I said if she doesn’t get a hip replacement she’ll end up in a wheelchair; she said “That’s fine with me; I won’t mind a wheelchair.”
Afraid of surgery and that’s why you’ll never have a hip replacement even though you know that eventually this will be your only recourse?
Let’s call her Marge. She appears 50ish. She said two previous back surgeries went wrong and that’s why she won’t have the hip operation.
Marge walks off-kilter and somewhat hunched over from back and hip pain, but her job in a cafeteria requires being on her feet.
She mentioned that a doctor said she’d eventually need a total hip replacement. But then: “No way, I’m never gonna have that surgery!”
There’s another woman, Sue, who has visited this agency’s cafeteria who lives life out of a wheelchair – a younger woman who, years ago, had suffered a severed spinal cord in a car accident.
She’s considerably overweight, while Marge would be, at the most, at the low end of obesity or high end of “overweight,” according to clinical standards.
I asked Sue’s good friend if Sue had always been so large, or if she had gained the weight only since the accident; the friend said she had gained following the injury.
I’m sure that Sue would sell her soul to be in Marge’s position: able to walk, though with difficulty, with the chance for a game-changing joint replacement surgery to make walking not so painful and a lot easier.
My father and mother have had total hip replacements; this revolutionary surgery changes one’s life for the better.
How does one refuse a total hip replacement surgery, knowing that eventually, they’ll be dependent on a wheelchair?
In fact, Marge will opt for a motorized scooter; there’s no way she’ll be manually propelling herself.
This may sound like a cushy and practical existence for one who’s deathly afraid of major surgery, but there’s more to this than what seems like an easy way to live.
What Happens When You Refuse Total Hip Replacement Surgery
Marge’s choice to avoid surgery and live with progressively worsening hip osteoarthritis means she is likely to experience increasing pain to the point of inability to get around even with a walker.
As the disease progresses, cartilage loss will lead to bone-on-bone contact, causing constant pain even at rest in a scooter.
A 2015 study in Osteoarthritis and Cartilage led by Dr. David Felson found that people with advanced hip osteoarthritis reported substantial functional limitations and higher pain scores, which were strongly correlated with how severe the condition appeared on imaging.
Marge won’t just be eventually using a walker and then a scooter, but the pain will be banging on her door even during sleep, waking her.
Narcotic painkillers can do only so much. Plus, daily use at max dosage will impair quality of life.
Don’t underestimate the pain that awaits Marge and anyone else who, due to fear of general anesthesia or fear of medical malpractice, has decided that a THR is out of the question.
As osteoarthritis progresses, the increasing pain will likely lead to gait changes.
A study (Journal of Orthopaedic Research, Green et al) showed that people with severe hip osteoarthritis develop an abnormal gait pattern that increases stress on the lower back and opposite limb.
This can lead to secondary problems such as back pain and knee issues. For Marge, this means that the hip problem won’t stay isolated; it’ll impact her entire musculoskeletal system.
If Marge eventually uses a wheelchair or scooter, she may preserve energy and reduce pain walking (use of a walker will eventually become futile against the growing pain).
However, long-term chair use brings its own problems. A 2018 article in Disability and Rehabilitation by Dr. Samantha Parker reported that long-term wheelchair users frequently experience shoulder pain and overuse injuries.
This outcome doesn’t get solved with a motorized chair. Living out of a chair – be it manual propulsion or motor/electric – increases risk of pressure sores.
Living life out of any kind of moving chair means that daily life will be limited to tasks only within arms’ reach.
There will be no way for Marge to maintain upper body strength unless she performs resistance exercises – which she’ll never do.
This is a person with no history of working out, who has a very deconditioned upper (and lower) body.
Activities that many take for granted — transferring in and out of a car, reaching high shelves or even getting in and out of bed — will require assistance or adaptive equipment once someone like Marge has been living life out of a seat.
The thing is, it doesn’t have to be this way for her; a THR can give her back so much of her life.
Hopefully, someone down the road will counsel her on this. I’m not in a position to because I’ve seen her only occasionally and while she was on the job.
If Marge still opts for a scooter, this can then lead to limited social engagement and opportunities she may want to participate in such as volunteer work.
Ironically, at this agency is an employee who gets around on a scooter, though at times is seen briefly walking (and with difficulty). This individual is slated for a THR very soon, and she’s looking forward to it.
Marge, in contrast, will eventually be at high risk of withdrawing from hobbies that involve walking or standing, like gardening or shopping, which can affect her sense of identity and wellbeing.
If you’ve been considering avoiding a THR due to fear of surgery – you should have a good talk with the surgeon who recommends the surgery, and also have a good talk (if it can be arranged) with the anesthesiologist.
The total hip replacement surgery is one of the greatest medical breakthroughs, and the procedure has been honed over many decades. It’s a relatively safe surgery.
Large registry studies in The Journal of Bone and Joint Surgery and The Lancet report low mortality rates (well under 1% within 30 days) and high success rates for the long-term.
