You're not too young for hip replacement

I first felt it while walking with my wife a few years ago. A throb in my right hip that never seemed to go away, causing a limp, which triggered other problems (trouble sleeping, lower back pain). After years of cycling, skiing and other sports, I shrugged off the pain as an old pulled groin muscle reawakening itself just to be ornery.

But when a friend suggested I get it checked out, I wasn't prepared for the diagnosis: osteoarthritis, degeneration of the cartilage in my hip joint.

Joint degeneration? That's something for old guys with canes and shuffleboards, I thought. I was a reasonably fit dude who did a 100-mile ride on my 45th birthday and commuted to work 11 miles each way.

My doctor at the time, Matthew Parker, himself an accomplished competitive cyclist, said the cartilage between my hip's ball and socket was slowly disappearing, while bony growths prevented the joint from moving smoothly. While there are many causes of arthritis, in my case the culprit was femoral acetabular impingement, an abnormality in the way the ball of the femur (thighbone) and the acetabulum (hip socket) fit together.

The impingement causes friction in the joint and the hip to “jam” in front when bending forward. Over the years, it wore down the cartilage between ball and socket, causing pain when I drove a car, rode a bike or slept.

Parker knows about osteoarthritis, the most common form of arthritis. He had two hip replacements in his early 50s, recovered and still competes on his bike.

He figured it was better to get his hips done then and enjoy life instead of waiting until the arthritis made everyday activity nearly impossible. Some studies show that arthritis patients are at greater risk for weight gain and the conditions that accompany it, such as diabetes and high blood pressure. Yet the idea of surgery (my first), and installing a plastic/ceramic/metal contraption into my body wasn't sitting well.

I poured myself into research. It turns out that more and more people in their 40s, 50s and early 60s are getting their hips replaced, unwilling to live with pain and give up activity.

Overall, the annual number of total and partial hip replacements jumped 56 percent, from 263,000 to 411,000, between 1998 and 2011, according to the latest figures compiled by the American Academy of Orthopaedic Surgeons. The portion of patients ages 45 to 64 having this procedure jumped from 27 percent in 1998 to 42 percent in 2011.

I wrote about the trend of younger hip replacement patients in a 2011 Washington Post article. After interviewing each of nearly a dozen Washington-area surgeons, the question would always come up about my own condition.

“You'll be back,” said one doc. “Sooner or later, you'll give me a call.”

I remained anxious. Apart from the risks of surgery itself, there was also fear about uncertainty down the road. Since a hip implant lasts only 15 to 20 years, I'd probably need a second one. Surgeons told me that these “revisions” are more difficult to perform because they have to remove the metal stem of the first implant from bone that has grown around it, the blood loss is greater, the risk of infection is higher and recovery takes longer.

Not a pleasant scenario.

I shifted to a strategy of delay. For nearly a year, I went to a physical therapist who gave me daily exercises to strengthen muscles around my hip joint, pulling it back into alignment and reducing the pain somewhat. I figured that if I delayed long enough, researchers would invent an implant that would last longer.

After PT, I took up yoga, finding relief in movements and positions that improved my posture as well as my flexibility. After three years of down dogs, eagle and child poses, I still wasn't getting better.

Undeterred by constant pain, last winter I worked as a weekend ski instructor at Liberty Mountain in Carroll Valley, Pa. With a shot of painkilling cortisone injected into the hip socket, I was able to teach both kids and adults how to make it down the First Class beginner hill.

The cortisone's effects lasted about six weeks. Then it was back to gobbling handfuls of anti-inflammatory agents, which provided temporary relief.

By February, tired of waking up sore, tired of complaining to my family and friends, and now 51, I gave in.

I arrived at Suburban Hospital in Bethesda at 5:30 on the morning of April 30. I was tense and nervous the week before. I fought with the scheduler to be orthopedist Christopher Cannova's first patient that day. I had read studies that showed a slight improvement in surgeries performed first thing in the morning, when the surgeon and his team are most alert.

The anesthesiologist started an IV drip, my mouth went dry, then drowsiness and blankness. The only thing I remember was curling into a ball, I think when they moved me onto the surgical table. In talking to Cannova later, I was able to reconstruct what happened for the next 90 minutes.

After making a five-inch incision on the right front of my hip, he pulled aside, rather than cut, the muscles overlaying the joint. This anterior (as opposed to posterior) approach has become more widespread in recent years as doctors have found that patients recover faster this way.

He then cut the femoral head (the ball) and removed the arthritic growths as well as the socket. A cup and plastic liner was inserted into the hip joint. A metal implant with a ball on top was inserted into the leg bone. Where bone was previously grinding on bone, now there is a smooth-sliding ceramic-plastic interface.

I was under the knife for only 60 minutes. Anesthesia and other preparations took 30 minutes, according to my doctor. The recovery takes months.

That night in my hospital room, a therapist came to get me out of bed and shuffle my feet. Physical therapy — on a walker, then on crutches — began the second day. By the third day, I was discharged from the hospital and began therapy at home.

Nearly three months after the operation, I'm able to walk, swim and ride a bike (for short periods) without lingering pain. I'm also sleeping through the night, which is one big reason I did this in the first place.

I'm still using a cane (no shuffleboard) and icing my leg a few hours a day. I've already had one setback caused by too much activity. But I'm getting stronger every day. Except for some muscle soreness, that pain in my hip is gone. Years of anxiety have evaporated.

With any luck, I'll be on top of the beginner hill this coming winter, waiting to guide down the next class of skiers.