So I want to compile a list of things I don’t understand about the operation, and my concerns. I will add answers as I progress and find them. They are in no particular order

 

1 — If the pain seems to centre in the middle of my left shin bone (which the xray indicates is the more damaged side) then could the problem also be my knees and should they be xrayed.

2 — Any mattress, even if very firm, is causes too much pain for me now to sleep on, I can only sleep on the floor on a yoga mat. If I have an operation on one side, there is no way they will let me sleep on the floor in a hospital, and when I leave, then will I be able to get up and down off the floor? How will this be managed.

Sleeping after surgery
Hospitals usually don’t allow patients to sleep on the floor, and after a hip replacement, you probably wouldn’t be able to get down or back up safely for several weeks. Getting up from floor level involves deep bending at the hip, which increases dislocation risk.
If you’re staying in a cheap hotel after discharge, a recliner won’t be an option—but removing the mattress and using a flat wooden frame with your yoga mat could be a compromise. It gives you a surface that’s low-pain but still elevated enough that you’re not struggling to stand up. You could also use thick foam mats to raise the surface higher.

The 90-degree rule
This is a standard post-operative precaution where you’re told not to bend the hip past 90 degrees to avoid dislocating the joint. That means no low chairs, no crouching, no sitting on low beds. Unfortunately, this is hard to follow in much of Asia—especially for someone 188 cm tall, as most furniture will be far too low.

But here’s the good news:
Not everyone needs to follow the 90-degree rule anymore. It depends on:
– The surgical approach
– Anterior approach (from the front) has a lower dislocation risk and often doesn’t require movement restrictions.
– Posterior approach (from behind) has a higher risk, so precautions like the 90-degree rule are usually enforced.
– The implant type
– Dual-mobility implants and large-head implants are more stable and less likely to dislocate. These are often chosen when patients have muscle weakness or are at higher risk of falling.

Myopathy and joint stability
If you have undiagnosed myopathy or general muscle weakness, you’re at greater risk of dislocation because the muscles won’t hold the joint as securely. Surgeons can adapt to this by:
– Choosing a dual-mobility implant
– Being more conservative with post-operative rules
– Possibly using a cemented implant for extra fixation if your bone quality is also questionable
Bring this up directly with the surgeon before surgery:

“I may have an undiagnosed myopathy or generalised muscle weakness. Will that affect the implant type or surgical approach?”

Cemented vs uncemented implants
– Cemented implants are fixed with special glue and provide immediate stability. They’re often used in older patients or those with weaker bones or muscles.
– Uncemented implants rely on bone growing into them, which takes time and requires good bone quality and muscle support.
– For someone with possible myopathy, a cemented or hybrid implant (cemented stem, uncemented cup) may be safer.

Key questions to ask the surgeon
– Will you use the anterior or posterior approach?
– Will I need to follow the 90-degree rule?
– Can I get a dual-mobility implant for extra security?
– Will you use cemented or uncemented components?
– Does my muscle strength or possible myopathy affect the plan?

Summary
There are ways to make this operation work, even in your situation. The key is to speak up clearly beforehand. Highlight your muscle concerns, your living environment, and your limitations around beds and chairs. A good surgeon can adapt the approach and implant choice to give you the safest possible outcome—with fewer restrictions and a smoother recovery.

3 — If I have a dislocation, how much will it to be put back in, where can do it. Will I be able to look after myself? How long does that risk last?

Dislocation risk period
Dislocation risk is highest in the first 6 to 12 weeks after hip replacement surgery, while the soft tissues are still healing and stabilising the joint. After this period, the risk gradually decreases but never disappears entirely, so some caution is advised long-term.

Treatment if dislocation occurs
If your hip replacement dislocates, it usually requires urgent medical treatment to put the joint back in place—a process called a closed reduction. After this, your hip will often be immobilised for 2 to 6 weeks to allow the muscles and ligaments around the joint to heal and regain stability.

