Total Hip Replacement Question & Answer

The purpose of this blog is to answer the 10 most common questions that I get related to my hip replacement and hip replacements in general.

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About Me

If you’re new to the website, my name is Marc Surdyka. I’m a physical therapist and I had my right hip replaced in 2009 when I was 19-years-old because I developed a condition known as avascular necrosis, which is essentially bone tissue death due to a lack of blood supply. This was likely caused by long-term corticosteroid use that was part of the medical treatment for when I had cancer as a teenager. So, not only do I understand what you’re going through based on my education and working with people like you over the years, but I’d like to think that I’ve walked a mile in a very similar pair of shoes.

These are the 10 most common questions that I get related to my hip replacement and hip replacements in general that I’m going to answer:

1. How is my hip doing after 13 years?
2. What’s the best surgical approach and materials to use for the implant?
3. Should I see a physical therapist after the surgery?
4. Do I have to follow the post-surgical precautions forever?
5. What stretches can I do to improve my range of motion?
6. What exercises should I avoid?
7. Can I go back to running, high-impact activities, and contact sports?
8. What’s the best way to maximize the lifespan of my total hip replacement?
9. Do I worry about having to get a revision?
10. Can I have a normal sex life?

Quick Disclaimer

As a quick disclaimer, this blog is NOT a substitute for a consultation with a medical professional. It also doesn’t supersede, or take the place of, any information already provided to you by your doctor or physical therapist. With that out of the way, let’s get into the questions!

Question #1 – How is my hip doing after 13 years?

Well, I’m able to sit in a deep squat, lift weights, and play pickleball without any issues. 

My normal routine consists of walking my dogs several miles per day, riding my bicycle 30 minutes per day for commuting purposes, going to the gym 5-6 days per week, and doing the occasional outdoor activity on the weekends.

My range of motion, strength, muscle mass, symptoms, and overall function are as good as they’ve ever been, and my recent check-up showed that everything looks good, so I’m happy with my progress thus far. 

Question #2 – What’s the best surgical approach and materials to use for the implant?

I’m going to keep this answer really simple. There are pros and cons for the different approaches and materials used, but your most important decision is picking an experienced surgeon who you trust. 

This is their area of expertise and your surgeon is going to choose the best options for you to increase the likelihood of success in the short and long-term because your success is their success. Just like you, they want a positive outcome. 

For context, because people often ask, my surgeon used a posterior approach and I have an uncemented, metal-on-metal implant, which is very uncommon nowadays. Also, the exact model used was actually recalled 2 years after the operation. 

I bring this up for 2 reasons:

1. People see me doing well and want to know how they can recreate that for themselves. My advice is to not compare yourself to me. You shouldn’t try to choose your approach and implant based on how I’m doing. 
2. If you’ve already had the surgery, make the best of what you have and only worry about things that are within your control. Like I said, my prosthetic components, the ones still in my body, were recalled. But there’s nothing I can do about that, so I don’t worry about it. 

And just for clarification, just because the components were recalled, doesn’t mean they’re completely defective. The risk of getting a revision far exceeds the risk of keeping what I have.

Question #3 – Should I see a physical therapist after the surgery?

Yes. This is where I disagree with some surgeons, but I think most would agree with what I’m about to say.

Some surgeons do not recommend post-operative rehab because there’s research to suggest that, on average, it doesn’t significantly alter long-term outcomes in a specific set of the population. My issue with the interpretation of this research is that it gets generalized to the entire population even though it doesn’t account for all ages, lifestyles, goals, etc. Let me provide four, real patient examples to better explain my point of view.

Example #1 was a man in his 60s who saw me prior to his surgery. Despite his surgeon stating that he did not need to see a physical therapist before or after the surgery, he did not feel comfortable with this recommendation because he was anxious about the situation.

His main goal was to return to doing some of the smaller hikes in Los Angeles. So what did I do as his physical therapist? I provided reassurance, answered all of his questions, provided general rehab principles that he could follow, and gave him some basic exercises that he could do after the surgery.

