Question about when to get hip resurfacing done

[kpaulson98]

Hi, I am new to the forum.  I recently had an orthopedic surgeon recommend hip resurfacing as the only option to alleviate pain that I am having.  I am relatively young (39) and active (running, tennis, etc).  I started having pain a few years ago and noticed when running and exercising the pain got worse instead of better.  The only other option he suggested was a big bottle of all alleve.  And avoid "weight bearing" exercises, which evidently includes everything (i.e. walking). 

Right now pain and range of motion problems are more annoyance than unmanageable.  I also have 2 young children, so being immobile or limited for the recovery is hard. Is there advantages in waiting or is this something that should be done sooner.  I am curious about the cement-less option (femur) as they intuitively sound better.  Is Dr. Gross the only surgeon performing this as it is under trials?  I am in Tampa area, and noticed at least 1 surgeon with the 1000+ mark on this type of surgery, but I have not contacted yet for second opinion/guidance.  X-rays and MRIs show that I basically have no cartilage in left hip and both have Femoroacetabular Impingement (FAI) cam type.  Any guidance or suggestions appreciated.  Glad I found this great resource.

Opinions and guidance welcome.

[Juno]

Welcome. You will find many of us are / were in the same scenario you are right now. I'll echo what almost everyone on this site will tell you: 1. Find the very best surgeon you can. Someone who does tons of these surgeries and is passionate about it. 2. Get it done sooner as opposed to later so you can get pain-free and on with your life.

Dr. Gross does the cement-less. I had both hips done this past year (see my signature) and am very pleased. The first few weeks post op are the hardest. But, barring any complications or severe osteoporosis, you will find that if you are in decent shape going into the surgery, you will likely do very well and have a good recovery. Many people travel for their HR surgery. Being you're in Florida it might not be a bad idea to try to see Dr. Gross :)

I am 3 1/2 months post op my second HR -- I was back to work in 5 weeks and yesterday I walked 8 miles, worked all day, attended a weight class and a spin class. No pain!

Check out the stories on this site and take in all the information you can.

[atl2013]

Keep up the good work "Juno"

ATL2013

[chuckm]

Hey Kpaulson98, if surgeon has deemed you a candidate for resurfacing then I would go ahead and get it done so you can get back to feeling good. And I mean back to your sports too.
FAI and the arthritis get worse, not better. Except once you book the surgery for some reason your hip feels better. Happens to many so don't be fooled because the x-rays don't get better.

Your best bet is to pick the best surgeon you can even if you have to travel. The uncemented device by Dr. Gross is doing very well. But its results have only matched the outcomes the BHR implanted by top surgeons, not surpassed them. So it really has mostly to do with surgical expertise. As far as I know your top surgeons are using BHR, C+, and Biomet.

As far as recovery and young kids, you won't want to do too much the first week or two. After that you very well might be off the crutches and be able to cook dinner, load the dishwasher, etc all the stuff you don't want to do.

Good luck,
Chuckm

[Vinman]

Hi kpaulson98,

It might make sense to ask your surgeon what the risks of waiting are.  I had avascular necrosis so for me there was the risk that the femoral head could deteriorate to a point where a resurfacing was not a viable option.  I was told you need at least 50% good bone.  I don't believe there is risk to not being a good candidate  with waiting if you have arthritis but suppose if bone on bone is bad enough it could creat some sort of issues.  Only your surgeon or a few you speak with could answer but i would certainly ask the "risk of waiting" question.  I can tell you that I was not super bad pain wise but was walking with a limp and could not do certain things I wanted to do.   Even with the risk created by avacular necrosis I could have waited a few months.  Am I so glad I did not.  I am 7 days post op and besides some twinges here and there as well as the "monkey fist" that I feel occasionally when I sit to long I fell very great.  The pain I had prior is gone!

Good luck on your journey.

Vince

[Miguelito]

Welcome kpaulson98!

Reading your post you note that your hip is not yet unmanageable, more of an annoyance. Provided that you are not limiting your options vis-à-vis HR, I just want to say that I do not see a need to rush into surgery. I am obviously pro-HR for a patient your age (and particularly if you are male). That being said, the recovery from this surgery is lengthy. I could not run at six months after my first, and did not feel athletic until a full year had passed.

More significantly, the first five days are brutal. Particularly from a little over 24 hours to end of day four. I can say this because I just went through it three weeks ago and I made it a point to document the early days. People forget this.

Even now at three weeks it is very uncomfortable for me to sit upright in a chair for the length of a meal, so I have only done that a couple of times. I can do lots of other stuff, just saying.

Lastly, no one believes that an artificial joint is as good as a fully functional normal hip. (But of course, an artificial hip is better than a severely arthritic one that causes chronic pain.)

