Welcome to The Hip Replacement Podcast, where healing and recovery lead to a whole new lifestyle. I'm Chris Bystriansky, your host. I'm an author, athlete, and double hip replacement patient. One more than 12 years ago, and the other more than 10 years ago. I've been through the surgeries, the setbacks, and the comebacks. And I'm here to help you do the same.
Each week, I'll bring you tips, tools, expert advice, and inspiring stories to help you take back your life one step at a time. Whether you're preparing for surgery, in recovery, or just looking to move and live better, you're in the right place. Thanks for joining The Hip Replacement Podcast. New hips, new you. Let's go.
Welcome back to The Hip Replacement Podcast. And today I have a question for you. What's worse than one hip replacement surgery? Two hip replacement surgeries.
So in this episode, I'm going to talk about going from one hip replacement surgery to two hip replacement surgeries. And you may be out there thinking, "Whoa, Chris, whoa, slow down. I've just had one hip replacement surgery. I don't need to start thinking about a second one. I don't need you to scare me about a second one. Or you may just be getting ready for your first one and you don't want to hear anything about a second one. But it's not like I'm the person who's going to be dragging you into the operating room and holding you down and doing your second hip replacement surgery. We're just having a conversation here. All right.
I've had two hip replacement surgeries. Not because I wanted to. I didn't want to have one, but I had to have two. And mine were 18 months apart. We'll get into more of those details later. But having a second hip replacement surgery is way different than having one hip replacement surgery. It's certainly not like the first one at all. It's not like having the first one over. It's not the same because a second one adds complexity, risks, different sensations, balance issues, and on and on and on and on.
The result, I guess you'd say the result is more than the sum of the parts. It's like 1 + 1 equals 3.
Let me give you a different analogy. Imagine running or heck even walking 10 miles. 10 miles. You go and do 10 miles and then right after that you run or walk 10 miles again. They theoretically should be the same, right? 10 miles to start with and then 10 miles right after that. That's one way to look at it. It's just the same 10 miles.
Well, no, it's not the same because your body is in a different position before starting your second 10 miles than it was before you started your first 10 miles. So, you do your 10 miles, you start fresh, you do your 10 miles, and then right away you start another 10 miles. Those second 10 miles are way more difficult than those first 10 miles. So all 10 miles are not created the same.
But maybe you don't run, maybe you don't walk. That's fine. What about driving? Let's say you drive a car for 10 hours. And then right after that, you drive another 10 hours. Is your second 10 hours as easy or as manageable as your first 10 hours? Well, no, because there's a lot more that goes into it. The longer you drive, your body and your mind are in a different state or position before that second 10-hour drive than they were before your first 10-hour drive. Does that make sense?
I'm trying to use an analogy because there might be a lot of people out there, maybe doctors or physical therapists or even patients just like me who are thinking, well, it's just another of the same thing I've already have or I've already done. That's not the whole truth. I'm not saying it cannot be done. I'm just saying it adds complexity and other things to consider. Whether you have it a few minutes after the first one, a few months, or even a few years after the first one, it adds complexity.
Okay, so let me address this. There are basically three reasons why you may need a second hip replacement. And I'm not talking about a revision to that first one. I'm talking a second hip replacement inside your body at the same time. I mean, you have two artificial hips in your body at the same time. That's what I mean. All right. Three reasons why this could possibly happen.
Number one, unless you've been in an accident that damaged that first hip to begin with, maybe you had a severe fall, maybe you were in a car accident or some other type of industrial accident and it damaged that hip causing you to need a first hip replacement. If that wasn't your scenario and your body just naturally developed and something within your body caused you to need that first hip replacement, well, that same thing is in your body for your other hip, your other natural hip that's remaining. So, whatever caused you to need your first hip replacement, other than an accident, is also going on in your body for that other hip.
We don't know why this happens to our bodies. Is it a lack of blood flow? Is it a lack of calcium? Is it some other mineral we're missing? Is it some activity we're doing or not doing? Is it genetics? Nobody knows. I would love to see a study because everybody watching this who's had a hip replacement barring an accident has something in common. So if your body has developed the need for one hip replacement, why wouldn't your body develop the need for that second hip replacement?
Number two, you may need two hips right away or you may be in a position to need two hips, but you're only feeling the one that hurts more. Okay? So, both hips may be bad, but one may be a pain level nine out of 10, and the other one you're not even thinking about it because all you're feeling is that nine. The other one might be a seven. And you don't feel that seven out of 10 pain in that second hip until that nine is fixed, has been replaced and is back down to a one or two or even a zero. All of a sudden, that other hip that was a seven that you did not feel may feel excruciating because now it's the only thing that's bothering you. All right? So, you might have two hips that need to be replaced and you're only feeling the worst one right now.
