Chapter 6 – How Do You Know That You Need A Hip Replacement?

Chapter 6 – How Do You Know That You Need A Hip Replacement?

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How Do You Know That You Need A Hip Replacement?

Hip Pointers – This chapter discusses the following:

“Because as we know, there are known knowns; there are things we know we know. We also know there are known unknowns; that is to say we know there are some things we do not know. But there are also unknown unknowns — the ones we don’t know we don’t know.”
Donald Rumsfeld

That Rumsfeld quote may seem confusing, but it is not as confusing as the self-assessment I went through trying to figure out why my hip hurt so much and why it hurt all the time. I will share with you what I did right and what I did wrong in eventually ending up with having my hip replaced (I did more wrong than right).

I Am Going To Bet… – If you have read this far, odds are that you need your hip replaced (psychic, remember). Just to be sure though, you are probably asking what are the…

10 Potential Symptoms That You Might Require A Hip Replacement

True Indicators – Shakira is right: your hips don’t lie. Here is a list of the top 10 indicators that you need your hip replaced. The more you have, the more you need your hip replaced:

• Getting Older? The older you get, the worse your hip pain becomes.
• Hip Pain And Flexibility Loss – You can feel your hip and femur grind across each other. Your hip becomes less limber and more stiff, causing normal daily activities to become more challenging and take longer and longer to complete. These activities can include: walking, bending over to pick something up, tying your shoelaces, clipping or painting your toenails, or even pulling your pants up.
• Groin Pull And Muscular Pain – You have muscular pain in your buttocks, thigh, knee, groin area, and in your hip. Your hip feels like a groin pull, but has lasted longer than two months. Your hip pain is dull and aching, and is usually constant but may be intermittent.
• Diagnosis Uncertain – Your hip hurts, but you are not sure why it does. You have problems sleeping and wake up at night when you are turning in bed. It gets hard to go from sitting to standing.
• Social Degradation – Your interpersonal interactions worsen due to your pain. (I know, I know, it is hard to believe that my interpersonal skills could get any worse.)
• Ineffective Nonsurgical Treatments – Your hip pain is not relieved trying various nonsurgical techniques such as stretching, chiropractic treatment, or by using over-the-counter pain relievers.
• Time Doesn’t Heal – Your hip doesn’t get better. Damaged cartilage can’t heal on its own.
• Loss Of Functional Mobility And Gait Abnormalities – Your hip pain causes you to limp. Rising from a sitting position becomes more difficult and takes longer and longer to achieve. You are moving more slowly than you should.
• You Speak More Slowly – Pain begins to compete with mental fortitude and you find yourself over-concentrating on speaking.
• Flamingo Pose – If you transfer all your weight to your good leg to relieve pain when standing, you are ready for hip surgery (just imagine the ‘Karate Kid’ pose).

A detailed discussion will follow for each of the above items.

Potential Symptoms That You Might Require A Hip Replacement – Age

You Always, Easily, Meet The First Criteria – Generally, the first symptom leading to a hip replacement is that you are getting older. Don’t worry; it happens to the best of us. Be sure to see a doctor. Here is Dr. Seuss’ take on age:

“Just why are you here?
You’re not feeling your best…
You’ve come in for an Eyesight and Solvency Test.
And if you’re the type that gets finicky-finick,
At this point you’ll try to get out of that clinic.
But they will outwit you as quick as a wink!
The Quiz-Docs will catch you!
They’ll start questionnaire!
They will ask you point blank,
How your parts are all fairing.”
You’re Only Old Once – Dr. Seuss

One problem with aging is that you accumulate aches and pains. You are not quite sure which are normal and which indicate that there may be something more severe.

“I will not make age an issue of this campaign. I am not going to exploit, for political purposes, my opponent’s youth and inexperience.”
Ronald Reagan during the 1984 presidential debates when asked if, at 73, he was too old to be president.