Recovery and rehabilitation
During this healing period, you’ll use crutches or a walker to reduce weight-bearing and avoid stressing the joint. Physical therapy typically begins soon after reduction to rebuild strength and improve control of the hip.

Most people recover stable hip function within 4 to 8 weeks after a dislocation, but full return to all activities may take longer, especially if there are muscle weaknesses or repeated dislocations. If surgery is needed to repair repeated dislocations, recovery time can be longer, similar to the initial hip replacement healing period.

General recovery timeline
While the initial hip replacement surgery recovery usually takes 6 to 12 weeks with crutches used for 6 to 8 weeks, recovering from a dislocation specifically focuses on a shorter 4 to 8-week rehab period after the joint is put back in place.

Living alone considerations
Because you live alone in a simple room, it’s important to plan for extra help after surgery or if a dislocation occurs. Make sure you have assistance arranged, clear spaces to avoid falls, and a way to call for help quickly.

4 — If I have one implant on my left, then a while later, have the right done, does it need to be an identical implant? What if I cannot get one like that?

You do not necessarily need to have identical implants for each hip if you have them replaced at different times. Surgeons often choose the implant type and brand based on what is available, your anatomy, and their experience at the time of surgery. It’s common for the two hips to have different implants.

However, having different implants on each side can affect factors like leg length, joint mechanics, and how the hips feel. Your surgeon will try to balance these as much as possible during the second surgery to avoid problems like uneven gait or discomfort.

If the exact implant used in the first surgery is not available later, surgeons will select the closest suitable option. Modern hip implants are designed to be compatible with a range of components and allow for adjustment.

Before your second surgery, discuss with your surgeon about the implants used previously and what will be chosen. It’s important they review your medical records and imaging to plan the best approach.

5 — Previously, I woke up from anesthesia during surgical procedures. Is that a risk during this operation? Could I be trapped feeling pain? Is an epidural or similar better and/or possible for me?

Waking up during surgery under general anesthesia, known as intraoperative awareness, is rare but can happen. The risk is generally very low in planned hip replacement surgery, as anesthesiologists carefully monitor anesthesia depth throughout the procedure.

If you have a history of waking during anesthesia, it’s important to tell your anesthesiologist before surgery. They can adjust the medications and monitoring to reduce this risk as much as possible.

Being “trapped” and feeling pain without being able to move or communicate is an uncommon but serious concern. Modern anesthesia techniques aim to prevent this through careful drug administration and monitoring.

An epidural or spinal anesthesia, which numbs the lower body without putting you fully to sleep, is often used for hip replacement surgeries. These can be safer for some patients and allow you to avoid general anesthesia’s risks. However, not all patients are suitable candidates for epidurals or spinal blocks, depending on medical history and the surgeon’s preference.

Discuss your anesthesia history and concerns with both your surgeon and anesthesiologist well before the operation. They will tailor the plan to your needs to ensure you are safe and comfortable.

6 — Is it all paid upfront? How is a large amount of money transfered. Under what circumstances is it refunded?

Hospitals in Vietnam, especially private or international ones, often prefer payment upfront in cash or by bank transfer. Credit cards might be accepted but can be less preferred due to risks like chargebacks.

For major surgeries like hip replacement, you should expect to pay most or all of the estimated costs upfront before the operation.

Follow-up care policies vary between hospitals. Some include a standard follow-up period for free to address complications or issues related to the surgery, while others may charge separately for additional visits or treatments.

It’s important to clarify payment terms and follow-up care policies before surgery. Ask the hospital if they cover correction of any surgical mistakes or complications within a certain period and what costs might apply.

7 — If I go to a state hospital to save money getting a cheap MRI, how is it portable? Is it film or a picture or a written report? How will I know I am getting the correct one? Are some machines better than others? What should I ask? Will I need something specialised if I suspecy myopathy also?