Third reason, you've likely been compensating with more weight on your less painful hip, so it could be damaging it more. So, think about it. For probably years, you've been putting extra weight on the hip that did not hurt the most. So, even if that hip started out fine, as your time goes on, as the years go on, that you're compensating, your body's compensating by putting more weight on the good hip, you may be wearing that away at a faster rate.
And the same goes for after surgery, during the recovery period, after your first hip surgery, right? you may be putting a lot more weight on your nonoperated side. I see stories and hear from people all the time about, oh, I got rid of the walker or I got rid of the crutches or the cane or whatever. I'm at home walking around on day two after surgery or at week one, I got rid of all that stuff. Well, that walker or those crutches or that cane are there not only to help you with your surgery side, but also so you don't compensate with your healthier side after surgery.
Okay?
So think again before you ditch the crutches or walker or cane and think you could just move around. Your body is going to naturally compensate by putting more weight and stress on the hip that you did not have surgery on. Well, you may be wearing that away and doing more damage to that nonoperated hip by getting rid of that walking assistance device a little too quickly. Absolutely. Get up and move around. But those walking assistance devices are there for a reason.
All right. So, put the ego away. Take care of your operated side by using the walking assistance devices and your nonoperated side as well and prolong that as long as you can. All right? So, you got to take care of both sides of your body no matter what side you had surgery on.
All right. So what about for a second surgery? What about a fear factor? Is there a fear factor for the second surgery? Because with the first surgery, it certainly was a very scary situation. And the second time around it's not as bad. It's not as bad, but there's still something certainly there.
The good news is, you know what is going to happen. You know what the surgery is going to be like. So, the second time may be a little bit easier for you mentally. You're still taking risks, though. As with any major surgery, you know, infection, blood clot, you name it, whatever the major factors are in a surgery, whatever the major risk factors are in surgery, they're happening here as well. But you kind of understand what's going on.
For me, the first time was terrifying. I was dreading it. And then, you know, leading up to it, I was absolutely terrified. The second time I was, let's get this over with. Let's do it. I know sort of what to expect. It was a little bit different. Just the whole procedure, the preop procedure was a little bit different, but I kind of knew that, all right, for three months, for six months, this is going to be my lifestyle. And I was mentally prepared for that. So having a second surgery the fear factor might be slightly reduced for you as it was for me.
What about the time between surgeries? You know is it if you're going to have a second surgery is it years later? Is it months later? Is it days later? Is it minutes later between the two surgeries? Mine were 18 months apart. And the reason they were 18 months apart is because only one of my hips hurt and I was in a situation where they were both pretty bad. But we didn't even look at the one that hurt less. The doctors and I, we didn't even look at the one that hurt less because we were so focused on that one that hurt more. And then 6 months later, a year later, as I was recovering and the pain was pretty much gone from that first one, the second one started to feel a lot worse. And then you go in, I went in for the X-rays. Sure enough, needed a second hip replacement surgery.
So, mine were 18 months apart. I see a lot of people post on social networks and I've talked to some folks about they have their second one at the same time or they're staged meaning they're a few weeks or a few months apart. I think the longer you can wait the better to give yourself the opportunity to heal that first hip and go ahead and compensate on that other non-operated hip. Now that depends on your absolute pain level. That depends how bad the situation is for you. But that's a different consideration like a medical necessity situation compared to a convenience factor of having them both done at the same time or having the mentality that well I'm going to have one done. I might as well have both done and get it over with. That's a different situation that I would recommend careful consideration of.
If you're going to the dentist and the dentist discovers two cavities that need to be filled, that need to be cleaned out and filled, in that situation, sure, you're already at the dentist. The dentist has everything that's needed to do what you need done. It's not going to take that much more time. The recovery is not going to change your life. And so you might as well get it done at the same time rather than coming back a week or two weeks later. That makes sense.
But having two hips done at the same time, I mean, not because of medical necessity, not because of your severe pain level, but just out of convenience, that's a different consideration because you're adding a lot more risk. Maybe you're not able to recover the way you would be able to recover if you did one hip at a time and staged it over a longer period of time. I don't know. Are you getting a good deal on two hip replacement surgeries at the same time? Why is the doctor recommending two hip replacement surgeries at the same time? Ask them, is it your preference or is it their preference? These are considerations.
I'd recommend waiting as long as you possibly can, several months at least to let that six months, if possible, to let that first hip heal and you go through that recovery process, go through some physical therapy and really start being a little more mobile on that side.
