What you need to know about hip replacement surgery – and nobody tells you

Hip replacement is very common.

I live in Regina, Saskatchewan, Canada.  Here we have a public health care system where we should be able to access necessary medical treatment free of charge.

Hip replacement is one of the most common surgeries in the world. Chances are that you or someone you know is going to need a hip replacement soon.

If so, and you live in Saskatchewan like me, you need to read this. If you live anywhere else, you many not need to.

I need a hip replacement.

It seems like an old person thing, and I’m not there yet.  At least in my head I’m not.  And let’s face it, my mom was about 20 years older than me when she had a hip replacement.  I know of several people who have had hip replacements, and those people are all older than me. 

But here we are.

How did I get here?

I started salsa dancing about 8 years ago.  I found out that I loved it, so tried other kinds of dancing also.  Bachata, kizomba, chachacha, pachanga, mambo, or as a tour leader from Myanmar called it “salsa, chacha, blablabla”.  What a huge world of dance is out there!  And I met so many amazing people from all over the world through taking lessons and social dance events.

I also love travelling, so I worked dancing into my travelling, taking lessons or attending dance festivals in Paris, Havana, Cali (Colombia), and Istanbul.

Along the way I tried out pole dancing in 2018.  Fun!  I went once a week or so, and it was great exercise.  Then one evening we did a “twerking” exercise.  “Twerking involves squatting down low and popping your butt back and forward. It strengthens muscles in just about every part of your body! Not only do you sculpt, tone and grow your butt, your thighs become super strong, your hip flexibility increases and more than anything, boosts your confidence!”  That’s what they say anyway.

I thought I had injured my hip flexor muscles.

And that was the start of my hip problems.  The next day, I was hurting.

I thought I had overworked my hip flexors.  Twerking is a lot of work!  I went to physio, chiro, and massage trying to get the problem fixed.  This went on for about two years until my physio said, maybe we should get you to see the doctor here.  He sent me for x-rays in March, 2020.

And then covid hit.  No doctor appointments, no physio, no nothing.  Everything shut down.  

Only emergency surgeries were done. Clinics and hospital staff were re-assigned to covid related duties. Wait lists for all surgeries piled up.

I kept my pain under control and kept up my activities.

I carried on, staying fit with my regular activities. Painkillers helped – tylenol for arthritis, and sometimes advil.  And only if I was really hurting, or knew I was going to be very active, I took prescribed painkillers.   

It wasn’t my muscles, it was my bones.

A year later, covid restrictions relaxed, and I got in to see the doctor at my physio facility again.  He told me the problem was in my hip joint, not the muscles.  So dance wasn’t the cause of my pain, it just showed me there was a problem.

He told me I had the joint inflammation known as osteoarthritis.  It was caused by the loss of protective cartilage, so this huge joint was moving bone on bone.  Ouch. He referred me to an orthopedic surgeon.

The surgeon told me I would need a hip replacement.

The surgeon said I could either go on the wait list for a hip replacement, or try cortisone shots which might do the trick by reducing swelling and pain.  He suggested leaving hip replacement as long as possible, since it is a major surgery, and trying the cortisone shot first.

In hindsight I should have just asked to be put on the waiting list right away, since I’m sure it was already a long list at that time.

I tried the cortisone shot, which was extremely painful just for a brief time thankfully.  I had to go to a hospital for the procedure, and bring a friend to drive me home. The cortisone shot did nothing for my pain.

(Fast forward to August, 2023 – I developed a “frozen shoulder” in late 2022. It provided me with a lot of pain for many months. I finally got in to a rheumatologist, a specialist in inflammation. He wanted to give me a cortisone shot. I was reluctant, and explained my experience with the cortisone injection for my hip. He shook his head, and told me that research had proven years ago that cortisone shots for hips did not work! The cortisone shot in my shoulder, however, did help my pain.)

I got added to the surgical wait list.

I carried on as usual.  My physio gave me exercises to keep my hips working.  The stronger you keep your muscles before surgery, the better. You should get through the surgery better, and recover more quickly.

On my annual golf trip with a group of friends, I was asked why I was limping.  I didn’t know I was!  On the same trip, I had a massage.  My therapist said wow, you have no lining left in your hip, I hope you’re on a waiting list for hip replacement.

That prompted me to reach out to my surgeon again in June of 2021. He asked how the cortisone had worked. I said it hadn’t worked at all for me. He said that’s what he thought would happen!

He said he would add me to the wait list for total hip replacement.  I was to let him know if my problems became more severe, and then he could put me on a priority list. 

Then I blew out my knee.