 

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1. Portability: how to take the MRI to another doctor or hospital

An MRI is usually provided in a few forms:

• Digital copy: This is the most important. Ask for the images in DICOM format, which is the standard medical format used worldwide. It should be given to you on a USB or CD. This allows any doctor to open and view the full scan in detail.
• Radiologist’s report: This is a written interpretation of the scan. Ask for it in English if you plan to show it to doctors in other countries.
• Printed images: Some clinics print a few slices of the scan on paper or film, but these are limited and not enough for detailed review.

Make sure you ask the imaging centre:
– Will I receive the MRI in DICOM format on USB or CD?
– Can I have the written report in English?

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2. MRI quality and machine type: what to check in advance

Not all MRI machines are equal. For a useful scan:

• Look for a 1.5 Tesla (T) or 3T machine. These are the international standards. Machines below 1T often give blurry or low-detail images—avoid if possible.
• Ask how old the machine is, and whether they regularly use it for joint and muscle scans.
• You don’t need contrast injection for this unless a doctor specifically orders it.

Ask the centre:
– What strength is your MRI machine? Is it 1.5T or 3T?
– Is it suitable for checking both hip joint damage and muscle abnormalities?

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3. Choosing the right scan for both hip replacement and possible muscle disease

If you’re only checking whether the hip needs to be replaced, a standard hip joint MRI will focus on bone, cartilage, and joint damage.

But if you also suspect myopathy (muscle disease), you need a different or extended scan. Muscle MRIs show:

• Muscle inflammation
• Atrophy or fatty replacement
• Patterns linked to inherited or inflammatory muscle diseases

To check for both, ask for a scan of the hip joint and surrounding muscles, ideally including the pelvis and proximal thigh. This way, the radiologist can look at both the joint and the gluteal and thigh muscles.

You also need the right MRI sequences:

• T1-weighted images: Show muscle structure and signs of degeneration.
• STIR or T2-weighted images: Show inflammation, swelling, or fluid.

Ask these questions:
– Can you include the gluteal and upper thigh muscles in the scan?
– Will the scan use sequences that show muscle inflammation or atrophy?
– Is this MRI suitable for investigating both hip joint damage and possible myopathy?

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4. If myopathy is suspected: what else might I need?

An MRI can show signs of a muscle disease, but it won’t identify the exact cause. If the scan suggests anything unusual, I may need:

• Blood tests (e.g. creatine kinase)
• EMG (electromyography) and nerve conduction studies
• Muscle biopsy
• Possibly genetic testing, depending on the findings

In that case, I’d also need to speak to a neurologist, not just an orthopaedic doctor.

8 — What other tests are likely before I get a hip replacement?

Before a hip replacement, your medical team will usually order several tests to ensure you are fit for surgery and to plan the operation accurately. Common tests include:

• Blood tests: To check for infection, anaemia, blood clotting, and overall health status.
• X-rays: To assess the hip joint’s condition, alignment, and bone quality.
• MRI or CT scan: Sometimes used to get detailed images of the hip, muscles, and surrounding tissues.
• Electrocardiogram (ECG): To check heart function, especially if you have risk factors for heart disease.
• Chest X-ray: To assess lung health and detect any issues that might affect surgery or anesthesia.
• Urine test: To check for infections or other kidney issues.
• Physical examination: To assess joint movement, muscle strength, and general fitness.
• Possibly pulmonary function tests if you have lung disease.

Your surgeon will decide which tests are necessary based on your health, age, and medical history.

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Additional Questions and Answers Suggested by AI

Q: How do I choose the right hospital and surgeon for my hip replacement in a foreign country?

Choosing a hospital and surgeon abroad requires research. Look for hospitals accredited by international standards or with good patient reviews. Ask about the surgeon’s experience with hip replacements, success rates, and complication rates. Check if the hospital offers comprehensive pre- and post-operative care. If possible, get recommendations from expat forums or locals who have had similar surgeries.

Q: What about infection risks and prevention during surgery in Vietnam?

Infection risk exists with any surgery but can be minimized by proper hospital hygiene, experienced staff, and following pre- and post-op instructions carefully. Confirm the hospital’s infection control policies and ask if they use prophylactic antibiotics. Post-surgery wound care is crucial—ensure you understand how to keep the wound clean and when to seek medical help.