Now, there are different types of surgeries. And if you're going to have your second one, one thing to consider is, do you go to the same doctor? Do you have the same type of surgery? Meaning lateral or anterior? Well, if you were happy with your doctor the first time, maybe go to the same doctor because they have all your records. They know what's going on. They've already seen what your anatomy looks like. Maybe going to the same surgeon would be helpful.
I had mine done with the same surgeon because I was comfortable with that surgeon and I had done a lot of due diligence before my first surgery anyway. Plus, I wanted the same type of components on both sides of my body and both my hips. So, I went back to the same surgeon.
All right. What about the type of surgery? the anterior or the posterior? If you've had if you started with the posterior, should you switch to anterior or vice versa? It makes sense to me to have the same type of procedure. Mine were both anterior. And the reason I wanted that was so that number one, I knew how to recover. The physical therapy was the same or very similar. The restrictions were the same. I knew what to expect. I did the due diligence upfront to know that the anterior approach was right for me. I cannot sit here and tell you that this approach or that approach is better for you. That's your decision. You and your surgeons with your surgeon's input. That's your decision.
So, but I do recommend if you've had one, try to stick with the same type unless you've had complications from that first one.
Make sense?
What about the rehab? Is the rehab any different after your second hip replacement compared to your first one? Well, it should be relatively similar if a long enough time has passed. Maybe the techniques have changed. Maybe the equipment has changed. Maybe the physical therapists and the surgeons want to be more aggressive on your timeline because you did so well before. Or research has shown that it's better to be more aggressive or it's better to be less aggressive. Or maybe your age has changed. Maybe you were 50 on your first one and now you're 65. Well, yeah, your physical therapy may change a little bit because of your age and your change in body composition, but know that while you're going through the physical therapy, you're going to be putting more stress on the non-operated side.
So this is why you kind of want to spread the time out. There might be some things if you have surgeries too close to each other. There might be some movements or some stretches or exercises that you cannot do correctly or do at all because of that other hip. So, if you're working on your right hip, but your left hip has also had surgery, maybe you cannot get into certain positions or you're not strong enough in the muscles around your hips and your butt and your legs to do certain things.
So, yeah, the rehab may change depending upon how far away your surgeries are from each other. Ideally, if you can wait longer, your body will be in a better position to do more of the exercises and stretches and physical therapy. So, that's another reason why I recommend waiting if you can. Again, if you're in pain or you have some other medical condition or some other limitation, that changes the dynamic completely.
What about leg length discrepancy? You know, maybe you've heard about this. This is where one leg is going to be maybe a little bit different length than the other one after surgery. And a lot of people say that, well, your body's going to compensate. Your body will make up for it. And I disagree with that. And the reason I disagree with that is because number one, I felt it and I continue to feel it and I'm 10 and 12 years past my surgeries.
But consider this. A lot of people have leg length discrepancies from birth. They're just born with different leg lengths. But if that is the situation, your body over time will develop the muscles and the tissues to do its best to compensate over time. So maybe your back gets stronger on one side, maybe your leg gets stronger on one side. Okay? Over 10, 15, 20 years, your body will fix that. But when you abruptly have surgery and your leg length is different, your body cannot compensate naturally. It's not going to grow muscle. It's not going to develop the muscles. It's not going to develop the flexibility in certain muscles to compensate for your different gait, for your different walk, for your different strides, for your different balance. It cannot do that like it would have if you were born that way and you have 20, 30, 40 years for your body to develop that way. So when it's abrupt, you're going to feel it.
And when you have one hip done, you might feel it a little bit, but when you have two hips done, well, on a positive note, you may be able to fix an issue that was caused the first time, but it also may create other issues. It may create a leg length difference, and you're going to notice that a lot different, a lot more than you would have with just one surgery or obviously no surgery. And if you don't fix this with stretches or exercises, your body is going to compensate the wrong way. Your body's going to actually could actually hurt you by leaning a certain way, by giving you a limp, by putting too much stress on a different joint.
So if you have two hips done, this is also certainly possible if you have one hip done certainly. But when you have two, it just more than doubles the risk. All right? When you have two hips done and you have the possibility of leg length discrepancy, your body may be compensating and it may impact your back, your other joints in your body like your knees, your ankles, and your body's not going to grow and develop the flexibility or the muscle mass and tissue to compensate for that. All right. So, it's going to rely on impacting a joint, which is something you don't want. You don't want more wear and tear on a joint because your leg lengths are different.
This is just something that is to consider following a second hip replacement surgery. Again, certainly after one hip replacement surgery, you can have a different leg length, but at least one side of your body is natural and that will compensate a little.