Hip Tip – You Are Not Too Old (Or Too Young) For A Hip Replacement – Your age is not a problem if you are in reasonable health and you want to continue to live a mobile and productive life. I was 58 years old when my hip replacement occurred and my doctor said I was just a ‘youngster.’

Potential Symptoms That You Might Require A Hip Replacement – Hip Pain And Flexibility Loss

While this may seem obvious, your degree of pain is an indicator. The second factor is your hip hurts most or all of the time. You also find the range of motion for your hip becomes limited. Additionally, you notice a bone-on-bone sensation with normal movements.

I Didn’t Know How Bad My Hip Really Was – I had been athletically active all my life. I participated in team sports as a youth and, as I got older, I gravitated to more individual sports such as biking and hiking. I had various encounters with gym memberships, self-created home gym workout regimens, and outside workout routes and activities. I thought I could keep my athletic activity going forever. Before too long, it was even hard to bend down to tie my shoelaces.

Toothache Pain – Everyone is different and everyone has a different pain tolerance level. I was speaking with a 50-year old woman who had been a waitress all her life and just had her hip replaced. I asked her about her pain level and she stated her hip just felt like a dull toothache all the time. I remember thinking, on my least painful day, my hip was way more painful than a dull toothache.

Potential Symptoms That You Might Require A Hip Replacement – Groin Pull And Muscular Pain

When Is A Groin Pull Not A Groin Pull? I thought it was just a groin pull, like a nagging, recurring pain in my right hip area (and no, it wasn’t from my college-aged daughter taking my wallet out). Throughout my various sports incarnations, I had a broken thumb (untreated), multiple sprained ankles, a hyper-extended elbow, more shin splits and blisters than you can count, sore knees, foot pain, groin pulls, audible popping sound from my calf muscle, leg cramps, dehydration, aching muscles, and even ferocious sunburns. Although the injuries were steady and constant, most got better by using athletic tape, elastic bandages, band-aids, and muscle ointments, or just by letting enough time pass. I beat those injuries, and I thought I could beat the pain in my hip as well.

Groin Pull, What Groin Pull? For at least the first six months, I attributed the pain in my hip to a groin pull. I mentioned it in passing to my wife a few times and once to my mother-in-law. My mother-in-law responded, “What? You have a groin?” Well, yes…

I Have A Groin – Ultimately, when I met with my orthopod he told me that a ‘groin pull’ is one of the more common incorrect diagnoses by patients and an early indicator of a hip gone bad. Not only did my groin hurt, it felt like…

A Thousand Lilliputian Pain Arrows – Sometimes, just a slight body movement would cause a multitude of Lilliputian pain arrows. Each arrow by itself was manageable, but when added together, they would permeate my perception and that pain would compete with my thought process. It became harder and harder to focus on complex business-related tasks that once took just hours to conceptualize and complete and now took days to organize. Like Gulliver, I really didn’t grasp the magnitude of my situation from all these individual little issues.

All ‘Dem Bones Are Connected – The song below illustrates another set of potential symptoms; your bad hip can lead to sore knees, sore feet, or a sore back.

“The toe bone connected to the heel bone,
The heel bone connected to the foot bone,
The foot bone connected to the leg bone,
The leg bone connected to the knee bone,
The knee bone connected to the thigh bone,
The thigh bone connected to the back bone,
The back bone connected to the neck bone,
The neck bone connected to the head bone.”
‘Dem Bones – James Weldon Johnson

My body was experiencing a…

Muscular Civil War – Right before I had my surgery, my gait was really poor due to so much hip pain and muscular pain, and now my good knee started to hurt as well. My limp had worsened because I had placed an awkward burden on the joint. My body was trying all types of compensating plans to reduce the pain in my hip. My body was making other muscles work hard, or abnormally, or not at all. My hip muscles were freezing up and I…

Couldn’t Bend It Like Beckham – The thigh muscles on my bad hip side were constantly knotting and behaving badly. Some muscles opted to stay permanently clenched while other muscles totally disregarded their normal functions and other muscles just checked out. It was a full-on muscular rebellion. It felt like someone had 10 drinks then tried to do macramé with my muscles. You are probably wondering if the pain gets any better, well…

