Walking Tall: Jesse's Journey Through Double Hip Replacement
A diagnosis of advanced arthritis
As a person who practices Orthodox Judaism, Jesse doesn't use a car on the Sabbath. Instead, he walks the one mile to and from his synagogue every Saturday.
During one of these walks, Jesse realized he was stepping with his right foot on the grass to ease the pain he was feeling in his left knee and right hip. Those walking alongside him also noticed a slight limp. He consulted his primary care doctor, Susan Ruth Gordon, MD, who referred him to orthopedic surgeon Antonia F. Chen, MD/MBA.
Dr. Chen takes a comprehensive approach to evaluating patients like Jesse to determine the best treatment options. "I always start with the history—the duration of pain, the nature of pain, what makes the pain better or worse," she said. "From there, I do a physical exam to see if there is any restriction of motion or pain that might indicate arthritis. Lastly, I look at X-rays, which help me determine whether surgery is needed."
In Jesse's case, the X-rays revealed advanced arthritis in his right hip joint. The images showed significant wear and tear, with the cartilage almost entirely worn away, leading to bone-on-bone contact. This level of degeneration explained the persistent pain and limited mobility he was experiencing in his right hip. In addition, it probably led to the uneven walking that caused the left knee pain.
Based on these findings, Dr. Chen initially prescribed a steroid injection. It didn't help much. Neither did two years of exercise and physical therapy. Eventually, Dr. Chen concluded that total hip replacement would provide the most effective relief. This procedure would both alleviate Jesse's pain and restore his ability to walk comfortably, improving his overall quality of life.
The hip joint consists of a ball (the rounded head of the thigh bone) and a socket (the acetabulum, which is located in the pelvis). In a total hip replacement, surgeons remove the damaged ball and resurface the damaged socket. The ball is then replaced with a metal cup, plastic liner, and a ceramic or metal head.
Robotic-assisted surgery enables greater precision
For both of Jesse's hip replacements, Dr. Chen performed robotic-assisted surgery. "Not every surgeon uses it, but I find it useful," she said. "I use a robot to place the cup with greater precision, which potentially reduces the risk of the ball coming out of the socket and other complications."
Physical therapy (PT) is crucial to the success of a hip replacement. Four weeks before his first hip surgery, Jesse began exercises designed to strengthen key tendons, ligaments, and muscles and help him recover from surgery more quickly. Since it was early in the COVID-19 pandemic, he completed PT at home with the guidance of a smartphone app that Dr. Chen's office recommended.
Waking up from surgery was a revelation. "Before the hip was replaced, I had pain in the left knee and right hip. The right abductor had been tender and sensitive as well," Jesse said. "All three got fixed on the same day. They didn't hurt anymore. It was like night and day."
Just hours after surgery, Jesse took his first steps with his new hip. Walking and other forms of movement improve circulation, reduce swelling, and help prevent bed sores and other problems associated with prolonged bed rest.
Following a hip replacement, doctors carefully monitor the patient's pain, typically starting with Tylenol and providing stronger medications if needed. Jesse was one of the rare patients who only required Tylenol to manage his pain.
Commitment to physical therapy pays off
Thirty-six hours after surgery, Jesse headed home. He attacked his postsurgical PT with relish. Once again using the smartphone app, he completed his PT every day—including the Sabbath, when he did it by memory. His dedication paid off.
Within a couple days, Jesse was climbing stairs to sleep in his bedroom. Within five or six weeks, he said, he was "pretty much fully mobile." At his six-week visit with Dr. Chen, his range of motion and strength were superb. Upon completing his 12 weeks of PT, he was able to return to tennis and other athletic pursuits.
"I tell patients that doing PT two or three times a week is great, but it's not enough," Dr. Chen said. "You need to do the exercises on your own at home, too. Jesse got back much faster than other patients because he really stayed on top of his exercises."
"If you want a good recovery, you have to invest the time in it," Jesse added.
Dr. Chen said that a timetable for returning to athletic activities varies from person to person. "It really depends on your comfort level," she noted. "What I tell patients is you can return to activities whenever you feel up to it. And there are no restrictions when doing so."
Major heart surgery delays second hip replacement
Four years later, Jesse's started to have trouble with his left hip. He consulted Dr. Gordon, who ordered X-rays that showed it might be time to have the hip replaced. Before he could explore that option, however, another health issue arose.
During his regular one mile walk to the synagogue, one of his grandsons noticed that Jesse had to stop on occasion due to shortness of breath. Several weeks later, Jesse underwent a stress test with cardiovascular medicine specialist Leonard Stuart Lilly, MD. It revealed that Jesse was suffering from clogged arteries. The next day, cardiac surgeon George Tolis, MD, told him that he would need triple bypass heart surgery.
The surgery went smoothly, and Jesse was back home four days later. About a month after that, he decided to run for the Brookline School Committee. To ensure his body could stand up to the rigors of campaigning, he wanted to have the second hip replacement surgery. But the timing would be tricky, as he was still recovering from heart surgery. Jesse contacted Dr. Lilly for his input.
"He was told that three months was enough time in between his heart procedure and the hip replacement," Dr. Chen said. "We then reached out to Dr. Lilly and coordinated with the anesthesiology clearance team to get on the same page and ensure that Jesse was safe to undergo surgery."
The surgery went very well. In fact, Jesse said that his experience the second time around was even better than the first.
"In the four years since my first hip surgery, the tools, techniques, and methodologies all got better," he said. "In that time, Dr. Chen probably did hundreds more hip replacements. And she's also heavily involved in research in the field, like how changes in protocols affect outcomes. I'm the beneficiary of all of that."
A model patient
Since his left hip replacement took place after the pandemic, Jesse was able to receive in-person home care and physical therapy this time around. Mass General Brigham's Davina Wong fulfilled these responsibilities for the first few weeks. He subsequently engaged in outpatient PT after completing his home PT.
Just 10 days after surgery, Jesse was on the campaign trail. He started with a walker, soon graduated to a cane, and was moving around with no assistance five weeks post-surgery. Better yet, he won a School Committee seat. Dr. Chen said Jesse's hard work paid off once again.
"Jesse was a phenomenal patient," she exclaimed. "He showed remarkable dedication to his recovery plan and physical therapy regimen. For both hip replacements, he did everything possible to have the best possible outcome."
According to Dr. Chen, Jesse's new hip joints have a projected 20- to 25-year lifespan, giving him many more years to enjoy his grandchildren and various recreational pursuits.
Today, Jesse experiences no limping or pain in either hip. Dr. Chen has since performed two hip replacements and one knee replacement on Jesse's wife, Brenda.
"I feel blessed that I got such an amazing care team," Jesse said. "The outcome has been perfect—I have absolutely no issues."