I sold my business in June of 2021.  Before deciding what else I wanted to do, I was going to take the summer off, for the first time in my life!  I was going to have such a great summer!

Early in July 2021, I overdid it.  One day I went for a long bike ride. The next day I felt sharp pain in my knee as I tried to go for a walk – so I turned around and went home.  Later that day I went golfing, and when walking up a slope I felt the sharp pain in my knee again.

The next morning I woke up unable to walk on that leg.

I was added to the priority wait list.

I called the surgeon.  When I spoke to him I told him what had happened, and he told me he would add me to the priority waiting list.

My knee had been working too hard. It was taking up the slack for my hip that wasn’t working very well.

Then I waited.  And waited.  And made phone calls.

I booked a trip to Italy in September of 2021, and I planned to hike the Cinque Terre trails.  Would I be able to with my knee? I tried massage and physio, neither of which helped.  Nothing could help my knee while my hip was in this condition. I bought a good knee brace, and as soon as I could I started walking, trying to go farther each time.

In Italy I had no choice but to walk a lot, but I limited myself. Towards the end of the trip I hiked a portion of the Cinque Terre trail.  I was thrilled!

Once home in October, I called the wait list phone number I found online, and was told my wait time was 2 – 4 months.  I called again in December, and was told 2 – 4 months.  And again in February 2022, and once again was told 2 – 4 months. 

I asked some questions. But I didn’t know what I didn’t know.

Each time I called, I asked questions, and the staff who called me were patient and answered as much as they could but I still didn’t understand.  Why did I never move on the waiting list?  Well, covid, emergencies, etc. was the answer.  I found that patients were booked only a month or so before the surgery date. 

And there haven’t been any cancelled because someone tests positive for covid?  (I had heard that was fairly common).  “Oh, did you want to be marked short list?”  Whaaat does that mean called if there’s a cancellation?  Of course I do, who wouldn’t want to be “marked short list”?  How would I know I had to tell you that?  “Oh, people call us all the time, asking to be marked short list.”  Really, isn’t that good to know.  Yes, please mark me short list. 

I was tired of waiting and wondered what else I could do.

I planned a trip to Turkey in March 2022, so decided to wait until I got back.  The trip involved dancing, but my knee stopped me.

On my last day in Turkey, I spent most of the day with a man giving me a personal tour around the area I was staying.  Since I was wearing a knee brace and limping along, we started talking about the hip surgery I needed.  He said he had a surgeon friend who he could probably get to see me the next day, and I could get surgery very soon there, and go home with a new hip.  But I went home the next day instead.  

I found out later that Turkey is a hot spot for medical tourism. That means leaving home to get treatment that you either have to wait for, or is just not available at home.

In April, the answer from the wait list was 2 – 3 months.  I asked more questions, finding there were 2 people ahead of me.  So does that mean my surgeon operates on less than one person a month from his waiting list?  I just don’t get it.

I called my surgeon again.

This time I called the surgeon. When he called back, I told him that I wasn’t sure how the waiting list worked, since I never moved on it.  He told me he would put me as next to be called on the waiting list.  He said I could expect a 6 – 8 week time frame.

I waited for a full week, and called the waiting list number.  I had no different position of the waiting list!  What the heck.

I followed up. And I got a surgery date.

So, I called the surgeon’s office again.  I told the receptionist I was supposed to be marked next on the waiting list, and that hadn’t happened.  She said yes, I just got the dictation this morning and I will be sending it.  I asked when, and she said she would send that afternoon.  So my 6 – 8 weeks had just been increased by more than a week.

But, two working days later, I got a call from the wait list staff.  I had a date!  The surgery was booked for about three weeks later.  

I’m pretty sure this would not have happened without my follow ups.

What do I know about my surgery? Nothing that I needed to know.

The only thing I knew so far about my surgery was that the new joint would be titanium.

No information was coming to me from anyone so far in the health care system, unless I asked for it.  I learned later that covid had taken a step out of the process, and I should have been sent information about the surgery. It was not the information I really needed anyway.

But let’s face it, I was studiously avoiding doing any research on my own about this major surgery.  I figured I would find out what I needed to know when I knew the surgery was going to happen. 

I knew that hip replacement is one of the most common surgeries done.  There is a long recovery process.  I knew that my mom, who had a hip replacement in her later years, didn’t walk very well for the rest of her life.  Sadly no one thought that was a big deal because she was not really active, and she never complained. 

But I know of lots of older people who have had the surgery and seem fine.  

And I must have searched on the internet at some point, because I did know that the incision for the surgery could be done on the side, or on the front.

So I already knew a lot, right?

Wrong.

There are many kinds of hip replacement surgery. But two main kinds.

