Hip and shoulder surgery - order?

[Scuba]

I got good news and bad news today.

My hip ortho doc recommended I have hip replacement surgery. I consider this good news. The diagnosis is osteoarthritis with subchondral cysts, and I’ve been dealing with hip pain and inability to do various activities such as hiking and even lap swimming without pain for almost a year and a half. After losing 15 lbs and doing PT exercises every day except one for the past 3 months, with no real change, the doc recommended hip replacement. I’m actually kind of excited about this because I’ve read and heard that recovery is pretty quick for most people and most feel great afterwards and wish they’d done it sooner.

The bad news - I had a fall in March that resulted in a partial thickness tear of my rotator cuff. I’ve done 8 weeks of PT plus daily exercises, and the pain is really bad, worse than when I started. Pain wakes me up 2-4 times every night. The bad news is that my shoulder doc thinks I need surgery to repair it. Ugh. Shoulder surgery has a much longer recovery.

If anyone has had both of these surgeries, what are your thoughts on the order to do them? The shoulder is much more painful, so fixing it first seems logical. Also I’ve read that delaying repair of the rotator cuff can actually cause more damage and make the ultimate repair more difficult. OTOH, recovery from hip surgery is usually quicker so maybe get that taken care of first?

 

[Marita40]

As a veteran of shoulder surgery (also partial tear) I'd recommend it first, mainly because your pain in worse there. Pain at night is the definite indicator that you have the tear, as my surgeon explained. The rehab is long and tedious, but well worth it of course. Plan on 4-6 months of physio. I experienced stiffness and soreness (not really pain--no real "pain" except for the first couple days after surgery) for about 8 months, then suddenly was 100%. That was two years ago, and now I'm booking big toe fusion surgery which will be another long, long recovery. BTW, there are a couple Facebook sites for shoulder surgery than helped a lot, including how to prepare, what to expect, etc. Good luck!


You will need your shoulder to help you when the hip is done, and if the shoulder hurts it will really hurt then.

 

[Lucie]

Would you be using a walker or crutches after hip surgery? It sounds difficult and painful with a bad shoulder. What order did your surgeons recommend?

 

[Aerides]

Personally I've avoided shoulder surgery twice, but for lesser injuries, and plan to avoid it like the plague. But in your case I'd do it first:

I assume you're at the pain phase with your shoulder where injections don't help, and some nights, dread going to bed. You know it's going to wake you up when you move. It's a source of stress overall on your body.

I believe you need to resolve that, be out of other stress/pain, and able to sleep properly to recover when you have hip surgery. Doing the hip with that all still going on with the shoulder might impair your recovery on the hip. You'll also want to depend on your upper body during the early parts of hip-rehab.

Read and prep a lot. Stuff your (male) doctor won't know much about. How to get dressed, bras and shirts to accommodate an immobile shoulder.

 

[Scuba]

Thanks for the great advice! The shoulder doc originally recommended doing the hip first because shoulder surgery has such a long recovery and I’d likely have to wait at least 6 months after shoulder surgery to do the hip. However this doesn’t really consider the fact that my shoulder is in a lot of pain and my hip pain is not as bad.

I guess another consideration I hadn’t thought of is financial. I could probably squeeze both surgeries into 2022 if I do the hip first. Much more iffy if I do the shoulder first. Since I have never before even met my deductible, let alone my out of pocket maximum, it’s appealing to get both done in the same year. But the higher priority is what makes sense health wise and I agree that hip surgery recovery may need a strong upper body to use the walker I’ll have initially.

 

[Ian S]

While I haven't had hip surgery, I've had full tears of the rotator cuff in both shoulders, both of which were repaired via surgery after conservative measures failed and the pain worsened. The problem with the shoulder surgery is as others have suggested the recovery. You are in a sling typically for six weeks then several months of P.T. It is the latter that I found toughest. The first several weeks consisted of the therapist getting your motion back followed by strength of the muscles. The pain during the sessions could be very intense at times - afterwards, I'd be exhausted for the rest of the day. P.T. went on for several months and it was close to a year before the either of the shoulders were back to about normal. You didn't say if the shoulder was your dominant arm; if it is it will be more difficult to do routine tasks for the first couple of months. Practice before your surgery with the non-dominant arm especially for toilet and bathing tasks. I don't know what to suggest as far as the best order for the surgeries. Good luck!

