SCFE-SLIPPED CAPITAL FEMORAL EPIPHYSIS -never diagnosed before

[TBONE]

Hi-I am a 51 y.o. male, 205 lbs. Recently, I was told I need bilateral hip replacement due severe arthritis. Frankly, I should have seen this coming in the last 5-6 years but I ignored it. I had always been thin and fit, playing basketball, triathlons, weightlifting, etc. In the last 5-7 years, that has reduced to zero and now, even the shortest walk is painful. was recently diagnosed by a wonderful OS, but was never diagnosed as a child, when it likely occurred and never addressed until earlier this year. I recall no pain, etc as a child, or adult except I do recall in my later teens and twenties, not being as flexible as I wanted to be.
I should also say that I've seen 3 reputable OSs, all of whom recommended bilateral total hip replacement.  I went to the 3rd OS because the others wouldn't really give me an opinion on resurfacing, which I found troubling.   The 3rd OS, and the one I am using, spoke very highly of the resurfacing procedure, the benefits and the results, and even said that I would be a candidate for resurfacing.  However, he also said that, on balance, he recommended total hip replacement, which I have scheduled for April 1, 2009.  I confess that I really didn't press him on his analysis much but I am comfortable with my decision and with him as my surgeon, so if I am on the wrong site with my question, please let me know.
My question relates to whether there may be complications with my hip replacements peculiar to my situation-undiagnosed and uncorrected scfe-and the fact that I have been functioning on essentially deformed hips for 40 or so years. Also, might resurfacing lessen those complications?  Might special prostheses be required? Will my gait be limp free? will my implants need to be specially measured?  I understand the risks of hip replacement and of resurfacing and I am prepared for these risks, but are there any special risks with this condition and the fact that I have had it for 40 years?  Has anyone ever had my type of predicament?
I understand that these are questions also to be posed to my OS, but I thought I'd try here as well.
Thank you for any responses.
Tom

[karenj_m]

Hi Tom, and welcome to the board.

I had SCFE as a youngster...3 surgeries later...20+ years of bone on bone, no range of motion in my 40's...

Wanna see what hip resurfacing can fix? Read this (my story - see the xrays):
http://www.surfacehippy.info/hipstories08/karenmitchell08.php

Then let us know what state you live in....check out this list of surgeons that do resurfacings...
http://www.surfacehippy.info/listofdoctors.php#Doctors_with_over_100_Hip_Resurfacings_

There is no reason why you should have a THR, unless your bones are weak and thin....

(We will tell you the truth here)

[John C]

Hi Karen,
After looking at your before and after x-rays, I could not resist sending my best wishes and congratulations to you and Dr. Gross. Seeing the finished product, and considering what you had to start with, should provide hope and inspiration to many people with severe hip conditions. Thanks for being part of this site, and providing such hope and inspiration. :)

John

[obxpelican]

I agree with everything John said.

Karen you're a great asset to this forum.  I never read your story until now.



Chuck

[karenj_m]

Thank you John and Chuck  ;) ;) ;)

[Pat Walter]

Thanks to everyones responses.  Your personal stories help others to learn.

I would suggest to Tom that he get in touch with a couple of the best resurfacing surgeons to see if he is a candidate for resurfacing.  When you have difficult hip problems, you need the best in the business.  For resurfacing that would be doctors like Dr. Gross in SC, Dr. Su in Ny, Dr. Mont in MD and some of the other most experinced surgeons depending on what area of the country you are in.  Most will give you a free email consultation so you will know whether your really are a candidate or not.  Many of us had to travel far distances to get our resurfacings.

Many less experienced resurfacing surgeons won't do difficult hips.   So if you still think resurfacing is a good solution, which all of us do since we own them, I would encourage you to look further.

This is my list of surgeons:  http://www.surfacehippy.info/listofdoctors.php

If you don't feel resurfacing is right for you, I will remind you and everyone that MOM THRs are a good solution to hip problems too.  You need to make sure that your surgeon gives you a MOM THR and not an old fashioned, small ball plastic/metal THR.  Those are very restrictive for younger people.  You can learn more about THRs from my Hips for You website  http://www.hipsforyou.com

Good Luck.

Pat

[elar]

Granted, I'm only 18, so I don't quite have the life-long experience factor in my corner, but I was also diagnosed with SCFE when I was 12. With that, I developed severe avascular-necrosis, which has essentially wiped out the cartilage in my joint to add to the trouble of my misplaced femur.

I haven't had resurfacing yet, but my surgery is scheduled for June 2009.  My surgeon and my orthopedic doctor both agree that my previous condition shouldn't have any negative consequences on my surgery.  Obviously we don't have the same case, but after talking to several doctors and doing some of my own research, I'm quite confident that resurfacing would be a much better option for me than THR.  This is because my femur is still quite structurally sound, and most of the problems I currently have are due to the severity of my slipped hip. 

However, if your legs are significantly different in length, you might be better off with a THR, as your leg length could be more easily fixed.  But still, resurfacing would definitely be worthwhile at least to investigate.