Q: How should I plan for post-surgery rehabilitation and physical therapy as an expat?

Rehabilitation is key to recovery. Check if the hospital offers physical therapy services after discharge or if you’ll need to arrange outpatient therapy. Find local physical therapists experienced with post-hip replacement care. Consider how language barriers or travel restrictions might affect your rehab and plan accordingly.

Q: What should I do if I experience complications after returning home?

Have a plan for follow-up care in your current location. Keep all medical records and implant details. Know the signs of common complications like infection, blood clots, or dislocation. Identify nearby clinics or hospitals familiar with hip replacements. Have emergency contacts ready, including your surgeon and local healthcare providers.

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If the posterior approach has such a higher degree of dislocation, why does anyone do it at all? 

The posterior approach is still widely used for hip replacements because it gives surgeons excellent access to the joint, which can make the operation quicker and easier, especially in complex cases. It also avoids cutting through major muscles at the front of the hip, which can mean less pain and faster walking recovery for some patients.

While it does have a higher risk of dislocation compared to the anterior approach, that risk is manageable with good surgical technique, proper implant positioning, and post-op precautions. Many surgeons are very experienced with the posterior method and trust it for reliable long-term results.

Which is the most common, posterior or anterior?

The posterior approach is still the most common method used worldwide for hip replacements.

It’s well-established, many surgeons are highly trained in it, and it works well for most patients. Although the anterior approach has grown in popularity—especially in private hospitals and in the US—for its lower dislocation risk and faster early recovery, the posterior approach remains the standard in many public hospitals and in countries where newer techniques are less common.

What is the lateral approach?

The lateral approach is a technique for hip replacement where the surgeon accesses the joint by going through the side of the hip.

It involves cutting through or splitting some of the hip abductor muscles—mainly the gluteus medius—which help lift your leg to the side. This gives good access to the hip joint and has a lower dislocation risk than the posterior approach, but it can sometimes lead to a limp or weakness if those muscles don’t fully heal.

It’s less common than the posterior or anterior approaches today, but some surgeons still prefer it, especially for patients at higher risk of dislocation.

If dual mobility implants have such a lower chance of dislocation, why are they not always used?

Dual mobility implants are not always used because they cost more, and they’re not needed for every patient.

They were originally designed for people with a higher risk of dislocation—like the elderly, those with weak muscles, or patients needing a revision surgery. For younger, healthier patients with stable joints, a standard implant often works just as well and is cheaper.

Some surgeons also prefer to stick with what they know best, especially if they’re getting good results with traditional implants. And in some healthcare systems, dual mobility implants might not be routinely offered unless there’s a clear medical reason.

If a hip brace lowers the risk of dislocation, why is it not always used?

Hip braces can lower the risk of dislocation by limiting movement, but they’re not always used because they’re uncomfortable, bulky, and can slow down recovery.

They make it harder to walk, sit, and sleep, and most patients don’t need one if the implant is well positioned and the muscles are working properly. Surgeons usually reserve braces for patients at higher risk—like those with weak muscles, poor balance, or who’ve already dislocated.

For most people, following movement precautions and doing rehab exercises is enough to keep the hip stable without a brace.

I received a quote that included ‘robotics’, what does it mean?

I cannot wear shoes other than flip flops for many years now, or soon after walking there is an unbearable pain in my thighs. I think it’s the heel, even if there is a very slight one. I have a pair of flipflops that I use as a standard, but also some watershoes and some plimsoles, both of which have completely flat bottoms.

    I assume this is to do with muscles, not being used perhaps and then overusing them. The thing that worries me is getting my hips replaced and then it changes my body mechanics and I’m in more pain again, that never gets better and so I’m worse off as I can’t walk even as much.

