Find out if Total Hip Replacement is right for you

Hi. I’m Dr. Dan Lieberman, the medical director at Best Practice Health. I will be your guide through this interaction. Everyone is different, and this stuff can be complicated. But for all practical purposes, total hip replacement is one of the greatest things modern medicine has to offer. Finding out if total hip replacement is right for you by completing the interactive is worth your effort. Please let me know if you have any questions or comments.

One of the risks of total hip replacement is the implant wearing out and having to be replaced. Since you are over 65 years old your expected lifetime risk of needing to have your implant replaced is less than 4%.

One of the risks of total hip replacement is the implant wearing out and having to be replaced. Your risk of implant failure over your lifetime is around 8%. That means there around there is around a 92% chance you will not need another surgery for your hip.

No one is too young for total hip replacement; however, the risk of the implant needed to be replaced is higher due to your young age. Your surgeon will work with you to exhaust all other options before entering into total hip replacement.

Hip implants are made of metal. Your surgeon will obtain testing to see if there is an implant available to which you are not allergic.

Given your input, your Body Mass Index (BMI) is :

IF you are over 18, have no red flags, and have had hip pain for more than 3 weeks despite rest, ice, and anti-inflammatory medications then an x-ray of your hip may be your next step. Ask your doctor for a prescription.
Dan Lieberman, MD

If you have any infection in your body at the time of surgery, or you have impaired immunity such that you have a prior surgical site infection, then you are at higher-than-normal risk of developing an infection with total hip replacement. Your surgeon will discuss the risk of surgery as well as any clearance you may require this with you.
Dan Lieberman, MD

Total hip replacement surgery is usually done under a spinal anesthetic that does not require you to go to sleep. However, any surgery has a risk of making a pre-existing heart problem worse. If you have a heart issue, then your surgeon will likely request you undergo risk stratification by a cardiologist before considering total hip replacement. You may also be required to have surgery in the hospital and not an ambulatory surgery center.
Dan Lieberman, MD

Any surgery that requires anesthesia has a risk of making a pre-existing lung problem worse. If you have a heart issue, then risk stratification by a cardiologist is appropriate before considering total hip replacement.
Dan Lieberman, MD

During surgery anesthetic agents are cleared from your body by your kidneys. If your kidneys are unable to properly clear the anesthetic, then you are at risk of a complication.
Dan Lieberman, MD

Poorly controlled diabetes dramatically increases your risk of a surgical site infection with any surgery, including total hip replacement. Your surgeon will work with you, your primary care doctor, and possibly involve an endocrinologist to get your diabetes under control before moving on to total hip replacement surgery.
Dan Lieberman, MD

First, let’s talk about you...

Which hip hurts?

Left

Right

Both

Since your current pain began, how many weeks has your hip hurt?

Less than 6

6-12

Greater than 12

Do you mind if we ask how old you are?

Age

What is your BMI? Let's see. Enter your weight and height:

Lbs:

Feet:

In:

Do you have a known allergy to any metals?

No, I don’t have any known allergies to any metals.

Yes, I have known allergies to one or more metals.

What does your X-ray say? (look at the written report)

Need help interpreting your x-ray?

I haven’t had a recent x-ray

Normal

Mild or moderate Arthritis (1 or 2)

Moderate, severe, or marked arthritis (grade 3 or 4)

Hypoplasia (birth defect)

If you had an MRI check the report for...

Need help interpreting your MRI report?

I didn’t have an MRI

Hypoplasia

Osteonecrosis or Aavascular necrosis

Labral tear

Select any of these treatments you’ve already tried:

None

Physical therapy

Injection

Medications

Not Available.

Past Medical History

Have you had a recent bodily infection, or history of surgical site infection?

Do you have any heart problems for which you see a cardiologist?

Do you have any lung problems that require home oxygen, or are you a smoker?

Are you or have you ever been diagnosed with kidney (renal) failure?

Are you diabetic?

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You should do 3 weeks of physical therapy before considering an MRI—studies show worse results if you get imaging at this point. If you are not better after 3 weeks of therapy, then (6 weeks since the pan began) you should get an MRI and referral to a board-certified anesthesiologist or physiatrist with subspecialty certification and specialization in pain management. They will do a medial branch block and radiofrequency ablation as appropriate. Don’t let anyone talk you into epidural injection; that is not what you need.

You should do 3 weeks of physical therapy before considering an MRI—studies show worse results if you get imaging at this point. If you are not better after 3 weeks of therapy, then (6 weeks since the pan began) you should get an MRI. We can help you find a board-certified anesthesiologist or physiatrist with subspecialty certification and specialization in pain management who doesn’t over-prescribe dangerous narcotics.