[brownie]

I also had SCFE as a kid and had no problems until I reached the age of 42, when as an active golfer found I could no longer walk 18 holes of golf without my leg stiffening and pain. I wnt to an othopedic surgeon who advised I had arthiritis in my hip and total hip replacement was my only option and at my age to wait as long as possible. I put up with the pain until last summer when I found out about hip resurfacing from this website and track down a doctor in Toronto who performed this surgery. An appointment was setup but the news was not good as he said he could not do anything for me. I also found out about a doctor in Hamilton who was the expert doing hip resurfacing and asked for a referral which I got. He saw me in November and surgery was scheduled for March 5. Due to the SCFE he advised that if he did a hip resurfacing he would take the pins out and that meant he would have to graft bone which would mean no weight bearing for six weeks. The surgery on March 5 was successful, Dr. Smith performed a hip resurfacing(right hip) and was unable to get the pins out so he left them in which meant no weight restrictions. The day after surgery I was up walking with the aid of a walker and within a week I was on crutches. It is now three weeks after surgery and I am no walking with a cane. I must say during this whole ordeal, I have had no pain what so ever. I also have been back to work a couple days a week for 3 hours at a time and drove for the first time today. I would like to thank Pat and all the others who post on this website, the info here is amazing

[cindy26]

I had scfe bilaterally left 13 right 15 and 18 pins removed from both.    27yrs old just received my first total hip replacement 1 weeks ago yesterday.    It never stopped me from doing the things I wanted until recently.  Good luck. 

[TBONE]

To all--Thank you much for your posts.  I appreciate all comments made and I've certainly learned a great deal in this process.  We all have a tendency to think that our particular ailment is the worst of its kind.  After much research, I have concluded that while all arthritis requiring surgery is serious, there are many who have and have dealt with problems far worse than mine.  Karen, your story, in particularly, is very moving.  I appreciate people's passion on this topic, and the fact that the site itself is so open to all opinions and addresses even serious problems, complications and risks.  I also appreciate hearing from others with my problem and particularly from someone who had SCFE which was never diagnosed.   

After additional consideration, I am going to have BTHR on April 1, 2009-anterior approach, MOM.  I'm comfortable with that decision and with my OS.  I'm 51 and my hope is that this will be a one time deal for me.  If I'm wrong and I need a revision some day, I'll deal with it.  My OS is on the list of surgeons who have done many resurfacings, though admittedly, not at the very top of that list.  He has suggested BTHR for me.  As someone had suggested, he probably is more conservative than most, but I am OK with that too.  And I like him and trust his judgment.  As an aside, I also have a good friend who had BHR last year with one of the very top docs on all of these lists, and he had complications which will require revision THR.  So, I suppose that has tempered my decision a bit.  That is not a knock on resurfacing, just a recognition that in surgery, stuff happens. 

I guess my only gripe or concern is the failure of OSs to address options like BHR as part of the consultation.  My first 2 OSs were with large, reputable practices that performed a fairly large number of resurfacings, but the particular surgeons that I saw apparently did not do them themselves.  No one mentioned resurfacing to me, despite the fact that their brochures say that they would do just that.  In fairness, I didn't ask all the right questions, but I, like many people I think, do get a little bit flummoxed in such consultations. I still don't really know if the reason resurfacing wasn't mentioned was because I was not a good candidate or because the surgeon simply didn't do them.  I suspect it was the latter, based upon my current OS's very positive opinion on resurfacing.  I simply assumed that I was not a candidate.  I think that, in hindsight, had I known more earlier, I might have sought out Dr. Gross, who is so highly regarded on this sight, or another experienced doctor on the topic.  I don't think I would have traveled overseas to have surgery, but I'm very impressed by those of you who have.  I do think OS practices, either statutorily or otherwise, ought to be required to address all available options with patients.  Just an opinion, but this site and ones like it currently are the main source of information on resurfacing. But this information should be addressed and disclosed fully by all competent surgeons. Currently it is not done very well, in my opinion.

Thank you for this very useful site 

Tom

[cindy26]

Tom,

I've seen my share of OS too.  I've seen 3 in my area and the 4th and final one at Duke Orthopaedics.  I was diagnosed with SCFE 15 years ago.  It did change my life some but I never let it stop me from doing the things I loved as a kid.  Because of the placement of my hips and my feet, I became very clumsy.  I have had multiple falls which caused multiple herniations in my back which were fixed by surgery.  I am glad I found my surgeon when I was a kid when I did.  He told me that the slip was so bad that if I didn't have the surgery immediately that I more than likely would never walk again and 2 yrs later the same on the right hip.  The right hip always fooled the Orthos.  It looked "OK" not the best shape but defiantely not the worst.  Once my ortho did the surgery on my right hip to pin it, he said he couldn't believe how I walked with it that way.  Because of my age, every ortho I've seen told me that I need a hip replacement but nobody was willing to do that for me here.  These drs were general orthos.  The last one I saw told me that I would need to see a specialist and that is how I found Dr Attarian at Duke. I am now 1.5 weeks out of surgery and feel pretty good.  No more bone on bone rubbing pain just general soreness and muscle pain.  I wanted to do the resurfacing but everyone of the drs I saw told me it was out of the question because of the shape of my hip and the pins that haven't been out that long could cause instability and on top of all of that I have a very very small hip socket, neck and head.  I really didn't care so much that they couldn't do this after I was told all of the reasons.  It makes since to me.  I had an anterior lateral approach with a Depuy hip.  Incision is probably 8 inches. 

Best of luck.