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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. 
** 2021 Editors Note: The comments get updated often & present a resource of their own. Don't miss them.
  • 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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This was a good read. Not

This was a good read. I had my left hip replaced (direct anterior approach) 12 days ago and am having my right hip replaced in 2 days. I am still very stiff and very limited in range of motion in my left hip but was wanting to put them together closely so my recovery and PT was consolidated. I am 50 years old but surfed 5 days a week, skied 30 days per year and worked out religiously prior to this. I had FAI or cam impingements in both hips that accelerated the wear and tear. Looking forward to getting past the next surgery in a couple days and getting back to my active lifestyle in 2-3 months. Thanks for the info. I though the amount of stiffness and discomfort in my left hip after 12 days was abnormal but from what I read it is very common.

Wow. That is a short time

Wow. That is a short time-line for TWO surgeries. Who was your doctor? Any more hints about chooseing a surgeon would likely be helpful to others. Additionally, your post recovery drug protocol and what you used during surgery. It has been quite some time since this post was written and we care curious what advances have been made, if any?


posted here about a year ago, pre hip replacement.  it was a great help reading beforehand so i thought i would add to it for those who follow.

surgery 12/20

medicine prescribed post op:  baby aspirin 2x/day,   celecoxib (anti inflam) 2x/day,   pantoprazole (gi upset) 1x/day,    tylenol 650mg @6 hrs if needed,    oxycoden 5mg @4 hours

my meds regime: the first 3 i did for a month.   the tylenol i did 2/3X/day for a week then once a day, usually at bedtime, for 2 more weeks.   the oxy i used 3/4X/day for the first 2 days,  then 3X/day for another 2 weeks.  like the tylenol, the last one was just before bedtime. the last week or 2 the bedtime oxy was not really for pain.  the leg would spasm/twitch and keep me awake. the oxy would deaden the spasm. the surgeon switched me to cyclobenzaprine. i tried that for a couple of nights but it did nothing.

observations:  i was on the table at 8:15am and back in my house at 7pm. i recognised some of the tools on his table as stainless steel versions of ones from home depot, which i laughed at but some people might find concerning.  first night sleep isnt really sleep, more like falling into a haze, wake up, repeat.  try to stay ahead of the pain with the meds. im not a medicine taker, so i tried to stretch the oxy.  mistake.  the surgeons PA told me by day +2 all the painblocks will have worn off. he was correct. rest is your friend.  every day might be different. some days you will feel great so you will overdo your PT. some days you will feel like you got hit by a truck and struggle.  do the PT, its the only way forward  it gets easier every day.  i also started on the spin bike day+4 (3 minutes) with no resistance to help with regaining mobility.  about week 3 i was able to finally sleep on my side. doing that was like taking the first shower, it felt great. 

week 3-4 i was walking 3-5 miles a day and on the spin bike for 30mins.  remember i mentioned overdoing the PT?  this is where i did mine.  strained an adductor, groin pain through the thigh to the knee. pretty much shut down forward progress for about a month, very frustrating but its a journey. at 90 days recieved clearance for light soccer. from there it was only onward and upward.

Seems like a successful

Seems like a successful result. Our use of Oxy was far shorter at under 7 days and we were on the bike day 2 or 3. But very similar in terms of the "feel".

Yay, new life for you!!

Seems like a successful

Seems like a successful result. Our use of Oxy was far shorter at under 7 days and we were on the bike day 2 or 3. But very similar in terms of the "feel".

Yay, new life for you!!

In 2021, it was reported that

In 2021, it was reported that robotic assisted surgery is 5x more accurate in terms of matching leg length -- which is a critical factor in hip replacement surgery. As of now, most insurance carriers will NOT cover this process and it will likely add $2-$3k to any bill. 



I am so pleased I came across this.

I am a 44 year old female with hip dysplasia (only discovered at 33/34 years of age) and the past 10 years has been very difficult.  I hope I'm not going to bore you but I'll try and keep my story as short as possible!