What happened in the end? I never saw him again, but he emailed me a few months later saying that he was back doing the things he wanted to do and was thankful for that one visit.

Example #2 was another man in his 60s who saw me after his surgery. He was a very active individual who wanted to hike, swim, bike, row, and get back into the gym to do exercises like kettlebell swings. I probably saw him once a week initially, then once every 2 weeks, and then once a month until he was 6 months out doing everything he wanted to do. Once again, I think the guidance and reassurance allowed him to feel confident with his current function and future capabilities. 

Example #3 was a woman in her 50s who reached out 2 years after her total hip replacement because she wasn’t content with her current level of function. After creating a plan that involved meeting and updating exercises once per month, she’s stronger, fitter, and healthier than before.

Example #4 is me! There was no resource for me to read or watch to inform what I should do as a 19-year-old former athlete. 

If those surgeons I mentioned envision physical therapy after a total hip replacement as going to an office to perform some basic exercises 2-3 times per week for a few months, I completely agree with them that not everyone needs this type of care. However, I do think a customized approach for every patient is helpful. As you read from my examples, that might mean a single visit prior to surgery or monthly follow-ups at some point after the surgery.

Question #4 – Do I have to follow the post-surgical precautions forever?

Absolutely not.

Precautions are not always provided because they are dependent on the preference of the surgeon, but when they are provided, make sure to discuss the end date for those precautions with your surgeon. There is no reason you should be fearful of dislocating your hip 6 months out while squatting or doing simple day-to-day tasks. This is actually a good example of how seeing a physical therapist for one visit to ease some of your concerns can be helpful.

Question #5 – What stretches can I do to improve my range of motion?

This is a very common question. Obviously. But I get asked about it a lot from people who are only a few weeks out from surgery. 

My advice is to focus on other aspects of your function, like your strength and walking tolerance. Although the surgery is quite successful and only leaves a relatively small scar, it’s still an invasive operation that requires a significant amount of internal healing that’s not visible to our eyes. 

Early on after the surgery, your range of motion will improve naturally as healing progresses and symptoms subside. If you’re forcing your hip into aggravating positions with the intention of improving your range of motion, you might actually be delaying the process a bit.

In the long run, your hip range of motion will likely be better than what it was immediately prior to the surgery. Mine definitely is. But you probably won’t be doing the splits. And that’s a good thing. The technology is improving for people to have more range of motion, but there still needs to be a limit to that range of motion so the joint remains stable.

Question #6 – What exercises should I avoid?

I don’t think there’s any exercises that inherently need to be avoided by everyone. Instead, it’s about finding exercises and a routine that work well for you.

For example, I’ve learned that I don’t respond well to squatting or deadlifting with a barbell because if I try to push myself reasonably hard, I’m limited by pain in my hip as opposed to fatigue in my muscles. Therefore, I’ve opted for alternatives like split squats and dumbbell RDLs that accomplish similar goals without the discomfort in my hip.

It’s important to know that there are no special exercises that need to be done for building muscle, improving strength, or losing weight. You can do bodyweight movements, use machines, or even lift with the barbell if it’s comfortable for you. I just want you to create a positive experience with the exercises you’re performing instead of using a “no pain, no gain” mentality.

Similarly, I use a higher repetition range, usually 8 or more, for movements that involve direct weightbearing of my hip because it’s more tolerable for me. For my purposes of getting stronger, building muscle, and being healthier, I don’t need to max out or push my limits if it means flaring up my hip. It’s taken me awhile, but I’ve set my ego aside.

If you don’t know where to start, find someone who can help you. The benefits of being active far exceed any potential risks. At the very least, regularly walking is one of the best things you can do for yourself.

Question #7 – Can I go back to running, high-impact activities, and contact sports?

Can you do these things? Yes. Here’s a list of some activities I’ve done over the years: basketball, soccer, flag football, tennis, volleyball, ultimate frisbee, skydiving, wrestling, boxing, and much more. And there’s people who have had the surgery competing in professional sports. Frankie Edgar, who is 40-years-old, fought in a high-ranked UFC fight 6-7 months after he had his hip replacement. 