 
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You’re right to be cautious. But if your main concern is losing your current (limited but reliable) mobility, then the key is to treat rehab as essential—just like the surgery. With gradual training and the right footwear, you may find you increase your walking distance and comfort over time.

What’s happening now is likely due to a combination of altered gait mechanics, muscle imbalances, and chronic underuse of certain muscle groups. Your body has adapted to walking in a very narrow way. Even small changes—like different soles or heel height—can shift the strain to areas that aren’t conditioned for it. Hip replacement will change your alignment, and if you don’t prepare for it, new pain could appear even as old pain improves.

But this outcome isn’t inevitable. Most people do better after surgery if they commit to recovery and don’t rush. The people who end up worse off are usually those who:

• Skip rehab or stop too early
• Have existing nerve or chronic pain issues and no support plan
• Try to walk too far, too soon, or use shoes that don’t match what their body’s used to

Here’s what I’m doing to reduce the risk:

• Taking my current flat footwear into hospital and insisting on using it
• Explaining clearly that I cannot tolerate heel lift or rigid soles
• Asking for a physiotherapist who understands gait retraining, not just standard mobility exercises
• Doing some pre-surgery muscle prep to reduce the shock of new body mechanics

Below is the simple routine I’m using to start activating key muscles gently, without triggering pain or strain.

Pre-Surgery Strengthening Routine

1. Glute squeezes
   While seated or lying down, squeeze both buttocks together. Hold for 5 seconds. Relax. Repeat 10 times, 2–3 times daily.
2. Quad tightening
   Sit with legs out straight. Tighten the muscles on the top of your thigh by pushing the back of your knee down. Hold for 5 seconds. Relax. Do 10 reps per leg, 2–3 times daily.
3. Ankle pumps
   Point and flex your feet up and down, slowly and steadily. Aim for 20 repetitions per session. Good for circulation and light movement.
4. Heel slides
   Lie on your back with legs straight. Slowly slide one heel toward your buttocks, then return. Keep movement controlled and pain-free. Do 5–10 reps per leg.
5. Seated leg lifts
   Sit in a chair, lift one foot a few inches off the ground, hold for 3 seconds, and lower. Alternate legs. Start with 5 reps each and increase gradually.

None of these should cause pain. If something feels wrong, stop. The goal is to switch on muscles that will help you stabilise after surgery—especially glutes, quads, and calves—without overloading them. Small, regular effort now can make a big difference later.

 

Will I be able to get myself out of a chair after a bi-lateral hip replacement. What about after a single-side operation? I cannot stand now from a chair (pre-operation) without using my hands and it has been that way since three decades when I first had my hips go bad. My legs look thinner but I wouldn’t say are weaker and when I finally saw a doctor about six years ago now, then physio helped me a lot in terms of pain. 

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If your inability to stand without using your arms has been caused mainly by hip damage, joint pain, or years of restricted movement, then yes—there’s a real possibility you could regain the ability to stand up without your arms after the operation.

But if the problem comes from nerve damage, a neurological condition, or deep muscle atrophy unrelated to the hip joint itself, then the surgery won’t correct that. You’d likely continue relying on your arms even after recovery, though hopefully with less pain overall.

Here’s the difference in how it could play out:

• If the weakness is due to pain, stiffness, or lack of use—then once the joint is repaired and the pain is gone, you may be able to rebuild enough leg strength and balance to stand more easily, possibly without using your arms at all.
• If the weakness is due to nerve or systemic muscle problems—then your mechanics won’t change much after surgery, though you may still gain better comfort, posture, and walking ability with aids.

Realistically, the most likely outcome is that you’ll be able to return to your current level—using arms to stand—but with less joint pain. From there, you can see if strength training allows you to go further.

To improve your odds:

• Start strengthening quads, glutes, and calves before surgery if possible
• Focus on post-op rehab that includes full-body reconditioning, not just hip mobility
• Ask for physiotherapy that targets standing and sit-to-stand transitions directly

This type of recovery takes time, especially after decades of compensating—but it is not impossible if your muscles are still responsive and the pain is reduced.