 

[Marita40]

Probably the worst thing for me with the rotator cuff surgery was having to sleep in a recliner for at least 2 months. I didn't get a lot of sleep, especially in the first couple weeks. I took 6 weeks off work and really needed all of those 6 weeks to recover enough to go back to work.
That said, I live alone, am right handed, and this was my right shoulder. I hired help as needed (ie someone to clean, open things I couldn't open, rake the yard, grocery delivery as I couldn't drive, etc) and while not a walk in the park it was manageable. We do what we need to do.

 

[Traveller2021]

I got good news and bad news today.

My hip ortho doc recommended I have hip replacement surgery. I consider this good news. The diagnosis is osteoarthritis with subchondral cysts, and I’ve been dealing with hip pain and inability to do various activities such as hiking and even lap swimming without pain for almost a year and a half. After losing 15 lbs and doing PT exercises every day except one for the past 3 months, with no real change, the doc recommended hip replacement. I’m actually kind of excited about this because I’ve read and heard that recovery is pretty quick for most people and most feel great afterwards and wish they’d done it sooner.

The bad news - I had a fall in March that resulted in a partial thickness tear of my rotator cuff. I’ve done 8 weeks of PT plus daily exercises, and the pain is really bad, worse than when I started. Pain wakes me up 2-4 times every night. The bad news is that my shoulder doc thinks I need surgery to repair it. Ugh. Shoulder surgery has a much longer recovery.

If anyone has had both of these surgeries, what are your thoughts on the order to do them? The shoulder is much more painful, so fixing it first seems logical. Also I’ve read that delaying repair of the rotator cuff can actually cause more damage and make the ultimate repair more difficult. OTOH, recovery from hip surgery is usually quicker so maybe get that taken care of first?

I had shoulder repair and I was 59. Hang on, pt didn’t help me. Full work out 2-3 days a week for 6 months helped and massage therapy ….. I had frozen shoulder. SO BE PREPARED TO WORK

 

[Aerides]

One more thing on the PT - your shoulder injury was only in March, so it's got a chance to calm down. It will need to be repaired most likely, but maybe not. My Dad (older than you) has a rotator cuff tear that makes him a candidate for a shoulder replacement, but he does the exercises from PT very regularly and avoided surgery for a couple of years and now has almost no complaints. Takes advil when needed.

My shoulder was a bear, different injury (calcified tendonitis from a tear). PT helped only so much, but laser heat therapy and a massage gun and it broke up the calcification enough that I'm fine now.
Meanwhile I aggravated an older SLAP tear a few months back in November - the tendons connecting your shoulder to your arm/bicep. Only true path forward is surgery. But for me cortizone works like magic, my Doc gave me lots of tips on what to do and what to avoid, and for now I think it's calmed down again. Month 4 since the shot and I'm still good...I still know it's there, but with a pillow under my arm I'm good at night.

So, while I understand the rush to get back to real life and healthy, personally, since your shoulder injury is so fresh there may be steps with PT and pain management you can talk to put it "back in it's pram" and back into 2nd place. Since your DH is also recovering from his heart scare, I think perhaps taking the next 2-3 months to try everything possible to avoid shoulder surgery is the thing to do. Talk to your PT doc and have them throw the kitchen sink at it.

But then, if nothing works, still shoulder then hip.

 

[Marita40]

In fact, to add to what Aerides stated, the protocol here in the U.S. is typically a cortisone shot plus PT before they will move you to surgery. I was sure the cortisone shot worked! Heaven for an entire month--pain free. But then it wore off and the pain was more intense than ever. Same with PT which just made things worse. At that point, the MRI definitely showed the tear that needed surgery.

