get off the narcotics and rely solely on Tylenol as soon as possible.
  • Getting Off the Drugs: I stopped the daytime Oxy 3 days after surgery and nighttime Oxy, about 7-10 days after surgery. By week 2, I was taking the blood thinner (Xralto) and Tylenol only. 
  • Driving:  Getting off of the narcotics is a prerequisite to driving. I was driving within one week post both surgeries. However, I limited my range significantly for the right side. Getting in and out of a car will be a challenge for the first two weeks. Expect leg cramping. Even sitting in a normal "office" chair was a challenge in terms of comfort. Give it a solid month.
  • The “tipping point” is when the new hip feels better than the old. 4-5 weeks
  • Notice mobility improvement at 4-5 weeks
  • After both surgeries, massage helped loosen everything up. I had massages at 2 weeks post surgery. Using a foam roller is also helpful to loosen the IT band.
  • Started PT about 1 month post surgery. Do it. And do the exercises at home. Just do it. There is only upside.
  • 8 weeks: Hips are not on the mind. Mentally, it is a night/day difference. Leg "crampies" going away.
  • If both hips are bad, you will start to itch for another replacement at about 8 weeks. Because the light at the end of the pain tunnel shines brightly.  
  • 12 weeks: Strength and endurance are greatly improved. Range of motion now only limited in groin area. Balance on one leg still not as good as before. Thoughts about hips and pain...pretty much ZERO.


Hip replacements are known to be less complicated than knee replacements and the success rate higher. I am thankful that my "issue" could be corrected. At almost 3 months post second surgery, it's a whole new world. My range of motion is now better than before surgery and I have no pain. I walk better; I can finally kick a soccer ball; and do so many other things that had required modification or Advil. One of the best parts about being pain free is that I am not thinking about the pain and spending the time managing it. It is truly freeing. 

Good luck.

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44 year old female.

44 year old female.  Competitive Athlete.  Personal Trainer.  First arthroscopic surgery 2010, labral debridement.  Instant relief.  Lasted until 2016.  Symptoms returned without catching.  2016:  x rays and MRI revealed hip dysplasia (not enough to warrant Ganz osteotomy), total labral degeneration.  Labral reconstruction (with cadaver tissue), microfracture, and reshaping of the femoral neck performed fall 2016.  Non weight bearing for 2 months.  Told total recovery would be a year.  Religiously went to PT for an entire year.  Had worse hip pain post surgery and continuing until now.  Increased in severity in 2019.  Walking with a limp all the time now.  New MRI and X-rays confirm extreme arthritic changes and possible avascular necrosis.  Replacement appears to be only option.  Fearful as last surgery left me worse off than before.  Anyone have similar challenges out there?

WOW! What a journey. My THR

WOW! What a journey. My THR seems like a breeze compared to what you've gone through. Even your non-replacement recovery seemed more strict and prohibitive. Keep in mind that after 2 new hips...I was skiing 4 months later. Never had the non-weight bearing restriciton. I wish I had more medical knowledge to comment on your path, but seems that a replacement early on would have saved you pain and heartachte. HOWEVER, need to rule out AVN first. That condition was suspected in my case and ruled out, thankfully. Good luck.

The answer depends upon what

The answer depends upon what is meant by "recovery".  I was skiing in February -- about 3 1/2 months after surgery. Skiing with no issues. So I think "recovery" can be in 4-6 months for many people. Being in good health prior to surgery will speed recovery -- and this is the case for ANY surgery. In fact, we just read that for those who are in poor physical shape, pending surgery has proven to be the ONE motivator that has worked!

Just wanted to say thank you

Just wanted to say thank you for posting this blog about your experience!  I too just had right hip replacement surgery with Dr. Ball and agree, he's great.  I appreciated being able to lean into your experience, when I talk with friends who have had the surgery it is helpful but never too specific, I appreciated that about your blog.   It's only been one week out and so far things have been going well. I am also off the oxycodone during the day, pain is manageable with tylenol.  Using just one crutch to get around.  I am a swimmer so it'll be a few weeks before I am back in the pool but looking forward to it.  Thank you again for taking the time to post about your experience! 