The Pain Doesn’t Get Better – I have mentioned this multiple times, but for most people there is a gradual, worsening degradation of your hip. I was slowly slipping into a painful and limiting condition but I didn’t really know how bad my hip was. My pain was not only debilitating to me but also to my family, business workers, and friends. My pain slowly, and steadily, inhibited me like an ever-tightening python constricting my life away. Ultimately, the only way to determine if you need a hip replacement is to visit your orthopedic surgeon.

Potential Symptoms That You Might Require A Hip Replacement – Loss Of Functional Mobility And Gait Abnormalities

Standing Like An Expert Yoga Master – My right hip was bad so I found myself standing with all my weight on my left leg and my right heel elevated off the ground to minimize discomfort. I became very good at balancing on just one leg for long periods of time.

Are You Experiencing Inverse Running? I had been a runner most of my life. I started off running with Converse shoes (that probably gives you an idea of how long ago it was when I started running) and then graduated to the first version of Nike waffle shoes. I became the poster child for the de-evolution of running as I digressed from running to jogging to jaunting to now waddling. I had gone from Steve Prefontaine to Jim Fixx to Bill Clinton to a scurrying penguin. As my running ability gradually diminished, I took up hiking and walking.

“Everywhere is walking distance if you have the time.”
Steven Wright

Hip Tip – You May Waddle, But Don’t Dawdle: Keep moving, keep prehabbing, rehabbing, and keep going. You don’t want your muscles to atrophy.

You Compete Me: Climb Every Mountain – After I turned 50, my wife and I started hiking. We are both sort of competitive (I would ask, “Need a break?” She would respond, “No, I don’t. Do you?”) so flat, soft earth hikes were for wimps and we would find challenging trails with a bit of vertical. We would hike in the Olympic Mountains starting at about 1,000 feet in elevation and go to the top of the 5,000 foot-high peak and back. The competitiveness remained evident as I wore a Garmin GPS heart rate monitor. I would constantly bark out how far we had traveled and what my heart rate was doing. My wife, wearing her heart rate monitor, would respond with her results.

“Youth is a wonderful thing. What a crime to waste it on children.”
George Bernard Shaw

Age Appropriate Hiking – During the summer, we hiked almost every weekend. I remember seeing a group of four 20-ish year-olds and thinking the combined age of my wife and I is over 100, and the total for these four kids was only 80-ish. That mental mathematical feat followed my conclusion that my wife and I were both in good shape (for our age) and those kids couldn’t really appreciate not only the beauty of the mountains, but the life-long physical efforts we had expended to get to this point.

Before too long, the mountain peaks were out of my walking range. My pain caused us to give up our mountain hikes. I wondered if it could get worse. Well, it could…

The De-Evolution Of Man – Not only had my running de-evolved, by my well-being did as well. As I began my hip death spiral, at first, every month was worse than the previous month, then soon it was every week was worse than the previous week. Pretty soon, it was taking me 30 seconds to 3 minutes to stand up (I would start to stand up when a TV commercial segment started and by the time the show resumed, I had almost evolved to become Homo erectus). Soon, I had become my own cheerleader chanting…

Give Me An “A,” Give Me An “L”, Give Me Another “L.” If my wife was in the kitchen and I was at the dining table and tried to stand, she could hear me say, “A-l-l right… (five seconds) A-l-l right… (five seconds) A-l-l right… (five seconds),” as I tried to straighten out my hip. My bone-on-bone hip had to pass across a bone cyst and the roughened ridges in my hip, each like a wall of unbendable spiked wire. I slowly would stand, all the time self-talking the “A-l-l right,” phrase, somehow believing that this verbal pep rally would work. After I finally could stand, I triumphantly would proclaim, “OK!” I am not sure why I picked that phrasing but it only confirmed my hip was well past the expected expiration date. Not only was I slow to stand up, but I was now experiencing a…

