While I was in India in December my left hip began to hurt. I am of a stoic nature, but this was really painful. It hurt so much that I actually took a painkiller and dropped into a little clinic beside our hotel for an Xray. It showed that there was very little space between the head of the femur and the socket. I sent the image to a few people who know about these things and the diagnosis was unanimous; the cartilage was almost gone.
Cartilage loss = osteoarthritis = hip replacement.
I was fairly indignant, being of robust lineage not much given to medical intervention. But several of my friends had had hip replacements, most of them successful, so I accepted the inevitable. Anything to maintain my mobility through the next 25+ years predicted by my DNA.
I started researching. Where to do the deed, Bali or Bangkok? Should the incision be the traditional posterior one or could I find a surgeon doing the new anterior technique in which the muscles are pushed aside instead of being cut? What was the best material for the implant? What supplements should I use meanwhile?
My rational mind was looking at all this data and making copious notes but big red flags were waving offstage. Did I understand that the head of my femur – the largest bone in my body — would be sawed right off? That the hip socket would also be sawed away and a man- made implant of metal alloy, plastic or ceramic would be cemented to the bone margins? Serious stuff.
Then a friend sent me a link to a video by Chirpractor Dr John Bergman that changed everything.
If you’re considering a hip replacement, I highly recommend that you make a coffee or pour a beer and invest the hour it takes to watch Hip Issues, the Ignored Causes www.youtube.com/watch?v=unMisEfPIbg&feature=youtu.be
Both these highly trained joint specialists agree that hip conditions which are not the result of genetic defects or traumatic injury can often be relieved without surgery and that cartilage can regenerate.
Bergman states that the hip is a perfect joint, and joints do not ‘wear out’. He states that hips lose cartilage and become painful due to impaired blood and nerve supply to the joint because of misalignment of the sacroiliac joint/lumbar spine, all of which can be corrected without surgery.
Chiropractor Dr Chet Collins thinks otherwise. “In my opinion, mobilizing the muscles of the hips and increasing one’s overall physical activities are the primary keys. I don’t agree with the nerve and blood supply reduction being impinged at the spine. More so the mechanical restrictions of the hip muscles causing long-term excessive stresses on the joint structures that slowly overwhelm the body’s ability to maintain and replace the tissues.” He suggests hip mobility stretches such as those at drjohnrusin.com/10-exercises-to-instantly-improve-hip-mobility
Surgeons, of course, are in the business of surgery and the modern world is looking for the quick fix. But I personally feel that surgery of any kind, especially as major as joint replacement, should be the last resort.
Things can go wrong. Complications include blood clots, infection, dislocation and loosening, where the implant detaches from the bone. This last issue requires revision surgery to replace the implant, which is much more complicated than the initial joint replacement. About 10% of hip replacements will require revision in 10 years, and 20% in 20 years. The balance of hip replacements seem to last about 20 years, so if you outlive your hip it will require further surgery. Of the people I know with hip replacements, two required revision within one year.
After a hip replacement, that leg is usually slightly longer than the other. This causes further misalignment and soon – guess what? The other hip starts to hurt. So they replace that one too.
Then there’s the issue of Non Steroidal Anti Inflammatory Drugs (NSAIDs) which are the most commonly used drugs for the treatment of osteoarthritis pain. Common non-prescription NSAIDs include Advil, Motrin, Aleve, Celebrex and good old aspirin. These reduce pain by controlling inflammation but, except for aspirin, all have significant side effects. High dosage, long-term use can increase the risk of heart attack, stroke and stomach ulcers. (Tylenol is not an anti-inflammatory).
Studies show that NSAIDs may actually cause further damage to the joint by decreasing cartilage production. An article in the Journal of Prolotherapy 2010 states, “The use of nonsteroidal anti-inflammatory medication has been shown in scientific studies to accelerate the articular cartilage breakdown in osteoarthritis. Use of this product poses a significant risk in accelerating osteoarthritis joint breakdown. Anyone using this product for the pain of osteoarthritis should be under a doctor’s care and the use of this product should be with the very lowest dosage and for the shortest duration of time.”
Catching the situation and starting to work with the hip joints early can change the game. The doctor I saw in Bangkok took another Xray and pointed out that I still had enough cartilage to work with and we discussed what I could to do maintain and increase it. His suggestions include:
– Find a good chiropractor to correct alignment
– Be more active; sitting around just irritates the hips it seems
– Lose weight; I wish there was an app for this
– Google ‘how to relieve hip pain’, there are loads of videos and demonstrations of stretches
– Have a regular yoga practice
– Have acupuncture to stimulate the deep muscle around the hip
– Replace NSAIDs with plant based anti-inflammatories. Turmeric is an obvious choice but curcumin, the active ingredient, is not absorbed well by the body unless it’s mixed with a little cracked black pepper and oil.
– Glucosamine sulfate and chondroitin sulfate are supplements that help regenerate cartilage. Celadrin is locally available and I found it effective.
– Use the joint with weight bearing exercise!
So a hip replacement doesn’t need to be a knee-jerk solution to hip ‘pain. I may eventually have to have the hip replaced, but I’ll have exhausted all the alternatives first. My routine now includes daily yoga, hip stretches, glucosamine, turmeric, walking and I have acupuncture weekly. And I’m pretty much pain-free.
By Ibu Cat
The Boomer Corner is a column dedicated to people over 60 living in Bali. Its mandate is to cover topics, practicalities, activities, issues, concerns and events related to senior life in Bali. We welcome suggestions from readers.
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