While still waiting to hear about my surgery date after returning from Turkey, I went to a house party with some dance people.

I had been dancing a very little bit, to slow songs only, since my knee couldn’t be twisted.  At this party I was not dancing at all. My knee was getting worse, and I decided I needed to just stop dancing.

A friend at the party told me that his wife had her hip replaced many months ago, and was still limping. He said the surgeon had cut through the big muscles at the back of the hip, and I should never let them do it that way. 

I was shocked.  Cutting the big muscles at the back? That sounds terrible!

Now my education began – thanks to the internet.

What happens during any hip replacement surgery?

The surgery replaces the ends of the bones rubbing together, adding a plastic lining that lets them move with each other easily.  Kind of like a mortar and pestle moving together with some yogurt to glide around in. (I’ve had no medical training obviously.  And I’m all about the visuals.)

The surgeon makes an incision to get in to do this construction work.

Total recovery time from the surgery is around 3 months.

And there are many names for the ways to do this surgery.  The names are seemingly based on exactly where the incision is made. I’m going to break it down to only two main types. 

Lateral or anterior

I’m a skeptic. I don’t believe everything I read.  Or even everything that I see.  This attitude developed even more over the last two years with some of the ridiculous things that went on over covid times.    

So, I read a LOT of information on the different approaches.  I could see a bias towards one or the other approach in many of the articles I read.  And some information was conflicting.  But most of what I read agreed on these basic statements.

Lateral, or muscle-cutting method

The lateral, or posterior, approach has been done for over 50 years.  An incision up to 12 inches long is made on the side of the thigh.  The surgeon goes in and cuts your gluteal and other big muscles back there, detaching them from the bone. They then go in and replace the hip parts.  I think of this as the medieval torture method.

With this approach you will be in hospital for several days, and will be using a cane for six weeks.  You can’t drive for six weeks.  Bending past 90 degrees, or any twisting, is banned for this time period.  You may need a blood transfusion because a lot of blood may be lost. 

Anterior, or minimally invasive, or muscle-sparing method

The anterior approach is done with a much smaller incision on the front of your thigh.  Muscles are moved aside to let the surgeon in to replace the ends of the bones.  It’s a much newer type of operation, but not that new, around for 20 years or so.  It’s often referred to as the minimally invasive, or muscle-sparing approach. 

With this approach you may be able to leave hospital the same day!  You could be walking unaided within a week or so, driving in the same time period!

Well, which one would YOU want?

My surgery booking was for “regular hip surgery”

When the wait list staff called to give me my surgery date, she asked if I had any questions she could help with.  To her credit, she answered what she could, but in most cases said I really don’t know for sure, this is what I think, please confirm with surgeon/pre-op assessment staff/whoever.

She told me I was booked for regular hip surgery.  Well that sounds right I guess.  I said I had been learning that there was the lateral approach, that sounds horrific, and the anterior approach.  So what was I booked for?

She told me that “regular” hip surgery meant the lateral approach. OMG. NO.

With more questioning, she revealed that my surgeon has done the anterior surgery before, and the surgeries would have the same time allotted in the operating room, so the type of surgery could be changed.

I had to wait to talk to my surgeon again.

I immediately put in a call to my surgeon, and his call back to me was booked for ten days later.  I was giving myself a 50/50 chance for being able to get my surgery of choice, for that date just three weeks away. The date I had waited a long, long time for.

I went down the online rabbithole.

I checked everything I could find on hip surgery.  I came to the conclusion that no one who was eligible for the anterior method, and who was fully aware of their alternatives, would knowingly choose the other kind.  

At least, unless they had no access to money or credit, or chose not to travel.

I saw a clip on the tv news about an Alberta woman who had gone for hip surgery in Lithuania, since she was on a waiting list at home for years.  Surgery and rehab cost her $14000.  I assume her surgery was the anterior way since she was walking unaided quickly – https://globalnews.ca/news/8768307/canada-covid-surgery-backlog-travel-medical-tourism/amp.

What did I find out about hip surgery alternatives?

I found

• many countries have highly rated health care systems and will arrange hip surgery for prices as low as $5000.  Turkey, India, Thailand are all popular.  And they offer the anterior method, some excusively.

• a Saskatchewan resident, related to a friend of mine, had surgery at a private clinic in Calgary, the “new way”.  Of course I assume this was the anterior way. She said it was a wonderful experience and highly recommended, and cost $27000.

• two clinics in Calgary gave me information, and at least one of them offers only anterior method hip replacement.

• you must travel to another province for private surgery – if you have valid health care in a province, you cannot access private, paid alternatives in that province.  Apparently there is a federal law stating you can’t pay for health care if you have government funded coverage for that care. This is to prevent having a two-tiered health system. I believe we have one anyway.