I'm not saying wait until you are in constant agony to have your hip (or hips) replaced (as I did with my first, mainly due to a misdiagnosis). I think I am doing better with this hip than the first because the operated leg was much stronger going into surgery, so that is an argument for not waiting too long.

I am of the "you'll know when you are ready" school. Do your homework. Read as much here as you can. I have also found that my surgeon (the aforementioned Dr. Thomas Gross) has a pretty good website concerning HR. Reading his site could probably get you up to speed on HR, the surgery, etc., more expeditiously than this site could, if only because the volume of material there is smaller and more manageable.

Best of luck to you,

Mike
 

[Miguelito]

"As far as recovery and young kids, you won't want to do too much the first week or two. After that you very well might be off the crutches and be able to cook dinner, load the dishwasher, etc all the stuff you don't want to do."

So true...

Mike

[chuckm]

Kpaulson98, something to consider is your pre-op conditions. Look at both me and Mike. I had severe arthritis but I was forcing myself to keep active although I was having to consume lots of ibuprofen to do so. Mike let his symptoms go on much longer. Mike, you are so stubborn :D

While your arthritis continues to worsen, it directly affects soft tissues all around the hip and it affects other joints too. You don't even notice how much the tendons, ligaments, and muscles modify themselves in response to the deteriorating hip joint. These changes help keep you going pain free for as long as your body can go on. But then it can't keep up and once you feel pain you have probably gone through quite a bit of soft tissue changes. 

Your surgeon resurfaces the bone but he can't do anything for the soft tissues. They have to correct themselves. Whatever you go into surgery with is what you have to deal with coming out. The more drastic those changes were (loss of motion, etc.) the longer it will take to change back to a correct hip. Many on this site recommend keeping active and exercising right up to surgery to help improve and shorten the recovery.

A soccer teammate of mine also going through hip pain was able to witness my comeback to soccer last year in 6 months time. He was so impressed he had the same surgeon resurface his hip. His pre-op condition was excellent. He was still playing soccer and running well - just in pain. His comeback is the best I ever heard. He met me out for lunch four days after surgery and was using only a cane and he wasn't even leaning on it!

So if you hip is already keeping you from doing things you like, then you might consider getting that thing fixed. If there is anyone on this site who says they are glad they waited longer please chime in.

Chuckm

[DavidJ]

kpaulson98 welcome and glad you found this site.

I thought I was reading my orginal first post on this site when reading through yours.  I am a 40 year old male with 2 small children living in the Tampa area.  I have known for about 5 years that I have severe arthritis in both hips.  Some days are better then others for me but I realize I will need to do something in the next year or 2.  I found this site about a year ago and saw Dr Ratterman last Sept.

My advice to you is make an appt to see Dr Ratterman.  He is right in your backyard and he is one of the best in the country.  This is where you will get all your questions answered specfically for you.  After visiting with him I felt much  better about recovery times and activity levels etc. that I would experience post surgery.  Remember most of the posts and advice you are getting from this site are from people of different ages, activity level, weight, lifestyles, etc. You need info custom for your situation.

Hope this helps.  Good luck and if you have any questions please ask and if you decide to have this surgery before me I have some questions for you  :)

[23109VC]

I was in the same boat as you are not that long ago. I was 38 years old and my left hip was really really bad it had been bothering me for several years and I knew I needed surgery but I was afraid and so I postponed it until it was so painful I felt I had no alternative except having surgery

My hip had gotten so bad that I had extreme difficulty tying my shoes and I was physically incapable of bending my leg beyond 45°.   running was absolutely impossible even walking was painful.

Given how young I was, and the fact that I had three small children it was extremely frustrating to not be able to participate in a lot of fun activities that I should've been able to do.  now that I've had my surgery I so glad I  did it.

I am now three years post op and my hip is amazing.  While I still don't feel capable of running long distances I have gone for short jogs and when I say short I mean 1 mile or less I do a lot of bicycle riding and have done 25 mile bike rides with absolutely zero pain I've also played racquetball tennis and basketball all with no pain.

I would say that you should expect to be back up on your feet and walking around very quickly I believe I used a cane about 4 to 6 weeks after surgery and by then I was walking unassisted I began running at about six months but it definitely felt awkward.  I really don't feel like I was back to my old self completely until about the one year mark and I honestly felt that my strength and abilities continued to increase every year.  I definitely feel stronger now - 3 years post op.