 

[Montecfo]

Scuba, you are getting some good input here. I have not had those surgeries so no help. But I do wish you the best going forward and for a full recovery for your husband!

 

[aaronc879]

That's a really tough situation. I think you will need to deal with the hip pain for another year or so and do the shoulder first. Hip replacement is not as easy as some suggest. You will need fully functioning arms to help out for the first couple months and don't expect full recovery for at least a year. I still have pain issues 4 years after THR surgery when I do too much activity.

 

[Scuba]

Thanks for all the comments and advice. Unfortunately it is my dominant shoulder (right). Same with hip. Today at PT, I experimented with a walker. The therapist instructed me to put very little pressure on my right foot and lean on the walker as I moved. I’m now confident I will not be able to do this and walk very far with my current shoulder condition.

The therapist suggested trying a cortisone shot in my shoulder, having the hip surgery, and seeing how things go with the shoulder. He suggested this because hip surgery usually has a pretty quick recovery compared to shoulder surgery, plus this would hopefully allow my shoulder to have a lot less pain while recovering from the hip surgery.

Going to run this idea by my doc, and also getting a second opinion from another shoulder doc. Shoulder surgery is no picnic so I want to be confident that it’s needed.

 

[Aerides]

The therapist suggested trying a cortisone shot in my shoulder, having the hip surgery, and seeing how things go with the shoulder. He suggested this because hip surgery usually has a pretty quick recovery compared to shoulder surgery, plus this would hopefully allow my shoulder to have a lot less pain while recovering from the hip surgery.

Going to run this idea by my doc, and also getting a second opinion from another shoulder doc. Shoulder surgery is no picnic so I want to be confident that it’s needed.

Yes it that works for you, great. Cortizone can give you months of relief - easy to think you're healed. I find most shots take about a week to fully kick in, and can often be repeated once or twice with no worry (some will say "oh but nerve damage" but not remotely my experience and I've had several). But for some people they do nothing.

If you take this route, also continue the PT with emphasis on getting your shoulder as strong and fit as possible before the surgery. You want to go in with atrophy to spare.

 

[PatrickA5]

You might get the shots right before the hip surgery.

I've had two bad shoulders since a car accident a couple of years ago. I haven't had an MRI to tell me exactly what the problem is, but have had shots a couple of times and they work great - usually for a couple of months.

Doesn't work for everybody. I had neck shots before my neck surgery and they did nothing.

 

[PatrickA5]

You might get the shots right before the hip surgery.

I've had two bad shoulders since a car accident a couple of years ago. I haven't had an MRI to tell me exactly what the problem is, but have had shots a couple of times and they work great - usually for a couple of months.

Doesn't work for everybody. I had neck shots before my neck surgery and they did nothing.

 

[Scuba]

I did some research on cortisone shots today. My doctor had said he didn’t recommend it in my case and I wasn’t sure why. After researching, I determined a few things. Maybe most of you already know this, but I didn’t.

1. Cortisone shots help people who can’t do their PT exercises due to inflammation/pain.
2. Cortisone shots don’t heal rotator cuff tears and aren’t intended to be a long-term solution.
3. Cortisone shots can be quite damaging to tissue and even bones. There are quite a few studies published since 2015 indicating that having these injections prior to surgery can increase the risk of a poor outcome.

While I’m tempted to get a shot just to cut down on my pain in the near term, I’m going to take the long view and just focus on getting the long-term solution in place via surgery.

 

[Marita40]

You are correct with your research on the cortisone shot. Especially #2. If you have a rotator cuff tear, they will certainly not heal it but temporarily mask the pain. It is not therefore a long term solution. #3 is also true. I got one shot in my shoulder as part of the protocol leading to surgery and subsequently did this research myself. I'll never get another one.

 

[Aerides]

1. Cortisone shots help people who can’t do their PT exercises due to inflammation/pain.
2. Cortisone shots don’t heal rotator cuff tears and aren’t intended to be a long-term solution.
3. Cortisone shots can be quite damaging to tissue and even bones. There are quite a few studies published since 2015 indicating that having these injections prior to surgery can increase the risk of a poor outcome.

