The evening after his hip replacement surgery, Andrew Cromwell walked a few laps around the nurse’s station on his floor of Keck Hospital of USC. When he finally settled into bed, he fired up his laptop computer and sent out a quick missive to let his family and friends know how he was feeling.
“I am the Bionic Man,” he wrote before turning in. By the next day, Cromwell was walking up and down flights of stairs in the hospital, albeit slowly, and was sent home with a bag of pain pills that he never used. “I never needed them,” he says.
When his hip and back began causing him pain about a year ago, Cromwell decided it was probably related to a spill he had taken at home a few months earlier. Assuming it would subside with time, he visited massage therapists and a chiropractor hoping they would help speed his recovery.
Instead, the pain became more consistent and more intense. Before long, the banking executive was having trouble performing two key functions of his job: sitting comfortably at his desk and on airplanes. Cromwell bought new chairs and adjusted the way he sat at his desk in a vain attempt to find a solution to the pain that was beginning to wear on his good nature.
He eventually sought help of an orthopaedic surgeon in Orange County who told him he had osteonecrosis, or bone death preceded by loss of blood to the bone, in the head of his femur. His doctor also said he did not have the expertise to treat him, but did know someone who did.
“He said that I should see Jay Lieberman at Keck Medicine because he is someone who has significant experience treating osteonecrosis of the hip,” recalls Cromwell.
Though there are less dramatic measures for treating early stage osteonecrosis, his condition was advanced. The team at Keck Medicine’s orthopaedic surgery program could attempt a core decompression, a procedure to try to restore blood flow to the bone, but if that didn’t work, he would eventually need a hip replacement.
At 41, Cromwell did not expect to be a candidate for total hip replacement, but he quickly learned that this procedure is no longer performed only on older people. Though surgery is never the first line of defense, particularly when dealing with young people, Lieberman, MD, professor and chair of the department of orthopaedic surgery at the Keck School of Medicine of USC and director of the Institute of Orthopaedics, notes that in cases where other potential treatments have failed and the patient’s quality of life is compromised by conditions including osteonecrosis or osteoarthritis, the team of orthopaedic surgeons at Keck Medicine have replaced hips on people under the age of 20.
While those represent unusual cases, research from the U.S. National Center for Health Statistics shows that the number of total hip replacements performed on people between the ages of 45 and 54 rose 205 percent between 2000 and 2010. One of the reasons for this is that the prostheses have improved dramatically in recent years.
When hip replacements were first performed, the prosthetic hip often wore out after 10 years, so doctors avoided performing them on young people because it meant they would need many difficult surgeries in their lifetime.
Today, however, new materials used to construct prosthetic hips last longer, work better and create fewer complications in patients. As a result, notes Daniel A. Oakes, MD, associate professor of clinical orthopaedic surgery at the Keck School and director of the USC Joint Replacement Program, some patients may now have the same prosthetic hip for upward of 25 years.
Cromwell eventually decided that having a hip replacement was his best option to keep up with his responsibilities at work and at home, as a dad to young kids who are “always on the go.” He says he was also confident that he was in good hands. The multidisciplinary team of orthopaedic surgeons at Keck Medicine is highly experienced and often deals with complex cases.
Within a few weeks of his surgery, Cromwell made his first postoperative cross-country flight for work and, to his surprise, it was the first time he had flown in many months without pain.
Because he’s in his early 40s, it is likely that Cromwell will need to have his prosthesis replaced at some point in the future. There’s also the possibility that the osteonecrosis will affect his other hip and he will face having to have a second hip replacement, but that idea doesn’t have him too concerned.
“I took a week off work after surgery, but I didn’t need more than a couple of days,” he admits. “I feel great and I wouldn’t think twice about it if I had to do this again or if I have to do this on the other hip.”
by Hope Hamashige