Hip replacement is no longer just for older adults, thanks to better implants and advanced surgical techniques.
With his left hip and knee aching and all his recreational activities curtailed, Scott Shuster made one of the best choices in his life. He sought a second opinion for possible medical treatment. That decision led the retired Marine Corps officer to reject a questionable knee surgery for a hip replacement that has turned his life around.
Last Thanksgiving, retired Marine Scott Shuster could barely climb stairs or walk upright. Riding his beloved motorcycle was a distant memory.Photo for UCI Health by Michael Neveux
“I wasn’t happy with my consultation with the first orthopedic surgeon, so I went back to my primary care doctor and asked for an alternative,” says Shuster, 55. “That’s how we came up with the idea to get a second opinion at UCI Medical Center. It’s been a very positive experience.”
Corinne Shuster says her husband is no longer hunched over and shuffling when he walks. “He’s like a different person. He can climb the stairs. He can get down on the floor to play with his grandkids. And he can sleep without pain.
Patients seeking help for joint pain from UCI Health experts can expect a thorough, unbiased evaluation and recommendations that include state-of-the-art technologies and treatments, says Dr. Steven Yang, the UCI Health hip replacement specialist who fixed Shuster’s painful left hip in December.
Consider a second opinion
Patients with serious, highly painful or complex medical conditions are wise to seek second opinions at academic medical centers, where the latest technologies and treatments are tested and taught, says Yang, an assistant professor of hip and knee arthroplasty at the UCI School of Medicine.
“Sometimes the answer isn’t joint replacement,” he says. “We do what is best for the patient. We have the resources to offer the best, most comprehensive care. Our team-based approach, with specialists who can address the full range of surgical issues, is what truly sets us apart.”
During his consultation with Yang, Shuster said the first surgeon told him that he was too young for a hip replacement. Yang diplomatically explained that hip replacement technology and surgical techniques have evolved significantly in recent years. No longer is it limited to people over age 60.
Shuster retired from the military in 2008 as a decorated lieutenant colonel. Two decades spent in combat armor and carrying heavy loads took a toll on his joints. Even after taking an office job as a sales director, he relished an adventurous, active life — riding his motorcycle, working out and running.
About six years ago, he began to experience stiffness and pain in both hips and knees. He finally sought medical help about two years ago, trying nonsurgical remedies such as physical therapy and medication.
But the pain in his left hip, caused by severe osteoarthritis, worsened. He developed a limp, gradually gave up physical activities and saw an orthopedic surgeon near his Chino Hills home.
Modern implants not only last longer, improved surgical techniques also make recovery faster, says UCI Health orthopedic surgeon Dr. Steven Yang. Photo by UCI Health
Too young for hip surgery
“The first surgeon said I was too young to be a candidate for hip replacement because the hardware would only last 15 or so years before it would have to be replaced,” Shuster recalls. “He suggested I wait five or six years. He wanted to do knee surgery instead. Dr. Yang said, ‘Your knees aren’t the problem. Your knee pain is probably due to your hip.’”
Yang says it’s a common misconception that hip replacement surgery should be delayed until later in life so the implant doesn’t wear out and need replacement.
“Implants have gotten much better. The idea that your joint replacement will last 15 years is largely not true anymore with modern implants. An average 50-year-old with a new implant — barring some catastrophic injury — should expect it to last a lifetime.”
Spare the muscle, speed the healing
Shuster got more good news from Yang. Hip replacement surgery no longer requires months of recovery time.
Instead of the traditional method of replacing the hip joint by making an incision in the side or back of the body (known as the posterior approach), Yang uses a surgical technique known as anterior hip replacement.
The incision is made in the front of the hip, allowing the surgeon to avoid splitting the major muscle surrounding the hip joint. Evidence from clinical trials also suggests that anterior hip replacement surgery lowers the risk of hip dislocation — a potential complication of surgery, Yang says.
“We know these muscle-sparing surgical techniques are important for faster recovery. Patients nowadays are able to be more active earlier.”
Shuster was impressed by how fast he bounced back after his surgery. “Dr. Yang told me I would heal faster and there would be fewer restrictions in my movement. I think I’ve healed even faster than he thought I would.”
The doctor credits his patient. “A lot of the success of hip replacement surgery has to do with patient motivation,” Yang says. “Scott is a motivated guy who wants to do what it takes to get better.”
Other advances make the surgery more tolerable for patients of any age by controlling pain even before surgery, he adds. “Before, we used to do the surgery and we’d catch up on pain control afterward. We know now that treating the pain before it happens is helpful.”
Medications to reduce pain are also applied directly to the tissues during surgery, and the postsurgical pain protocol includes minimizing the use of opioid pain relievers. Opioids are associated with an increased risk of drug dependence and should be used cautiously, Yang says.
“We attack postoperative pain in a number of different ways. We are more sensitive to using opioids. We use nonsteroidal anti-inflammatory drugs (NSAIDs) and medications that target nerve pain and muscle spasms,” he says.
Shuster is thrilled to be able to roughhouse again with his grandchildren — Melody, 3 1/2, and Evan, 11 months.Photo by Michael Neveux for UCI Health
Rumbling and tumbling
Hip replacement patients are often discharged after one or two days. After rehabilitation and a recovery period of about three months, they usually can resume their lives in full, Yang says. Years ago, patients were told their range of motion would be limited after hip replacement surgery and that the implant wouldn’t last forever.
“All the improvements have made it more palatable for a younger person who is more active to have a joint replacement,” he says. “We can now tell patients that you can do whatever you want after joint replacement.”
Shuster was discharged on Dec. 11, 2020, two days after surgery. He returned to work two weeks later, elevating his leg to allow his incision to heal. By mid-March, he was working out on a treadmill. His knee and hip pain have disappeared.
He's grateful that he pushed for a second opinion.
“Everyone at UCI Health was so kind, I felt like my time was important to them, and they listened to me and communicated with me. I knew exactly what my treatment would be. Now my pain is gone. I’m so happy.”
Shuster has resumed his woodworking hobby. He has even dusted off his Triumph cruiser, tuned it up and taken it on the highway.
Best of all, he can get down on the ground and tumble with his grandchildren.