In research mode and the "how do you know when" question

[angelena99]

First, this site rocks!  I have learned so much already!  Thanks for all your work Patricia, and for all of you who have contributed. 

(Sorry, but goodness this turned out long) I'm 41 years old - but apparently have the hips of someone much older.   ;)

I first started noticing problems with my right hip when I was pregant 12 years ago at 29 - painful catching and feelings of instabilty.  I figured it was wonky pregnancy joints, but the symptoms continued after pregnancy so I went to a chiropractor, who thought it was probably bursitis - the adjustments seemed to help.  Six years ago, the symptoms were back, and adjustments didn't help, so after complaining for a couple of years, I had my hip x-rayed at my general practitioner's office,and the diagnosis was “seems to have some arthritis” which the radiologist and my primary-care gal both thought was odd, given my age at the time of 37.   She sent me for some physical therapy sessions, and the PT flat out told me she didn’t believe I had arthritis at my age.  I did some strengthening which I think helped my overall fitness level, but didn’t make a huge difference in the hip pain.

So after another couple more years of complaining I went to see actual orthopedist about 17 months ago.  He did more x-rays and confirmed the arthritis diagnosis, and noted that I had some dysplasia.  I heard the x-ray techs in the next room say “She’s 40!” while they were doing the x-rays.  The Dr. also asked me if I had injured myself jumping off of something as a child.  I jumped out of swings as a kid, and I did jump off of my grandmother’s garage with my cousin, but we jumped on the side where the hill met the wall, and I don’t remember any injuries. 

He said I should avoid high-impact activity, and that while I wasn’t a candidate then, I would likely be a candidate for a THR in the future.  I had heard of the resurfacing procedure by then and asked him about it, but he said that the studies he’d read said that the outcomes weren’t as good for women, but that it may be that I’d be an ok candidate as I was pre-menopausal.

Since that time my left hip has started aching some, but the right hip is almost always sore.  When I stand up, I have to sort of ‘prepare’ myself to walk, and I limp some, especially when I first stand up and start to walk.  I try to get exercise on elliptical machines or in a Zumba aerobics class (Latin ballroom steps, low impact).  I am achy if I get no exercise, but sometimes I am extra-achy after exercise.  The pain has gotten worse in my day-to-day life - I take ibuprofen every day.  But I read other people’s stories about how they couldn’t sleep without pain meds every night, and I am not at that point.  On the other hand, I always feel pain when I walk, my range of motion is not at all good, and I think about my hip pain all the time.

I have an appointment later this month with Dr. Boyd (who I found on this website - when I did a doctor search on the BHR website, I got the name of the orthopedist I saw who was only somewhat familiar with resurfacing), and I'm wondering - how do I know when the pain is bad enough?

On the one hand, I've given birth twice pain-med free, and I broke my ankle last year and didn't realize it was broken for three days, and the x-ray techs all said, "I'm surprised you're walking on that."  On the other hand, I also get occasional migraine headaches that bring me to tears.  Does anyone have a good pain-tolerance question to ask oneself?? 

[obxpelican]

I enjoyed reading your hip story and like so many other hundreds, maybe thousands of people have come up with that question.  "When do I know when" ---- you'll know it's time if you can answer one or more of these questions with a yes.  Chances are if you've been reading Pat's site for more than a few hours, you are probably ready.

Did your doctor tell you that you are nearing the end of the period where a hip resurfacing can still be done?
(if you answer yes to this one, proceed to scheduling your surgery VERY soon)

Have you had to give up things in life that you love?
Is the pain to a point where it's all you think of?
Is the pain bad enough that you cannot sleep?
Do you drive around parking lots trying to find a spot a few feet closer to the store?
Have you cutback your activites so much you are now depressed?
Are you walking so badly with a limp that strangers mention it to you?

Of course with your pain tolerance pay special attention to the first question.

Can anyone add anything to my list for Angelena


Chuck

[Lopsided]

... and I'm wondering - how do I know when the pain is bad enough?On the one hand, I've given birth twice pain-med free, and I broke my ankle last year and didn't realize it was broken for three days, and the x-ray techs all said, "I'm surprised you're walking on that."  On the other hand, I also get occasional migraine headaches that bring me to tears.  Does anyone have a good pain-tolerance question to ask oneself?? 