What you actually want to know though is – “Should you go back to doing these things?” That’s a more complicated question to answer.

Although surgeons are becoming more relaxed with their recommendations because the technology is improving, I know that some still advise avoiding or minimizing these activities. 

On the other hand, I’ve heard some physical therapists recommend just doing what you want because the purpose of the surgery is to give you a second chance. 

I fall somewhere in the middle. I think you need to make an informed decision after considering the potential benefits and risks.

The woman in her 50s that I talked about likes to go skiing. The way that she skis is pretty low impact and not too strenuous on the hip. If she happens to have a bad fall and breaks her pelvis or hip, the risk of complications is greater because she has a hip replacement. However, that small risk is worth it for her to do one of her favorite activities.

The professional fighter has chosen to compete 2 more times because it’s his livelihood, he enjoys it, and wants to prove to himself that he can before he retires.

So, is there a risk of immediate injury if you’re engaging in contact sports or activities with the potential for falls? Yes. That’s true whether you have a hip replacement or not, but if you get injured, the consequences are likely more severe. 

Is there the possibility of needing a revision sooner if you decide to run marathons on a regular basis for the next 5-10 years? Yes, but there’s no way for us to quantify or calculate the exact risk.

When I was in my early 20s, the joy of playing sports and feeling a sense of normalcy far outweighed the potential risk of reducing the longevity of my implant. You might feel the same way. No one else can make that decision for you.

I do want to highlight two things:

1. I never threw caution to the wind or purposefully engaged in activities that I knew would cause me significant pain. 
2. Despite playing sports, I personally changed my lifestyle and identity, which is not easy, by accepting that I was no longer a competitive athlete.

Now that I’m in my 30s, I’m happy walking, hiking, cycling, lifting weights, and playing a sport like pickleball that doesn’t require as much running, cutting, or jumping.

So, just to reiterate..

Can you return to running, high-impact activities, and contact sports? Most likely, after working through a comprehensive rehab program tailored to your specific needs and goals. 

Should you? That’s highly individualized based on your own risk-reward ratio. It might be worth risking a shorter implant lifespan if you’re a marathon runner who lives to run, but that risk might not be worth it if you’re a recreational runner who doesn’t mind switching to another form of exercise like cycling.

Question #8 – What’s the best way to maximize the lifespan of my total hip replacement?

Aside from taking everything I’ve already discussed into consideration, you just want to live a healthier lifestyle – not smoking, drinking in moderation, exercising regularly, eating nutritious foods and maintaining a healthy weight, getting adequate sleep, not engaging in overly risky activities, etc. All of the things that you probably already know. 

The better you take care of yourself as a whole, the better off your hip will be, especially during critical periods of healing like immediately after the initial surgery or after a revision. The risk of infections and other complications is lower in people who are generally healthier.

Question #9 – Do I worry about having to get a revision?

Honestly, I don’t. 

Since I had my hip replaced at the age of 19, I’ve known that a revision is inevitable. Assuming that I live into my 70s or 80s, it’s unrealistic for me to expect the implant to last 50 or 60 years. It’s possible that I’ll need multiple revisions.

However, as I mentioned earlier, I try not to worry about things that are out of my control. I’ve accepted this hand that I was dealt. I obviously want the initial surgery to last as long as possible and I’m doing all of the things I just talked about to improve my overall health and hopefully maximize the lifespan of my hip, but it doesn’t benefit me to stress about it.

Question #10 – Can I have a normal sex life?

Yes. 

Maaaybe you’ll have some limitations depending on your role and the positions you partake in, but unless you’re trying to get into the splits, put your heels over your head, or do some other extreme ranges of motion, you shouldn’t feel too restricted.

I think I’ve had a normal sex life, but my opinion doesn’t matter as much as my wife’s, so let’s she what she thinks…