They will offer you medial branch block and epidural injection. Those don’t really work for this problem. Your options are (off label) intradiscal injection of stem cell-derived growth factors, denervation with the relevant procedure, and then referral to a spine surgeon for interbody fusion if those fail.

You need an MRI now and referral to a spine surgeon for possible laminectomy decompression surgery. We can help you find one who is board-certified and specializes in minimally invasive surgery.

You need an MRI now and referral to a board-certified anesthesiologist or physiatrist with subspecialty certification and specialization in pain management. Don’t go to one that prescribes a lot of narcotics, they may get you killed. If you’re not better after 3 epidural injection you will be referred at 12 weeks to a spine surgeon to consider microdiscectomy. Note that you DO NOT need radiofrequency ablation; so, don’t let anyone talk you into a medial branch block.

This stuff can be confusing. Don’t sweat it. We’ve got you. Your MRI came with a report by a radiologist which describes the findings. If you don’t have a copy of your report, you can get one from the imaging center where the x-ray was taken. The doctor who prescribed the MRI has a copy as well. Find the section labeled Impression. First, under the impression, look for the word normal. If you see something like “Normal MRI of the hip then you are done. You do not need to check anything.

Next, search the impression section for the words osteonecrosis or avascular necrosis. If you see either one in the report, then ignore the rest of the report and check the osteonecrosis box. If neither of those is in the report, ignore the rest for now and continue.

This stuff can be confusing. Don’t sweat it. We’ve got you. Your x-ray came with a report by a radiologist which describes the findings. If you don’t have a copy of your report, you can get one from the imaging center where the x-ray was taken. The doctor who prescribed the x-ray has a copy as well. Find the section labeled Impression.

First, under the impression, look for the word normal. If you see something like “Normal x-ray of the hip then you are done. Check the box normal. Next, search the impression section for the word hypoplasia. If you see hypoplasia in the report then ignore the rest, and check the hypoplasia box.

If you are still going, then look for the word arthritis. The radiologist should have given the arthritis a grade from 1 to 4. If you see arthritis in the impression section but there is no grade, then look at the rest of the report for a grade 1,2,3 or 4 and check the appropriate box. If there’s no grade then you have every right to call the imaging center and ask them to have the radiologist to do their job and redo the report with a grade.

Not all orthopedic surgeons are the same. You deserve the best. That means a surgeon who is

Board certified in orthopedic surgery
Fellowship trained in joint replacement surgery
Always uses a minimally invasive approach
Operates in an ambulatory surgery center or hospital with lower-than-average complications
Uses registry proven implants

In my experience less than 10% of orthopedic surgeons meet all five of these criteria. That means if you go to the surgeon you’ve been seeing, or the one recommended by friends or family, there’s a 90% chance you will not be getting the best.

At Phoenix Spine and Joint we make it our business to know the best. Call us for help finding the best surgeon near you who takes your insurance and is accepting new patients.

If you have any of the following red flags you need to see a doctor NOW!

History of cancer, unexplained weight loss, passing blood
Pain is so severe you can’t walk
Also having fever, shakes, chills
Numbness or weakness

Radiculopathy. This condition is most often due to herniated disc, but can also be caused by bone spurs, or compression of nerve roots as they leave the spinal canal. The traditional treatment is to confirm the herniation or compression by MRI, followed by a trial of epidural injection, with microdiscectomy or laminectomy surgery if all else fails.

Enter below and we will email or text you more information about how to get rid of your radiculopathy due to herniated disc.

Facet syndrome. Your low back pain is most consistent with arthritis. Look for confirmation on your x-ray and MRI reports with discussion about “arthritis.” The traditional treatment is radiofrequency ablation done by a pain management physician.

Enter below and we will email or text you more information about how to get rid of your low back pain due to arthritis.

Discogenic low back pain due to an annular tear. Sorry, this is the least common and the hardest to treat. Traditionally, the recommended procedure is fusion; however, that does not always work and causes adjacent level issues. More recently a denervation procedure was approved called the Intercept procedure from Relievant. Some doctors recommend injection, The two options are stem cell-derived growth factors, and ozone.

Enter below and we will email or text you more information about how to get rid of your discogenic low back pain.

Interactive 3 Minute Hip Pain Assessment

Find out if Total Hip Replacement is right for you

First, let’s talk about you...

Which hip hurts?

Since your current pain began, how many weeks has your hip hurt?

Do you mind if we ask how old you are?

What is your BMI? Let's see. Enter your weight and height:

Do you have a known allergy to any metals?

What does your X-ray say? (look at the written report)

If you had an MRI check the report for...

Select any of these treatments you’ve already tried:

Past Medical History

First, let’s talk about you...

Past Medical History

Symptoms

Stiffness

Pain

Function, daily living

Function, sports and recreational activities

Quality of Life

Instructions

Pain

Function, daily living