If I could go back in time and change anything I would surely have had my surgery sooner I waited until it hurted so bad partly because I was nervous and had seen YouTube videos of how they do the surgery which is somewhat grotesque!  having been through the experience with Dr. Gross and now realizing that it really wasn't that bad - I will do it sooner if and when my other hip needs to be surfaced-  which there is a good chance it will sometime in the next 5 to 10 years.  I will not hesitate to have it fixed and I will certainly return to Dr. Gross

It sucks that your hip is going bad but don't get frustrated having the surgery will literally change your life I know for me that was the case.  I remember literally almost getting tears in my eyes when I started to walk after surgery  and realized that all the excruciating pain that I have been experiencing was gone,  completely gone.  you don't realize how drastically your quality of life can be degraded until the pain is finally gone.   I think in my case because the pain and limitations came on slowly and gradually got worse I simply adjusted my lifestyle to dealing with the pain and restricting activities and once the pain was gone it made me fully appreciate how bad off I was and how much better off I was.  I've become very active in the last year,  I've been cycling and working out with weights 3 to 5 times a week including heavy lifting with my legs including my operated hip!  I'm probably in the best shape of my life now at the age of 41... And if I had not had my hip fixed it would've been impossible

so my advice is trust your own judgment and have your hip fixed when you feel you need to do it but do not wait until the last minute and deal with unnecessary excruciating pain that severely impacts your quality-of-life because having the surgery will reverse it instantly.  Yes there will be a period of recovery but it will go by quickly and once you are back on your feet you will be amazed at how much better you feel

Good luck !

[Miguelito]

Great post! Just wanted to recommend deliberately NOT watching a video of the surgery before you have it done. I still haven't watched one, and I've had both hips replaced. I know it would not have been good for me to watch it. I'm sure plenty of people can do so without it impacting them. I am not such a person!

Mike 

[HowieF-16]

When to have the surgery is a tough question. I had been experiencing hip problems for 7  years before finally having HR surgery. I could have waited even longer. Some recommend holding out until you are losing sleep at night. Others recommend having the surgery when your lifestyle is impacted. I am in the latter camp. I am 50 with a teenage son who I could not support in his sporting endeavors. That was the last straw for me.

I found Dr. Raterman on this website and Pat recently posted my diary of the experience, so I won't bore you with the details here. All I can say is that I would certainly recommend the surgery before your condition worsens. Now you are in control. If things deteriorate quickly you may end up reactive and that is never good, especially with young kids. Whether or not to get cemented or non-cemented is up to you. Dr. Raterman does cemented BHR. OBTW, your story is exactly like David's. We corresponded several times before his last trip to Dr. Raterman. I traveled from Panama City for the surgery, so if you have questions about how that works, I briefly covered it in my diary. Good luck with your decision. This website is a great resource.

Hey David, if you read this, let me know what you have decided to do.

[lttez]

Just to Add my 2 cents.

   Our stories are similar, though I am a bit older.  I was very active with running, backpacking, skiing, hiking, bike riding, etc.  I noticed pain while running, and moved to a treadmill to soften the surface a bit.  At 45, I notice my problem hip was shorter then the other.  My initial diagnosis from my Ortho Dr said I had bone on bone in my right hip and I would have to have to get it replaced.  I was floored at first.   My hip was as you put it, "an inconvenience", but It didn't slow me down any.  I started with a PT and got back my range of motion.  I told My PT I wanted at least 8 years.  She told me to keep doing all my exercises.  Before my next Ortho appt.  I did lots of research which generated so many questions, many were about Hip Resurfacing.  My current Ortho wasn't to familiar with it, so she set me up with Dr. Brooks.
    Dr. Brooks answered a great deal of my question, but I still wasn't ready.  He was surprised i wasn't begging for it.  We agreed that I would get an x-ray every year to evaluate my bones, and if I was doing damage that may hinder a resurfacing.  5 years went by since my first otho appt., last summer my hip really started to bother, if I had the surgery I wanted to do it at the end of Winter.  There were days when I didn't know if I was going to make it.  I'm not big on medication, but I started using Advil once or twice a week.  I also could fall back on a cortisone shot if needed.  Last December I scheduled the surgery for March. 
     It is 2 weeks after getting my resurfacing and it has been a rough 2 weeks.  Today was the first time I have been able to put my socks on by myself.  I'm looking forward to getting back to a normal way of life and raising my activity level higher then my when my"inconvenience" started.
     I knew I waited as long as I could, had time to mentally prepare, and began looking forward to losing the pain.  It sounds like you have time to do though things too, you'll have to decide when that scale tips.  Good Luck, Tom

[breag]