Loss Of Balance Which Makes For Easy Cow Tipping – “Get a new hip and you won’t tip,” was the thought I had as I almost tipped over. My balance was becoming a problem as I was losing it, indicating I was way past the pull-date of my hip. My hip was so sore and the surrounding muscles so tight that my gait and balance eroded. My right foot no longer landed with a wide, stable base. It was now striking the ground more directly under my hip causing me to have my center of gravity change (imagine an ironworker on a Friday payday leaving their favorite bar at midnight) and if I turned to my right to sharply, I would start to almost fall over. Maybe if I put my foot down, it would help.

Stepping On Your Own Foot Doesn’t Help – Right before my surgery, I found my right foot was starting to turn a bit inward, kind of like the wrist and thumb of a Roman emperor sentencing some poor soul to death. Besides my balance problem looking funny, the other issue I experienced was that on sharp right turns, my left foot would sometimes step on my right foot. At least I thought I could still safely drive.

“Ever notice that anyone going slower than you is an idiot, but anyone going faster is a maniac?”
George Carlin

Hmm, I Guess I Was The Idiot – The pain in my hip became worse and worse and I was DUI-HP (driving under the influence of hip pain). A scary symptom I experienced just before my surgery was my right hip pain was so bad that I had to use my right hand to lift my right knee up so I could slide my foot over and operate the brake. It was getting harder to drive. Before too long, I was mimicking the driving skills of Al Cowlings chauffeuring OJ in the white Ford Bronco. Besides the discomfort I had in my hip, I was losing muscular strength as well and I found other problems.

I Used To Take Two Stairs At A Time, Now It Is Two Handrails At A Time – About two months before my operation, I started to notice that when climbing the stairs in my home, I frequently would ask myself why I was taking two stairs, like I always did in my youth. I would then look down at my feet and see that in actuality I had only taken one stair step, but I had used both handrails to accomplish that feat.

Potential Symptoms That You Might Require A Hip Replacement – Diagnosis Uncertain

Years Of Physical Wear And Tear – The competitive team sports I played as a pee-wee, in high school, in college, and after college took a toll on my ankle, knee, hip and shoulder joints. It seems my hip was just destined to go first. But I kept working out, even as the pain mounted. Sometimes, I would take three or four days off from working out to see if my ‘groin pull’ would get better. It never did. Besides, I had years and years of learning how to play through minor pain. I thought I could work my way through the pain.

Boiling Frog Syndrome – In retrospect, since the duration of the pain has been slow and gradual, but constant, the best way I can describe it is with the ‘boiling frog story.’ The premise is that if a frog is placed in boiling water, it will jump out, but if it is placed in cold water that is slowly heated, the frog will not perceive the danger, thus staying in the heating water and be cooked to death.

From Frog Legs To Dog Legs – I think my hip pain started in cold water and has been slowly heated, so I just tried to accept the pain and discomfort as the heat of pain continually increased. Before too long, I could envision myself being four-dog legs up, dead. Obviously, in retrospect, I shouldn’t have tried to ‘tough it out’ and ‘hope it gets better’ for those last two to three years.

Potential Symptoms That You Might Require A Hip Replacement – Time Doesn’t Heal

“Turn your wounds into wisdom.”
Oprah Winfrey

As An Aside – I Hate Quoting Oprah – I hate referring to Oprah because my wife does it so often. Usually something like, “Oprah says that you should be more considerate of my needs and she says you need to become a better listener.” Just when I finally graduate from Oprah-unqualified husband to Oprah-compliant to almost Oprah-certified, I get a new demand. Typically, it is some improvement on a previous demand like, “Oprah says that it is no longer enough to become a better listener of my needs. She says you now need to become a ‘proactive listener’ and anticipate what my needs are going to be.” About this time, I refer to my own personal ‘Oprah…’

“You know what I say to people who say their needs aren’t being met? Drop some of your needs.”
George Carlin

OK, enough Oprah bashing. (She really does have good advice, just not when it applies to me.)