I finally got the call from my surgeon.

My surgeon, Dr. Rodwan, called to ask if I had any questions.  Any questions!  I had nothing but questions! And it’s less than two weeks until the booked surgery date.

He said he would describe the surgery I will receive from him, and I could ask questions at the end.

He described the surgery as

• anterio-lateral method (I like the anterio part of that!)
• minimal risks of surgery (infection, dislocation, blood clots)
• detachment of the gluteal medius muscle (nooo that means cutting!)
• 4 days in hospital until physio has worked with me enough
• walk with a cane and no driving for 6 weeks

My heart sank lower with each sentence.

My surgeon does not do the anterior approach.

Time for my questions – I have just one. I know there’s another method where you do not cut muscles.  Can you do that surgery?  Oh, you mean the direct anterior method.  No, I don’t do that surgery.

Now my heart was in the pit of my stomach.

I was really upset. I don’t want my muscles cut.

After all I have found out, I know that I want the muscle-sparing surgery, anterior. 

I get that you want your surgeon to be competent in the surgery chosen.  But that doesn’t trump the surgery method.  Not for me anyway.

Dr. Rodwan went on to say that there is a surgeon new to Regina, Dr. Ardell, who does the direct anterior approach, and he would see what he could work out for me. 

I told him I wish we had talked about this a year ago.   If I had known what I know now, I would have arranged the anterior surgery somewhere else, and paid for it. Whatever the cost, it would be worth it to be doing everything I want to do and not having pain.

I also asked if he could get back to me that day, a Friday.  I didn’t want to spend the weekend like I had the last ten days while waiting for his call – taking steps to book a private surgery if this didn’t work out, and losing sleep.

He asked me to come to his office that afternoon, and he must have been busy the rest of the morning trying to work out a solution for me.

My surgeon came up with a great alternative

Dr. Rodwan had talked to Dr. Ardell, and arranged for two options: 

• I could go on Dr. Ardell’s short wait list, getting the same date position I had on Dr. Rodwan’s list.  And get the direct anterior surgery.

• or, I could have the surgery on the date booked, and he had arranged for Dr. Ardell to assist, so they would be doing the direct anterior surgery together.

He told me I could think about it for a while, but I didn’t have to think for more than a second.  I’ve heard only good things about Dr. Rodwan, and he has done this surgery before, but not enough that he thinks he should do it alone.  He’s been doing surgeries for 20 years. Dr. Ardell does the anterior method and is newly out of med school. Having both doing my surgery sounds like a great option.

Dr. Rodwan told me that with the approach he normally uses, he makes a small incision (like direct anterior), there is little blood loss (again like direct anterior), and he can do the surgery in 45 minutes compared to 90 minutes for the direct anterior method.  But he’s still cutting muscles so the recovery is not pretty.

He also told me that with the direct anterior approach I could be physically ready to go home the same day as surgery. But my hospital stay could be longer since services like physio and x-ray need to line up.

I could be walking unaided within a week, or it could take much longer.

A nerve on the front of my thigh could be affected and cause a temporary burning sensation.

But none of this is changing my mind.

I will be having the surgery I want

As far as I’m concerned having these two surgeons working on me is a huge win!  And of course I am getting the type of surgery that I believe to be much better for my body and my recovery.

But my situation would have been much different if I had not taken steps. 

What steps I recommend if you need surgery – hip replacement or anything else

My advice to anyone, and also to myself:

Take charge of your care in the health care system. No one else will.

Don’t be shy.  Ask any question you have when talking to anyone in the health care system.  Everyone who I dealt with patiently answered my questions as best they could.

If you have an injury that won’t go away, ask your caregiver to order x-rays. 

If you are referred to a surgeon, and told you may need surgery, get on the waitlist as soon as possible.

Ask your surgeon –

– how long the wait list is

– how they do the surgery

– if there are other ways to do the surgery, and if so what is the best option for you

– if they were having the surgery themselves, which way would they choose?

– what advice and help they can give you if you decide to go somewhere else and pay for the surgery?

Do some research on your own.  No one knows everything.  Talk to people who have had the surgery, use the internet.  You don’t know what you don’t know. 

Decide whether the cost of private surgery is worth it – what are your pain and limitations worth in the long run?  (answer – priceless)

If you decide your best option is to be on the wait list at home, find the wait list phone number and ask to be “marked short list” or called in case of any cancellation. 

Follow up regularly. 

My surgery is soon

I have a positive attitude going in to the surgery now, and that’s a huge bonus. I hope my experience will help others on this road.

Talk to you on the other side!