Marc Darrow, MD, JD
Over the years, we have seen too many patients who had a hip replacement or other “elective” surgery that did not go as planned. Since the time I became involved in surgery in 1989, I have seen more bad outcomes than I care to remember. And let me make it clear that I respect surgeons for the difficult and complex work that they do. To me, they are the masters of medicine. Not many of us are willing to bear such standards and responsibilities. However, I must say that in my humble opinion, most elective surgeries should not be done for arthritis. The risks are just too high. Medicine can offer many options for hip pain relief beyond drugs and medications, AND, hip surgery for many people. There are situations however, when a hip is “too far gone,” and the patient will need a hip replacement.
The replacement surgery may not be as successful as we think
Many people get great results from hip replacement, some get good results. So with that in mind, doctors may be anxious to recommend hip replacement. But are the surgeries that successful? A recent study (1) discussed the “increasing numbers of systematic reviews on total knee arthroplasty and total hip arthroplasty (which) have been published in recent years, but their quality has been unclear.” What the researchers said were unclear were the study outcomes: “Clinicians should be judicious when applying the conclusions of the systematic reviews results to their own patients.” The surgery may not be as successful as we think.
The feeling is that when traditional pain-relief treatments and pain medications have run their course and no longer relieve hip pain, hip replacement or arthroscopic surgery is readily available as options to the patients. There is an expectation that surgery fixes everything and improves general overall health and physical well-being and most importantly provides pain relief. There is a lot of expectation. Yet other research says these expectations are not met, and this is clearly cause for concern as post-surgical medications use and drugs for pain relief may be needed after surgery.
Presenting alternatives to hip replacement surgery is an important function in the patient–doctor relationship, as suggested in this recent study published in The Journal of the American Academy of Orthopaedic Surgeons: (2)
“Arthroscopic surgery is commonly performed in the knee, shoulder, elbow, and hip. However, the role it plays in the management of osteoarthritis is controversial. Routine arthroscopic management of osteoarthritis was once common, but this practice has been recently scrutinized. Although some believe that there is no role for arthroscopic treatment in the management of osteoarthritis, it may be appropriate and beneficial in certain situations. The clinical success of such treatment may be rooted in appropriate patient selection and adherence to a specific surgical technique. Arthroscopy may serve as an effective and less invasive option than traditional methods of managing osteoarthritis.”
In other words, as controversial and unproven as arthroscopic surgery is, it may still be better than hip replacement. Far better than both as a first option, in my opinion, are the biomedicine treatments including Bone Marrow Aspirate and Platelet-Rich Plasma (PRP) Therapy. These are non-surgical options for pain relief.
Why some patients need to continue opioids six months after knee or hip replacement
In a July 2023 retrospective analysis of 10,140 consecutive patients (3) undergoing primary total hip replacement postponed total joint replacement revealed a higher 90-day revision rate, surgical complications, internal complications and transfusion rate than on-time total joint replacement. Delay in elective primary total joint replacement correlates with higher revision and complication rates.
Continued use of painkillers following surgery, in the case of the above study, for a minimum of three years after the surgery does give the appearance of a successful hip replacement surgery.
Balance Remains Impaired after Hip Replacement
A March 2022 study (4) examined the hoped for positive effects of hip replacement on patient balance. Overall, the evidence found suggested that balance is impaired immediately after surgery and, 4-12 months after surgery, it becomes better than preoperatively, although without reaching the level of healthy subjects. A strong level of evidence was found for hip resurfacing resulting in better balance restoration than total hip replacement, and for strength and ROM exercises after surgery positively influencing balance.
Do patients have side-effects or do they think they have side-effects.
A 2020 study (5) suggested that people who report side-effects after their hip replacement surgery or prone to have worse surgical outcomes. That is not the point of this study. This suggestion is is that patients who report side effects have worse outcomes whether they actually have side-effects that can be confirmed by standard medical record review methods or they think they are having side-effects. “The observed negative trends suggest that patient perception of adverse effects may influence patient outcome in a similar way to those with confirmed adverse effects.” In other words if you are not happy with the surgery, you will have a bad follow up.
The gluteus medius tendon and weakened muscles
A December 2024 study (6) wrote that while patient satisfaction is high and functional ability improves after total hip replacement, residual impairment and pain are common. Degenerative changes in tendons and muscles are probable causes. The researchers suggest degeneration in the gluteus medius tendon and muscle strength in the muscles acting around the hip in patients with hip osteoarthritis, before and after total hip replacement is occurring. Pre and post-surgery muscle strengthening exercises should be explored.
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While hip osteoarthritis can cause severe pain, conservative care or regenerative medicine can help many people with disability, pain and loss of function.
In our practice, bone marrow aspirate or bone marrow derived Stem Cell Therapy is a treatment for musculoskeletal disorders. We treat degenerative joint disease, degenerative disc disease of the spine, and tendon and ligament injury. With over 27 years of experience, Dr. Marc Darrow and his team are pioneers in regenerative treatments, offering expert insights and personalized care tailored to your needs.
Schedule a free phone consultation today and receive our exclusive Regenerative Medicine Stem Cell & PRP Quick Start Guide —a digital resource packed with:
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Other articles
References
1 Wu X, Sun H, Zhou X, Wang J, Li J. Quality assessment of systematic reviews on total hip or knee arthroplasty using mod-AMSTAR. BMC medical research methodology. 2018 Dec;18:1-0.
2 Pitta M, Davis W, Argintar EH. Arthroscopic Management of Osteoarthritis. J Am Acad Orthop Surg. 2016 Feb;24(2):74-82. doi: 10.5435/JAAOS-D-14-00258.
3 Holzapfel DE, Meyer M, Thieme M, Pagano S, von Kunow F, Weber M. Delay of total joint replacement is associated with a higher 90-day revision rate and increased postoperative complications. Archives of Orthopaedic and Trauma Surgery. 2023 Jul;143(7):3957-64.
4 Di Laura Frattura G, Bordoni V, Feltri P, Fusco A, Candrian C, Filardo G. Balance remains impaired after hip arthroplasty: a systematic review and best evidence synthesis. Diagnostics. 2022 Mar 11;12(3):684.
5 Carpenter CV, Wylde V, Moore AJ, Sayers A, Blom AW, Whitehouse MR. Perceived occurrence of an adverse event affects patient-reported outcomes after total hip replacement. BMC Musculoskeletal Disorders. 2020 Dec;21:1-8.
6 Juhlin J, Sernert N, Åhlund K. Pre-operative gluteus medius tendon degeneration and its impact on strength and functional ability one year after total hip replacement. Annals of Medicine. 2024 Dec 31;56(1):2388701.
