When the bone in both hips is dying in a young man, should both hips be replaced at once?
Dr. Mahajan is Chairman Orthopaedics, Joint Replacement & Chief Robotic Joint Replacement at Max Smart Super Speciality Hospital, Saket.
A man in his thirties had had leg pain for a year and a half, with one leg slowly getting shorter, and had seen many doctors before Dr Ramneek Mahajan treated him.
How did it start?
The patient says he had had pain in his legs for about a year and a half, and after a while one leg began slowly getting shorter.
Who did the patient see first?
The patient says he had treatment and went to many doctors, some of them far away.
What worried the patient's family?
The patient says his family worried because it was a big operation: how he would sit, what would happen, and that he was not yet at the age for it.
What did Dr Mahajan find, and why both hips at once?
Dr Mahajan says the patient had avascular necrosis: the ball of the hip joint loses its blood supply and starts to break down. It was at stage four, the last stage, when the joint itself is breaking down, and the treatment was a hip replacement. Because the patient was young and fit for surgery, the decision was to replace both hips together, in a single operation on the same day.
What changed after the operation?
Dr Mahajan says the patient is out of bed and walking with a support, not yet unaided, because both hips were replaced.
The patient says that, two days after the operation, he is now sitting and walking, and the leg that had become about two inches shorter is as it should be.
What should a young person with hip pain ask?
This is one man's story, not a promise: what an operation can do for you depends on your own case.
Dr Mahajan says a young person should not ignore pain around the hip, back or knees, especially after a recent bout of COVID, so that avascular necrosis can be found early.
If one leg seems to be getting shorter, ask whether the hip could be the cause.
If both hips are affected, ask whether they can be replaced at the same time, and what the first days will be like.
What this case teaches
Avascular necrosis can progress from a healthy hip to a collapsed ball and severe arthritis at stage IV, the American Academy of Orthopaedic Surgeons says.
An MRI scan can show early avascular necrosis that an X-ray misses, the American Academy of Orthopaedic Surgeons says.
In hip replacements for avascular necrosis, 94% of implants were still in place at 15 years, a 2025 study of 99 hips found.