I would disagree with #1. (ie, I can do the PT, but it will take weeks to see relief, and meanwhile I can't sleep, pls jab me!) Even if you are still mobile and can move, then a shot helps you with everything else. Pain and inflammation both get (temporarily) resolved. So, if you can or can't do the PT, a shot is still a viable choice.

As for #3, there are studies to that effect, yes, and there are also tons of people (like me!) who don't have issues from them. I'm not sure what the percentage or risk is, but at least for me, I've used them to buy time to avoid surgery, if possible.

Oh, and if you don't like any needles, then these are not for you. A cortizone shot is a much longer jab, doesn't really hurt but does feel odd, and take several seconds to go in. On my last one, my ortho doc asked me a question right when he started, so I was talking. The needle got just far enough in and I stopped and took a breath... he said..."go on, keep talking" I guess to keep me relaxed and keep my mind off it.

 

[Chuckanut]

I did some research on cortisone shots today. My doctor had said he didn’t recommend it in my case and I wasn’t sure why. After researching, I determined a few things. Maybe most of you already know this, but I didn’t.

1. Cortisone shots help people who can’t do their PT exercises due to inflammation/pain.
2. Cortisone shots don’t heal rotator cuff tears and aren’t intended to be a long-term solution.
3. Cortisone shots can be quite damaging to tissue and even bones. There are quite a few studies published since 2015 indicating that having these injections prior to surgery can increase the risk of a poor outcome.

While I’m tempted to get a shot just to cut down on my pain in the near term, I’m going to take the long view and just focus on getting the long-term solution in place via surgery.

I stopped cortisone shots in my knee when I learned that over time they can actually increase the amount of damage to the cartridge. If you're stuck in a hole, stop digging.

 

[Montecfo]

I stopped cortisone shots in my knee when I learned that over time they can actually increase the amount of damage to the cartridge. If you're stuck in a hole, stop digging.

But if the alternative is knee replacement, you get a new joint. So damage to the old less an issue?

 

[Montecfo]

I stopped cortisone shots in my knee when I learned that over time they can actually increase the amount of damage to the cartridge. If you're stuck in a hole, stop digging.

But if the alternative is knee replacement, you get a new joint. So damage to the old less an issue?

Since Scuba is contemplating repair to her shoulder, caution does appear to be indicated.

 

[pacergal]

I have had surgery on both shoulders, and will do home PT for life to maintain mobility.
I was able to limp along for 4 years after surgery on the right by doing the PT and getting cortisone every 6-12 months on the left. Recovery from shoulder surgery is not as easy as some joint surgeries.

If you can get some relief and sleep by doing PT and getting injections, I would get the Hip replacement first. But only if by putting more pressure on the shoulder from using walker, etc after TKR does not make shoulders worse.

Best of luck in your decision, and great idea to get second opinions with both knee and shoulder ortho docs.

 

[Calico]

My heart goes out to everyone who has dealt with shoulder surgery of any kind, and the requisite recovery efforts.

I broke my left shoulder four years ago (face-planted on a brick sidewalk due to tripping on uneven bricks, and my left side took the brunt of the fall - and no, there were no substances involved!) It was a bright sunny morning and I was stone cold sober; just walking too fast to get to an appointment.

I met with a very competent ortho surgeon, and she said while it was a very bad break, it was also a "clean" break, and she recommended doing everything I could to avoid surgery to repair it.

I followed her instructions to the letter re: immobilizing the shoulder completely for two weeks, followed by four months of fairly painful (at first) PT, and I religiously completed the daily PT exercises at home on the days I did not see the physical therapist. I remember I also had to sleep sitting up for some weeks initially.

Having read this thread, I am eternally grateful to that ortho doc for helping me avoid surgery.

Good luck to all who are contemplating and/or dealing with shoulder surgery issues.