Angelena,

I had an argument with one surgeon I saw, because he wanted me to rate my pain from one to ten, and I insisted that in general I had no pain, or refused to recognize pain. It was his opinion that pain is the primary deciding factor for operation. I don't think so. Although I have some discomfort I am lucky enough that I do not have continuous pain, and do not take medication.

So maybe you should look at other symptoms. Is your strength and range of movement significantly reduced? Can you dry your feet after a shower, tie your shoe laces, pick up your children, roll over in bed without holding onto the headboard? I can't but it rarely hurts.

My deciding factor was not pain, but that it was getting worse and affecting other aspects of my life and health.

D.

[stevel]

Angelena,

Loss of function is an important parameter.  Since the cartilage had worn away and my hip bones were grinding against each other, I had a severe limp and an atrophied left leg due to favoring the right leg. I had light to moderate pain.  An ibupropen or two at night would alleviate the pain.  But I was rapidly loosing the opportunity for a hip resurfacing since my bones were wearing away and I proceeded with surgery promptly.
So look at your x-rays and if the cartilage is gone and your hip bones are developing osteophytes and cysts and are becoming deformed, don't wait but proceed with hip resurfacing surgery while you still can!

[Pat Walter]

Hi

PLease understand that pain is not the only indicator of the condition of your hip.  You need to have x-rays taken so a really expeirnced hip resurfacing surgeon can evaluate the degeneration of your hip.  Some people have a lot of pain and their hips are not ready for surgery, while others have little pain and very deteriorated hips.  You can't tell yourself - get input from an expiernced surgeon.  YOu can actually miss the window of opportunity of a resurfacing if you wait too long.

Usually the progression is pain meds, steriod shots into the hip capsule, heavy pain meds and then surgery.  Once you are bone on bone, there is nothing else you can do but replace your hip.  I was at a point sitting in a chair was my only activity and I could not sleep at night even with Vicodin.  Nothing woud stop the pain.  You don't want to wait that long. I did not have health insurance, so was not to quick to getting my hip resurfacing.  I had to go to Beligum to get mine done. 

Get good input from the really expiernced surgeons and then you will have information to make a good decision with.

Pat

[MarkNC]

Getting a Birmingham (or other resurfacing) had been on my mind for the past 3 to 4 years.  My left hip pain started 8 years ago and the intensity had slowly increased over that time.  I reached the "tipping point" when it hit me one day it was interfering with my day-to-day function.  My work quality decreased due to lack of rest and pain when doing certain things.  I used to be active in martial arts...I had resolved myself to teaching only.  I had another hobby that involves walking, bending and digging (metal detecting) that I couldn't do anymore.  So for me, I knew "when" when...

1. Day to day function was impaired
2. Lack of sleep due to pain (waking up multiple times a night)
3. Missing work on "bad hip" days
4. Can't do "fun" stuff I used to
5. No exercise because it hurt too much

I imagine the "when" point is different for everyone.  Believe me, getting major surgery was NOT something I waltzed into lightly!  However, it has been worth every bit of it!  I was sleeping all night the first week after surgery!!!  Hadn't done that in years.

[angelena99]

Thanks so much all - Ok, I feel good about scheduling to see Dr Boyd in a couple of weeks, and we'll see what he says after looking at x-rays.  I'll also try and bring my x-rays from a year and a half ago to see if there is progression to be concerned about.

Definitely I've cut back on things I love to do, and I'm frustrated by my range of motion loss, and my limping.  I'll bring this information as well to the surgeon.

[stevel]

Angelena,

My left hip was so bad that both a Dr. of Internal Medicine and a orthopedic surgeon recommended a Total Hip Replacement in July 2007, yet I still skied the entire 2007 - 2008 season and didn't have a lot of pain.  I wasn't keen on receiving a conventional THR since it is prone to dislocation and could wear out in 15 years or less.  I didn't learn about hip resurfacing until the Spring/Summer 2008.  By Summer 2008 my left hip had deteriorated so I needed to walk with a cane on level ground, but I still didn't have severe pain.  I had a hip resurfacing in late September, 2008.
So have x-rays taken by an experienced hip resurfacing surgeon(s) to know where you stand.