I have always been very active and above average on sports.  I ran for the County at school but one sport in particular was riding and I competed and got instructor qualifications with others at a young age. Not long after I had two discs removed (L4 and L5) as they were badly damaged.  No one could fathom why they were degenerative.  I was told my 'heavy' work style and riding was over.  From a young age I had always felt a clicking and sometimes cramping/aching in my hips but not pain to make me think any more about it.

I started an office job, and increased my walking and got into road cycling.  Aching hips started to be more frequent but again, not painful and I was told that hips/spines are two of the areas that refer pain to one another so it was always put down to my spinal surgery.

At the age of 33/34 I suddenly started having such aching pain in my hips and down my legs, I just couldn't bear it.  No position could get me comfortable.  When I went to my doctor (a number of times) I was always advised it was my spine causing it and when I had an MRI on my spine there was no reason for the pain.  After going back and forth I finally went back to my spinal surgeon (who was an ex-para and very no nonsense) and he took me to the x-ray room and told me I had shallow hip sockets and that was the problem.  I was immediately sent to a hip specialist.

There was two thoughts from my initial consultations:  too young for replacements but perhaps too old for osteotomy's.  Finally, it was decided to try and keep my own bones and as I was slim and fit, osteotomy's on both sides, over a period of a few years, would be the best choice.

The first one was the hardest, I lost blood and had a transfusion and felt terrible for a while.  The second went better.  My hips did not get better and after a few years, it was discovered my Labrum on both sides had been torn considerably and signs of arthritus were creeping in.

18 months on, the pain in my pelvis, and the pain in my legs (with some added nerve pain from the osteotomy's) is excruciating and over the past 5 years, I'm ashamed to say that I have put on 5 stone.  I'm just under 6ft tall and it's quite evenly spread but I'm thoroughly fed up.  Walking and going on the turbo trainer is minimal as I just don't wish to aggravate them.

Having seen a surgeon (who I am very happy with) we have a plan to do a complete hip replacement on the right first (currently scheduled 12th April 2021), then remove the remaining metalwork in my pelvis/hip on the left side (the screws are in the way of making the socket bigger) and lastly, have the left hip totally replaced.

I'm writing all of this as I'm nervous.  I'm worried this is the last chance and what if it doesn't work?  What happenes next?  On one hand, I read stuff that says I can excercise (and believe me I want to exercise until I'm sick!) but then I read there's limitations and I need to adjust to a new way of life.

I know I'm not the youngest to have this done and  I definitely know I want the pain to stop.  I want to not have my hips as a main point of discussion or limitation in my life anymore so basically, reading the above has made me feel far more positive.  Thank you very much!

It's actually very theraputic writing this.  Thank you for reading it (if you have!)

Best wishes, Lorraine

Nervousness is part of the

Nervousness is part of the game. But channel it to exciting! Once I made the decisoin to pursue surgery, I became excited at the prospect of a night of sleep without 2-4x getting out of bed to be on a foam roller to ease discomfort...We now laugh at our home videos of "before" and the way I walked...or waddled. My first reaction to your moving story was that to me, (NOT a dr), that Xrays and surgery FIRST would have been a better path. But you're on a path now. Please reach out more if you need to -- can also email info @ athleticmindedtraveler . com -- Best to you!!!

Thank you so much for writing

Thank you so much for writing this blog! It gives the best information that I have found, and I also love to see others' comments and questions.

I am a 54 yr old professional figure skater who has always been extremely active (karate, obstacle courses, dancing, skiing, skating) but started having unmanagemable pain and limited range of movement 2+ yrs ago. Was diagnosed with dysplasia and will be getting a new left hip in 2 weeks! Hearing from my surgeon that there is hope for a pain-free, movement-filled future snapped me out of the mild depression that I had slumped into. Treating my surgery date like an athletic event, I have been preparing by getting back in shape and using mind/body relaxation techniques and visualization. It seems that athletes have an advantage by being trained in event preparation.

If you are interested in using mind/body relaxation techniques, I highly recommned the book Prepare for Surgery, Heal Faster by Peggy Huddleston 

I wish you all the best of health and fredom of movement!



Thank you for the book

Thank you for the book recommendation. We are BIG readers! Good luck!!


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