questioning the surgery

[momy16]

 :-\Hello,

I'm glad that I found this website where you can get some insight and answers. I'm 42 years old with pain in both hips. The worst is my right side.Anyway, long story for me too... My pain started since 2008, and the orthopedic dr said that you have bursitis. I received a few injections that year but they were short lived. My xrays are normal no deformities a little arthritis but nothing bad. In 2012 I had a arthroscopic surgery for a labrar tear. I went though a very depressing time because I had no improvement. I did water therapy, physical therapy you name it, but I could not afford it anymore so I was doing it on my own at home and walking every day. I felt a little better after 8 months but the pain never went away. I'm still taking pain killers every day and the dr. told me to go for the hip resurfacing, but I still don't know what to do since my xrays and even MRI that I had before came out as normal, with some inflamation. I even had a bone scan which came out normal. This dr that I'm seeing said that 'I don't know what else to tell you but let's do the surgery. I'm scared and a little voice inside of me sais that don't do it.. Is anybody out there with the same problem that would give me some insight? I'm very upset and don't know what to do.

Thanks! 

[imgetinold]

Hi Momy (that sounds a bit strange....),

Your story sounds very similar to several stories I've heard here.  I hope they respond, but there have been others who have had x-rays that showed "normal" that actually had bone-on-bone arthritis.

What scares me to death is a doctor who can't diagnose the problem, but wants to do resurfacing on you.

A couple things:  read everything you can on this site, both in the forum (to hear other's stories), and on www.surfacehippy.info (to learn everything about the procedure and the doctors).  The most important thing with resurfacing is to pick a very experienced doctor, which means one who has performed hundreds of them, and perferably a doctor who specializes in resurfacing.

Also, there are several doctors who will give you a free consult over the phone.  Dr. Gross in South Carolina is one of them.  You just need to send your X-rays (and any other things, like your bone scan) to him first.  He's one of the best, and he did my hip. ( I'm a 44 year old male, by the way).

I'm not trying to talk you out of doing it.  It very well may be the best thing you could do.  But, from what you've said, I'd be more than a little leary of what your surgeon said as well.  Good luck, welcome, and stick around...there's lots to learn here.

[Dannywayoflife]

Momy,
         welcome to the group. Firstly i would say get several other opinions from the best Dr's that you can find. I too had an MRI, Xrays and a hip scope. Both the MRI and Xrays only showed minor OA but when i had my hip scope it was a very different story. The surgeon found grade 4 OA (the scale goes to 5). I would ask your surgeon who did your scope for a report on their findings as they should be able to tell you the actual state of your joint space.
Doing this should give you the answers so that you can make a informed decision.
Danny 

[Woodstock Hippy]

We happy hippies welcome you.  I had bilateral surgery on November 11 and I'm feeling great and starting to run again.  Your problem sounds  a lot like Triathlete98 who posts here.  His xrays didn't show much and he too had pain and frustration.  He is now recovering from hr surgery.  Check out his posts, especially the early ones.  Do as much research as you can, get email consults, talk to the doctors and you will find the key to solve this problem.

[momy16]

 :)Thanks for all of you that replied to my post. I live in upstate New York, and New York City is only 3 hours away. I also heard good things about Dr. Su (Hospital for special surgery). I have to call my insurance and ask if they can cover a consultation with him. I'm not going to give up just yet. By the way the dr that did my scope found grade 3 arthritis, and he said that in the future you are going to need a THR. Also he said that you are not there just jet (bone on bone). For now I'm going to gather all my information from the dr and get another opinion.

Thanks so much!

[Woodstock Hippy]

Dr Su doesn't take insurance, like a lot of the doctors at HSS.  His office quoted me $17,000 per hip and $200 for a consult.  If you're going to NYC, also see Dr Marwin at NYU.  He told me that with Empire it wouldn't cost me anything.  He was almost right, so far it's
cost
me $20.

He did an amazing job and my recovery has been nothing short of miraculous.  Check
My other posts.

[sheptr]

FYI... Dr Su took my United Healthcare Dec2009 and my brothers's BCBS Feb2012.  He rocks, and I'd highly recommend
seeing him also if you are already in NYC for another consultation.

[Dannywayoflife]

:)Thanks for all of you that replied to my post. I live in upstate New York, and New York City is only 3 hours away. I also heard good things about Dr. Su (Hospital for special surgery). I have to call my insurance and ask if they can cover a consultation with him. I'm not going to give up just yet. By the way the dr that did my scope found grade 3 arthritis, and he said that in the future you are going to need a THR. Also he said that you are not there just jet (bone on bone). For now I'm going to gather all my information from the dr and get another opinion.

Thanks so much!

I belive that grade 3 means deep fisures in the cartelage. I know that grade 4 ment fisures down to the bone that were more than 1.5 cm in diamiter (cos thats what i had).
I was told by my surgeon that when the OA is bad enough to cause problems like issues with every day things like getting dressed then theres no reason to prolong the suffering.
Go see several surgeons and see what they say im sure it will be along those lines

[momy16]

I live in Albany, NY. I have MVP insurance and hopefully they approve it.

[morph]

Hi Danny, just out of interest. Do you know what grade 5 means.

[hernanu]

Hi, some info on how OA was graded before and how it is now, plus some thoughts on what they're considering for the future:

From a National Institutes of Health (US) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3339535/ paper.