[Sherri]

It's time when...all you do is think about this hip problem and all you do is explain to others why you can't do this and why you can't do that! Pain s u c k s  :'(

[Jerome Arnold]

Angelena,

I enjoyed your story and it reminded me of me and my brother's jumping off my home's roof with an umbrella. 
I just had my hip resurfaced on 23 June 2010.  Dr. Gross is my surgeon and I opted for an uncemented BioMet recap.  I am quite pleased with my progress.  Dr. Gross, his staff and Providence Hospital are superlative.

I am 50 and post poned my surgery for about 8 years.  I dealt with the pain with inactivity.  I stopped running and playing soccer.  I reduced my aerobic activity to only an elipitical machine.  My tipping point came when I realized I condition would never stabilize and I had trouble sleeping at night due to pain.  Deferring surgery only would result in further loss of enjoying my life.

From reading your post, I felt your pain and frustration.  Pick your surgeon carefully.

To your health!,

Jerome

[KayakDeb]

Oh Angelena - you are my little (and younger) TWIN!!  Yep - as a kid we thought it was SO much fun to jump off garage roofs..OMG!

My L hip had bugged me off and on for a few years - then one day, it was like something had "let loose" and I started to limp.  Went to my regular Doc, who took X-rays - came back into the room and said "HOW are you still walking???  You're bone-on-bone!!!"  I was 49 at the time (2001) and he told me to go do some research because there was something "new" available for younger patients - and DON'T let anyone talk me into a THR.

In May of 2002, I drove to Baltimore, and Dr Mont gave me my life back with a Conserve Plus resurf.

Back to the "high threshold of pain": the pain of the incision seemed like a paper cut compared to bone grinding on bone, so immediately, I asked for some Tylenol.  Just good ol' Tylenol took care of my post-surgical pain - and by staying off the narcotic-based meds, I was bright-eyed and bushy-tailed :-)  No nausea or respiratory problems, either.

The important thing is that you *might* also be bone-on-bone; and there IS a  point where the head of the femur can get so  mis-shapen that they can't do a resurf.  I'm glad you're doing this now, even if you think you're still "not that bad".

Best wishes!
Deb

[ReneeP]

Hi Angelena,

Your story has a lot of similarities to mine.  For some people, it's obvious when they are ready to have the surgery so they book it, and never look back.  I had a different scenario than a lot of people.  For me, the duration of the pain is what's gotten to me.  I've had pain for 22 years, and it has definitely progressed in the past few years to the point where I don't get good pain relief from anti-inflammatories whether OTC or prescription.  I currently take aleve, tylenol AND tramadol (Ultram) together and I still have pain, and wake up several times a night.  I also now have knee pain on the same side that is almost worse than the hip pain, but they always occur at the same time.  It's hard to find a comfortable position while sitting, too.  If I am in any position other than having my leg straight, I have pain.  I cannot abduct, adduct, or rotate without it being very uncomfortable.  That being said, I have very good range of motion, and I don't limp except when I get up from sitting for a period of time.  I ALSO have high tolerance for pain, and my friend (who at 38 just had THR!) told me recently that once I have this surgery, I'll probably realize how much pain I was in and didn't realize.

So, I've felt for a while that I SHOULDN'T have the surgery because it seems that everyone else is limping noticeably, and can't tie their shoes when they have the surgery.  I thought I was supposed to wait for that before I booked it.  I recently asked my surgeon how long it was going to freakin take to get to that point so I could have surgery, he looked at me strangely and said, "you can have it any time you want it...you have very good reasons for having it now."   I was so relieved!  It was like a weight was taken off my shoulders.  He is a little concerned about my age (42) because if the resurf lasts 30 years as it possibly can, then I would need a revision in my 70s and still potentially need ANOTHER one some time after that depending on how long I live.  I originally told him I would wait until next summer to do it because I work for a school and would have it off.  But after talking to my husband and taking some other big things going on in our life right now into consideration, I decided to go for it.  So, I'm having hip resurfacing on November 2, 2010.  As far as my age and future revisions go, I figure in 30 years there will be some newer hip technology that might be available by then, so I'll worry about it then.  I don't want to miss out on the NOW and all the things I WANT to do while I'm still this young.

Anyway, my long-winded point is that you have to decide based on your OWN experience when YOU are ready.  There is no magic formula or "right" time to have it, other than YOUR right time.  From what you describe, I would say to go for it...you sound ready! 

Renee

[SteveT]

A friend of mine joked that in 30 years you'll probably be able to get a new hip installed at the Apple store and that I should devote my worry time to other things.