Hi you sound exactly like me 39 played tennis, run etc and could not do anything in the end.  Had my hip done by doctor gross five weeks ago and walking around the house walked half a mile this morning with no cane.  Did upper body work out this morning and looking forward to swimming in a week after he says I am clear.  Do not wait I suffered for five years and now have no pain five weeks out and feel great.  No anti inflammation medicince for the first time in years.  do it do not wait and do not listen to the media1

[happyhopper]

I wish I had waited longer for surgery.  Surgeons just want to operate and the ones I have seen do not seem to look at the bigger picture and have given me inaccurate information.  Have you had any falls or trauma that could be affecting your muscles, particularly the sacroiliac joint?  Are your X-rays showing severe or last stage arthritis, there are some to compare on the Hipresurfacingsite. If the X-rays show just moderate arthritis there may be other issues. After 6 years of pain I have been diagnosed with a  tear in Left Rectus Femoris and left QL  which a CT scan shows  has moderate arthritis and tears in the Right Soleus, Vastus Lateris and Right sacroiliac issues.  A surgeon recently would have operated on my left side  so it will be interesting to see, after I have had treatment for the muscle tears,who is proved correct.
I have recently had a diagnostic injectiction into my left joint but after 2 weeks have seen no relief in the pain.  Can anyone advise me how long injections normally take to work?

[oldsoccerplayer]

I had a series of cortisone injections in the problem hip for over a year. From my experience you can tell the difference within a day or two.

[Miguelito]

To happyhopper,

Just responding to your question about diagnostic injection (presumably some type of "cortisone"). I have had five cortisone injections in various body parts, including one into the hip (we talking pre-surgery? I am). Anyway, all were near miraculous EXCEPT for the hip, which did nothing but, I think, irritate the area. I am a huge believer in cortisone shots, but results seem decidedly mixed for the hip. I will add the caveat that there seems to be a belief that even if one shot doesn't help, a second might. I just had the one and it did nothing.

The ones that worked in other areas all seemed to work right away, and stay better for at least a year or two, usually more including one that gave me almost 15 years (shoulder). I had a swollen Achilles for six months until Dr. Gross gave me a cortisone shot the day before my most recent HR; it worked amazingly well. Coupled with the inactivity the swelling is completely gone four weeks later.

Mike

[chuckm]

I wish I had waited longer for surgery. 

HappyHopper, why do you think it would have been better for you to have had surgery at a later date than you did?

Chuckm

[HowieF-16]

I have had multiple cortisone injections into multiple joints. Ordinarily, some lidocaine is included with the cortisone. The lidocaine should give immediate relief and the cortisone should kick in within a few days. In every instance, the cortisone shot provided me with some relief, except when I got my hip injected. I later had the hip scoped because an MRI showed several loose bodies and we hoped removing them would solve the problem. X-Rays, MRI, and scope showed 4th stage arthritis. I got the hip resurfaced two years after the scope, not because of excessive pain, but because I could no longer keep up with my 14 yr old son. That is the challenge. My decision was lifestyle, not pain based. OBTW, I even had Synvisc injected into my bad hip after the scope. It was awesome...for about a week.

[Miguelito]

To the OP,

One reason to not rush into surgery: before my first surgery I heard that it took until about six weeks post-surgery before you were in less pain than pre-surgery. The pain post-surgery is from (more or less) healing muscles, etc. that were cut, and tissues that were very badly bruised, replacing the pre-surgery arthritis pain (plus other stuff, in my case the pseudo-psiatic lower back, leg pain). I found this six week rule true in the case of my first surgery, but I was in tremendous, debilitating pain (at times) before my first, right hip surgery.

But my left hip was a different story. It was following the same path as the other, but was not yet nearly as painful. I am now at four weeks after my second HR, on my left hip, but I suspect I will not be in less pain, as compared to pre-surgery, until a point well after six weeks. Perhaps two-three months. Further, my restrictions pre-surgery were not too great. Golf was one of them, though, and that was important to me (as my escape).

If I reversed my surgeries, I know that I would be regretting having had the surgery on my left hip done "so soon". I had the second one done, on some level, as a preventative measure so that I would not experience the high-end pain I did with the first. If I had never had that high end pain I would regret having had this surgery so soon.

This is major surgery (though of course not as serious as many other problems, heart, cancer, MS, a million other things). It should not be rushed into. For several weeks of your life you will be essentially handicapped. Three, four, six, more, it varies. How much vacation you have is a factor. The recommended two weeks before you can return to a sedentary job is ridiculously optimistic. I couldn't sit in a kitchen/office type chair for more than three weeks. Having small kids is a factor. Mine are 1, 4, 5. If they were all two years older recovery would be less stressful (though my wife is fantastic and does virtually everything).

There are plenty of valid reasons to not rush into surgery. Sometimes they get under-represented on this site.

Mike