So happy it helped! And glad

So happy it helped! And glad you hear that your experience thus far is a positve one. Feel free to reach out to us via email :) 

A few years ago, when I

A few years ago, when I consulted an orthopedic doctor as a lifelong 43-year-old athlete and adventure traveler, I assumed the relentless pain in my left hip was a flare-up of the bursitis that had plagued me throughout my collegiate soccer career. When the x-rays showed advanced, bone-on-bone arthritis and I was told by the doctor that total joint replacement was inevitable, I was devastated.  

Shock and denial gradually gave way to acceptance, but I still struggled - emotionally - with committing to the surgery. Then came the day I was frozen with pain simply standing up from a chair.  For the first time in the many long months of powering through, I broke down. The cumulative, yet somehow sudden, realization of the compromised quality of life I had been enduring caught up with me and it became clear - a moment the doctor assured me would come - that it was time. I went for a second opinion and scheduled the surgery that week. The only regret I have is not having done it sooner.  

Over the course of my recovery, it struck me that, despite the obvious challenges, this life-altering experience had surprisingly been defined far more by positivity and empowerment than by anything else. It also struck me that there was not more of a celebratory flare surrounding being able to reclaim our lives - both mentally and physically - like this.  (Naturally, I realize the journey is different for everyone and not all outcomes are equally successful or positive....) 

In my case (and I think I am in good company here), it was such an empowering experience, despite the initial fear and disappointment of needing to have it done, that I developed a line of celebratory novelty products for 'bionic' orthopedic patients (called Officially Bionic) in the wake of my experience. I am hoping to build a community of positivity around it, in addition to offering a line of fun products. Kind of a "Welcome to the Bionic Club!" feel.  Check out the site at your leisure -

Naturally, I am sharing partly to introduce Officially Bionic but, more importantly, to send the message that you are not alone and this can be such a positive experience that you are inspired to become an advocate of sorts, in whatever form that may take.  Stay strong, positive and look at this as a new lease on life!

All the best,
Jennifer Jakubowski

Founder, Officially Bionic

48 year old male. I had a hip

48 year old male. I had a hip resurfacing back in 2011.  The surgeon said it was a new procedure so had no long term outcome data to provide me.  He said it would be good for me to hold off the total hip replacement as long as i could.  The resurfacing bought me about 7 years but ultimately i did have the replacement surgery on 1/15/19.  My surgery was at 7:30 in the morning, took about 1.5 hours.  I was discharged that same day at 6:45 pm. Recovery went very well in the beginning. I'm 5'10, 150 pounds. At week 4 i noticed a plateau in my recovery, and now at week 5 i'm limping more than i have this whole recovery. I have no pain, its more of a weakness or instability feeling. My PT says when i come in to the sessions my pelvis if off by at least an inch each time. I feel discouraged because its been over 5 weeks and i still require a cane when out in public. My follow up with the surgeon is ealy March so I hope he can put my mind at ease.  Anyone else have great 3 week recovery, then backslide?

Ugh. Your story is concering.

Ugh. Your story is concering. Sounds like your PT is saying it's an alignment issue? If so, we'd hope strengthening the muscles in that area and core could stabilize. You are still quite early in recovery too. We know athletes that are back to their sport but encounter balance issues for months... Also, we have read about others complaining of a limp post replacement.  Here's an example of a thread:   Hope this helps. 

The Team.

Hi, Thanks for very useful

Hi, Thanks for very useful blog post.  I am 44 years old. Have had 2 Hip orthoscopes in past 6 years - left in Aug 2012 and right in June 2014 (hip impingement, parabal cysts, labral tears and synctovitis plus arthritis).  Have played a lot of football, running, gym work etc.  Can no longer play even 5 -aside or run due to pain in left hip / groin.  Have decided to bite bullet and am due to go for left hip surgery this Thursday.  I am becoming increasingly nervous.  Whilst i have constant stiffness, grade 4 arthritis in left hip and a limited range of movement, I can do most things i need to do and whilst i am now walking with a stiffened gait and limp, I am in overall good health and do weights based training (mostly upper body) 3 to 5 times a week.  I dont carry much weight and am in decent enough shape.  I am just worried that after surgery, I may be in more pain and discomfort than I am currently.  

Having read this, it appears to get up and mobile as soon as possible and do the proper re-hab.  I would love to get back to playing recreational football and even back to 10k running in time.  What is a realixtic timeframe for this?  I have also been told that there is a risk of 'squeaking' from the new joint but is this a real concern or highly unlikely?  I am nervous which is understandable at this point but hopefully I can see the benefits.  Any comments be appreciated. Thanks


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