Friday Q&A: Preparing for a Hip Replacement

Brooding Woman by Paul Gauguin

Q: It looks like I am scheduled to have my right hip replaced in two weeks. Have tried to work my way thru it for the past two years using alternate modalities without much luck. Any words of advice? 59 year old male in Portland.

A: From the sound of the first sentence, I sense a bit of ambivalence about the upcoming surgery from our reader. Can’t say I blame him, although I wish I had more information about why now is the time for the surgery. For some of us who do yoga and prefer to utilize alternative therapies as a first line approach to our health, we often can feel conflicted when the Western approach seems the one we need to try. If you are in this quandary, I recommend you check out Nina’s insightful post No Shame, Please (Western Medicine and Yoga are Complementary).

The most common reason for a hip replacement in an otherwise healthy adult without a history of osteoporosis or an acute fracture of the head of the femur bone is significant osteoarthritis or wear-and-tear arthritis with secondary pain that is becoming unbearable. Most of my patients and students who have found themselves in a position of worsening hip pain due to OA are usually told by their orthopedic surgeon to return for a hip replacement when they can no longer tolerate the pain or function normally with the pain. This is partially encouraged since the hip replacement has a limited life expectancy before it may wear out and need replacing—around 15 years of so. So your doc wants to have you wait as long as you can—within reason—so you are old enough at the time of surgery that you might be able to live out your life and not need said replacement of the replacement! 

As I said, I might feel a bit ambivalent about such a major surgery, as I always like the idea of keeping my body as intact as I can. However, hip replacements have become fairly routine and are overall safe procedures, although not without risks (as for any major surgery). It turns out your mind can influence the outcomes of surgery, so it never hurts to cultivate a positive attitude towards your upcoming surgery, anticipating a good outcome. There have been studies done looking at pre-surgery attitudes and outcomes, and it turns out that having a negative expectation, what researchers call the “nocebo effect” (as opposed to the more famous placebo effect), results in higher complication rates than are normally found. So, if you notice that your thinking around your upcoming surgery is trending on the negative side, consider employing the yogic concept of pratipaksha bhavana, or cultivating the opposite (although this is about healthy eating, see this for a general idea: Cultivating the Opposite). You can do this during your meditations between now and surgery day by using a mantra that reflects your desired outcome, such as “My hip is healthy and pain free,” which you can repeat mentally as you exhale during your meditation. 

Leading up to surgery, even if it is very soon, you could also be doing a modified home asana practice that avoids poses that worsen your particular hip pain, but that keeps all the other parts of your body flexible, strong, agile and balanced, so you head into surgery with a quality of physical and mental fortitude. Consult with a seasoned yoga teacher if you at a loss as how to do this on your own. 

Also, our in-house physical therapist, Shari Ser, has written about post-hip replacements and yoga in her post Total Hip Replacements and Yoga). So read that post over to get ready to employ your yoga tools along with the post-op physical therapy visits your doctor will likely assign for you. Shari has done such a thorough job of it that I don’t want to rehash this excellent post. I strongly echo her recommendation to work with an experienced yoga teacher following your surgery.

I’d add one more suggestion, however, to working with you pre-op attitude. You might see if you can speak with your physical therapist prior to surgery and ask them to describe some of the initial exercises they will have you start in the hospital or as soon as you go home. There have been studies that showed improved healing times and shortened discharge times from the hospital from surgical patients who were taught to visualize their exercises mentally in the days leading up to when their docs would OK them to start doing actual physical therapy compared to similar surgery patients who were not taught the visualized practices. As a yoga practitioner, you may find this sort of visualization easy to practice and beneficial in the same way as the study participants.

Finally, it couldn’t hurt to focus on the quality of gratitude, especially gratitude for the fact we have access to modern surgical technology that has the potential to return you to normal daily function of your hips and pain-free movement. I’d hope that in the same situation I could utilize all these ideas to improve my chances of a successful surgery and return to activity. All the best! 

—Baxter

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