Some Things Heal, Some Don’t – Arthritis came along and soon all my smooth cartilage started to wear away. Hair and fingernails may regrow, skin cuts may heal, muscles may regain strength, but cartilage doesn’t regenerate. Eventually, my cartilage was gone and those previously fluid movements were now raw bone-on-bone. I still, foolishly, thought it would get better. I resorted to a tried and true technique.

Couch Potato Pain Management – As my hip pain worsened, I opted for a well-known pain management solution: watching TV. I would get on the couch, spend three minutes configuring multiple pillows above, below, and around my leg and hip then watch a show that didn’t require a high degree of concentration (think Comedy Central). All I could really do is watch a comedy show or a movie, regardless of whether they were bad or good. It didn’t really matter. The couch comforted, and supported, my diminishing state.

Potential Symptoms That You Might Require A Hip Replacement – Social Degradation

Crummy Interpersonal Interactions – Now, I am not saying I was good (or even average) at communicating with my spouse and friends to begin with, but it definitely got worse. It was as if I went from semi-social to feral in just a matter of months. My pain acuity often resulted in short and abbreviated comments rather than articulating what I was really thinking. Two examples come to mind:

• My wife asked me a simple question about what option we should do to correct a problem with our home. Rather than laying out an analysis followed by a conclusion that normally would be a dozen sentences, I condensed it into ten or so words and I probably was not making much sense.
• My business partner and I spoke while I was working out on an elliptical machine, in mild to moderate pain, about a task and I, rather than properly addressing the business problem, told him I only had one hundred words for him for the month and that he had used all of them. It is all I could say.

I later apologized to both.

Like An Animal Going Off To Die – Sometimes, pets and other critters run away to find a place that is safe and comfortable while they await their death. Like those animals, I became more and more removed from social interactions, attempting to cocoon myself from external stimuli. It was probably a good alternative for those around me.

Potential Symptoms That You Might Require A Hip Replacement – Ineffective Nonsurgical Treatments

Kissing The Owie Doesn’t Work – You can try many of the non-surgical treatments such as stretching, OTC medications, chiropractic visits, and physical therapy, but once your hip degrades, these treatments only provide fleeting relief. An entire chapter follows discussing nonsurgical treatments.

“Tough times never last, but tough people do.”
Robert H. Schuller

Hip Tip – But Your Spouse Knows Better: Listen to your spouse. My wife was the driving force to get me to see the orthopod and pushed me to get surgery now, rather than later. If not for her, I probably, foolishly, would have waited even longer to make the first appointment.

Potential Symptoms That You Might Require A Hip Replacement – You Speak More Slowly

“Talk low, talk slow and don’t say too much.”
John Wayne

I Became A Bit Of A John Wayne, But Not In A Good Way – Once my hip pain became near constant, I found myself having to alternate my focus between managing and acknowledging pain and processing what I was going to say. I have always spoken rapidly, but the pain caused me to measure, calculate, and pause before I could get out any near-coherent statements. It was as if I was in a lava lamp and these bubbles of pain would constantly and randomly float into my brain causing me to lose focus. It was not good for me, nor those around me.

Bo Knows… Hip Replacement – Bo Jackson was a tough guy. He was a college football Heisman Trophy winner, a professional baseball all-star, and a professional NFL player. In his heyday, Bo was everywhere, including the famous Nike commercials. Bo injured his hip in 1991 when playing a NFL game. Allegedly, a tackle dislocated his hip, and Bo, using his strength, popped his hip back into place. Bo then had hip replacement and following his full recovery, he returned to major league baseball, but not to football. Of course, Bo hit a home run in his first at bat.

Bo after hip replacement surgery…

Bo has since had a second hip replacement surgery. Sadly, I could now almost beat Bo in a 40 yard dash. Even tough guys have problems with bad hips.

Alrighty… that concludes Chapter 6.