Describing how OA was graded in patients before:

Kellgren (1963) described 4 grades of hip OA:

• grade 1 (doubtful OA), possible narrowing of the joint space medially and possible osteophytes around femoral head
• grade 2 (mild OA), definite narrowing of the joint space inferiorly, definite osteophytes, and slight sclerosis
• grade 3 (moderate OA), marked narrowing of the joint space, slight osteophytes, some sclerosis and cyst formation, and deformity of the femoral head and acetabulum
• grade 4 (severe OA), gross loss of joint space with sclerosis and cysts, marked deformity of the femoral head and acetabulum, and large osteophytes

This was then updated to what is accepted now as the mode used to grade OA:

Croft et al. (1990) graded OA into 5 categories:

• grade 1, osteophytosis only
• grade 2, joint space narrowing only
• grade 3, two of osteophytosis, joint space narrowing, subchondral sclerosis, and cyst formation
• grade 4, three of the same features as above
• and grade 5, as in grade 4 but with deformity of the femoral head

And this is currently the thought on joint space narrowing:

Joint space width (JSW) was measured in the upper, weight-bearing part of the joint according to Jacobsen and Sonne-Holm (2005). The shortest distance between the femoral head and acetabulum was measured at 3 locations: the lateral and medial margins of the subchondral sclerotic line (sourcil) and along the vertical line through the center of the femoral head. The minimum JSW was used for diagnosis of OA. If minimum JSW was outside the 3 standard locations, an additional measurement at the site of maximum narrowing was performed. The definition of OA is a minimum JSW of less than 2.0 mm. In order to perform an intra-observer analysis, observer 2 repeated the assessments of OA more than 3 weeks after the first assessments.

That is how things stand now in how we were diagnosed and weighed for the grade of OA. There is some discussion that there are too many grades, and they can be simplified. From the same study:

"The K&L classification has 5 grades and the Croft has 6 grades including normal, doubtful, mild, moderate, and severe OA. A modification, reducing the number of grades, would make these classifications easier to use and would improve their reliability. Since Danielsson (1967) found that osteophytes alone are not a sign of OA, grade 1 of the K&L classification (“possible osteophytes”) and grade 1 of the Croft classification (“osteophytosis only”) could be included in the group with no OA. Grade 2 in the Croft grading “joint space narrowing only” is difficult to interpret, because there is no information about how much the joint space should be reduced and it is very rare to have a substantially reduced joint space without other signs of OA. Thus, grade 2 could be combined with grade 3 and called mild OA. The 2 highest grades, 3 and 4 by K&L and 4 and 5 by Croft, could also be combined and termed severe OA, because the distinction between them seems to be rather unimportant from a clinical point of view."

Their opinion is that the best way to test for OA is by Joint Space Width method. Their statistical analysis found that to be a more reliable way to detect existing OA than the grades. Quoting them:

"JSW measurements had good accordance with gradings based on global visual assessment. Thus, comparison of long-term studies of DDH patients could be sufficiently reliable, even if different OA classifications have been used. This indicates that the K&L and Croft gradings could still be used, but the categories should be as few as possible and should not exceed 3: no OA, mild OA, and severe OA. However, since the JSW classification is the most reproducible and also the simplest and fastest, this appears to be the preferred method for future studies, especially in DDH where the most important location of the joint is the upper weight-bearing part. Moreover, minimum JSW had a closer association with pain than the K&L and Croft classifications (Jacobsen et al. 2004). Digital measurements directly on the screen with 4 times enlargement of the radiograph adds to the convenience of the JSW method. Digital measurements have been found to be more accurate than traditional manual measurements on hard copies of radiographs (Conrozier et al. 1997).
Even if a hip has no OA by the minimum JSW method, global visual assessment can show severe OA (K&L grades 3â€"4 and Croft grades 4â€"5). Although this rarely occurs, such hips should probably be added to those classifed as OA by the minimum JSW method, giving the true total frequency of OA.
In conclusion, the minimum JSW method is the simplest and most reliable classification when grading the presence of hip OA in long-term studies of patients with DDH. A classification based on global visual assessment can be used in addition if only the severe grades of OA are included in the abnormal hips."

Sorry for the length of the post, but this caught my attention.

[Dannywayoflife]

Doh hern beat me too it!:-)

[hipnhop]

Ditto Hern.  Got to get a second/third opinion. I got three. 

[morph]

Thanks for that.

[Tin Soldier]

I know I'm a little behind on this, but I've been out having fun.  Not that posting here isn't fun.  It's tons of fun.  :)

Agree with all, get more opinions.  I had 4 opinions.  Su is obviously mentioned here a lot and also Marwin, both have lots of happy patients.   

Morph - I'm wondering if you might have only soft tissue damage like the labral tear, which is common with FAI and the beginnings of full-on OA.  Maybe the MRI would have seen that sort of an issue.  I like Hern's post, that's a juicy one.  I focused a lot on the join spacing and I seem to recall the 4 mm of spacing was the bottom end of the allowable limit for simply cleaning up the joint arthroscopically.  Once the joint has "deepened" that much, you need some form of arthroplasty, because it becomes instable if you remove too much of the acetabular rim. 

Nice recall Woody!  that's a good idea trying to search on Triahtlete's posts.  I thought there were a few others that posted similar issues in the last year or so.  Seems odd to me that the x-ray wouldn't be obvious if a surgeon is recommending surgery (arthroplasty).  Thus - more opinions, please.

There are some surgeon's that won't charge you to take a look at you images.  Not that you want to go all the way to Seattle, but Pritchett just called me up after looking at my x-rays and we had about a 25 minute conversation about HR and my OA.  No cost to me or insurance.  Pat has a few names of surgeons that will look at the images for free.  You might check with her.   

Good luck