But also consider not only the leg length, but what if the implant is put back in in a different position? This is what slightly happened to me. My second hip implant is slightly forward of my first implant. So my legs are not aligned and my leg is actually turned out a couple degrees. So when I'm standing straight looking, if I were looking at you, standing right in front of you, my one foot, my left foot would be pointed right at you and my right foot would be angled out a little bit. That's what straight is after two hip replacements for me. That's simply where the surgeon positioned the second hip. If you don't have a second hip replacement, you don't have to worry about an artificial placement of that second hip. Is that making sense?
I've said this a thousand times and I may sound like a broken record, but the way to compensate for that, the way to fix that rather than having your body do it by itself and causing stress on other joints is exercises, physical therapy, stretching, and possibly a shoe insert, which I wear all the time. All right. You want to level out where those hips are so you don't feel like you're standing in a hole or putting too much stress on one side of your body and one specific joint in your body. If I don't fix my leg length and the different angles of where my hips are located, I will have pain in the knee on my shorter side and pain in the hip of my longer side.
All right. Now, another thing that I was never warned about is that and it's been quite a shocker. It's subtle, but I notice it is that my coordination is slightly off. I don't feel like I'm connected to the ground as much as I was before. So when I went from zero to one hip replacement, I felt like my connection to the ground was slightly disrupted because I still had a natural hip on one side. But when I got that hip replaced, I feel like I've totally lost my connection to the ground and I feel like I'm topheavy. As if my legs I have to focus really hard to get my legs to do what I want them to do rather than things happening naturally as in the past.
So let's talk about that coordination. So let's say on a coordination level of zero to 10, I used to be a nine out of 10. Now, after two hip replacements, I'm about a seven out of 10. That's noticeable. I grew up being an athlete with very high coordination, excellent coordination between my upper body and my lower body. I knew what they were both doing because I could feel it. After my first hip replacement, I lost that a little bit. After the second one, I lost it a little bit more.
And it's not just the nerves because I had the anterior approach. The nerves in the front of my thighs were numb for a long time, for years. That has come back I would say 90 to 95%. But still I am not as coordinated. I cannot feel the ground as much as I used to. So, I don't feel as connected and my awareness is different.
And let me give you a golf example. Even if you're not a golfer, this could apply to a lot of different activities for you. So, when you golf, the upper and the lower body have to work together and they have to be in sync while simultaneously moving in different directions. That's the golf tip of the day. Upper body and lower body in sync while moving in different directions. All right. That used to come natural to me. But after it was sort of there after my first surgery, but after my second surgery, I totally lost it. I basically had to relearn how to golf, how to coordinate more between my upper and my lower body.
In the past, I could feel if something was wrong. I can't feel it as much anymore because my upper body does not seem to be connected to my lower body and my lower body doesn't feel as connected to the ground. Now, I think that's because I have these pieces of metal and ceramic between the bones of my legs and my hips and upper body. Maybe that's preventing the flow of something. I don't know. I'm not in tune with the universe like that. I can just tell you that I can feel a difference.
So, I really have to focus and concentrate really hard to make good golf swings, good balanced golf swings. And again, if golf's not for you, you may notice this more if you have two hips replaced, than one hip replaced, and certainly more than if you didn't have either hip replaced. I'm just telling you that my body feels different with two hip replacements. It's not life-threatening or painful by any stretch of the imagination. I'm really comfortable. I hardly feel any pain. I feel stiffness if I don't do my stretches.
But as long as I stretch, and again, do both sides because you're protecting if you're doing physical therapy and stretches and exercises, do both sides of your body because you're not only trying to recover from the hip surgery, you're trying to recover from the damage you've probably been doing for years. And you're also trying to protect that nonoperated side. And if you have two hip replacements, you're trying to protect both sides with stretches and exercises and flexibility.
So the question, two hip replacements is doable. One is doable. Two is doable as well. It adds some complications. It adds some other things to consider. And the question if you're faced with a second hip replacement surgery, the question is not can you survive another hip replacement surgery. The question is can you rebuild the symmetry, the confidence and the strength with artificial hips on both sides of your body? Because one surgery plus one surgery does not equal two surgeries. The two surgeries are not the same. That second one adds a lot more things to consider, but it's doable.
If you need to do it to stay out of pain to live your fullest life, you can do this. There's a lot of people who have two hip replacement surgeries and are back to a full active lifestyle that they enjoy. If again, if the pain is preventing you from the lifestyle that you want, then the decision to have a second hip replacement surgery is done for you. It's kind of a no-brainer, but there are complications that you will be able to address.
I hope this is helpful and thanks for tuning into The Hip Replacement Podcast. Until next time, I wish you the best recovery possible.
Take care.
