Question about when to get hip resurfacing done

[happyhopper]

Hi

Chucks, I would like to have got my muscle issues sorted out first and then seen if surgery was still required. 
Thanks, all, for the information on cortisone shots, I will update you if I receive any pain relief.  So, if I get no pain relief does it mean it is a muscle issue rather than a joint issue, or is no pain relief an indicator that the joint needs replacing?   Do you think there is any relevance that I have not noticed pain relief soon after the injection, whilst others seem to have had fairly early pain relief or are we all different.

[oldsoccerplayer]

I had my first cortisone shot as a diagnostic. When I described the various symptoms I was experiencing to my physiatrist, he said that if the shot worked, that would prove that they were being caused by the hip arthritis.
I would go back for another shot every 3 - 4 months to relieve the pain and delay the surgery until I got to a point where they no longer worked. With hindsight, I might have been better off having the surgery sooner but I made the decisions that were right for me at the time.

[chuckm]

Hey HappyHopper, to be of service to kpaulson98 who started this thread, it sounds like you firmly believe your surgeons misdiagnosed your hip pain and so you might have had unnecessary premature hip surgery. I don't think that is a reason for him not to get his hip resurfaced but it is just one more example of how important it is to educate yourself and then find the best surgeon you can. Your story of receiving misleading information and the rush to surgery is the first I have heard on this site so I didn't want to just ignore it. If fact, most of the stories are of surgeons urging patients to hold off.

On another subject, the cortisone shot, it seems on this site that it is almost always recommended before resorting to surgery. But, some get relief (temporary and of all different durations), some get no relief, and others actually get worse (my case). I had some pain relief but it ultimately it was allowing me a little more range of motion which just grinded the bone worse than ever so a couple of months down the road I was in real bad shape.

Chuckm

[Two4One]

Hello 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. - Miguelito

I agree with Miguel.

As your pain is not "more than an annoyance", I advise taking this breathing room to get a 2nd and 3rd opinion from surgeons.  I also would keep the fact that you sought a 2nd or 3rd opinion to yourself; that way you present yourself fresh and don't muddy the waters.  The nice thing is that many insurance carriers usually cover 2nd opinions.

While researching your Ortho surgeon Kpaul, look for the guy who's affiliated with your local leading medical research/Medical School University Hospital in the Tampa Metro Area that's the equivalent to a Mayo Clinic.  IMO, the #1 criteria is using a hip surgeon who uses ALL the implants in his practice vs. solely being a DePuy or a Smith & Nephew or a BioMet Guy, in other words, a respected independent.  Look for a CV like this guy's http://doctors.rush.edu/directory/profile.asp?setsize=10&pict_id=0002490.

Once you've done your 'homework', I think you'll be a lot more at ease - as much as anyone can be facing hip implant surgery.

All the Best To You,
2fer

[chuckm]

This thread is now really interesting. There are many out there like me who have undergone successful hip resurfacing surgery on one hip and are now faced with the task of managing the other hip as it deteriorates too. So this applies to all of us in that boat about when to get surgery on the other hip. And of course this applies just as much to someone on their first hip like kpaulson98.

An interesting thing. HappyHopper and 2fer, you are both reporting that you were misdiagnosed originally. And I think your points are to get opinions from other surgeons - at least ones who might be viewed as more "independent" from resurfacing or any device.

How did either of you conclude after getting resurfaced that you were misdiagnosed?
Was it a true misdiagnosis or was it a case where the surgery was ordered too soon and might have been more appropriate to wait for more severe symptoms?
Did your resurfacings turn out good?

Assuming that one has been correctly diagnosed and deemed a good candidate for resurfacing (let's assume someone did the impossible and consulted with McMinn, DeSmet, Su, and Gross) would there still be a reason to wait?

Chuckm

[Munch]

As you can see from my signature, I had both done last December. I am 53 but believe it or not I was first diagnosed with arthritis when I was 39.  At that point it mainly manifested itself in soreness after exercise and a marked limit to my range of motion.  I had little kids and a demanding desk job so I figured I'd just tend to those things and spare the hip from further decline.  My big mistake was that I stopped exercising for a while. This is of course bad for your health but really bad for the hip too. My range of motion got much worse and I couldn't walk 18 holes or play one set of doubles tennis.  First good thing I did was start to use a stationary bike on a regular basis which helped a little.  The huge and amazing change was when I took up swimming about 8 years ago.  That got me back into great shape aerobic ally and improved my range of motion and I started playing tennis again and was able to walk 18 holes.  It didn't cure anything and I still couldn't move very well on the tennis court but  it really did but me several more years that I am happy I took before surgery.  At age 52 my limp had gotten more severe and I was very slow on a tennis court and it was very hard to walk 18 holes.   Also if I was really active during the day it hurt at night and interfered with sleep.  Maybe I waited a couple of years too long but I have no regrets. Dr gross and his team and the hospital he uses were all everything I could have asked for.  I am now almost 4 months post surgery.  No limp, swimming since the 6 week mark, biking again ( and that's something I couldn't do at the end before surgery due to ROM issues) and can play golf as of the last few weeks.   

I guess my takeaway from all this is that here are ways to buy more time, and I have no regrets at having done that ( for me it meant getting to have resurfacing and with a doc with that much more experience) and when the time comes it is a great fix.  I have had no arthritis pain since surgery and the soft tissue just gets a bit better every day.  Also, for anyone trying to hold out on surgery, swimming is an incredible exercise to keep you in shape, keep as much ROM as possible, and stave off surgery. 

Good luck!

[Two4One]

How did either of you conclude after getting resurfaced that you were misdiagnosed? - chuckm

Thanks, chuckm, for pointing out my confusing tagline.  I'll fix that this afternoon!

What my tagline should reflect is that I had unnecessary labral tear surgeries and 2 years of my end stage OA misdiagnosed before my resurfacing.  My OA condition was rare and did not show up on X Rays and other test. 

I eventually had the correct diagnosis from The Top Ortho Surgeons in the country that I needed to either have a THR or a Resurfacing.  Today, my current issues with being allergic to Nickel would have likely caused ANY hip implant except maybe a custom Titanium to fail.

Let me be really clear; I think getting a second opinion when facing surgery of any kind is a good idea.  It costs nothing. 

[kpaulson98]

Wow.  Thanks everyone for the advice and sharing your experiences.   I just logged back in after a bit of time away, and I am amazed how much everyone contributed.  To be honest I needed to think about it (hip/surgery) without any input to really gauge how much or how little I have ignoring the pain, or altering my actions to avoid.  I have a mentally demanding job as well, so it makes the concept of being down very unpleasant to think about.   Has anyone with a resurfacing had to go for round 2 -- replace the resurface?  I think that is the one of the things that worries me most.  Going through this 2, 3, or even 4 times in my life.  Is there some sort of technology that if I can hold out, is going to make this a once in a lifetime replacement/resurface. 

To answer some of the questions: From x-ray and contrast MRIs, the diagnosis at this point is severe arthritis in left hip and mild in right, so definitely in the category of bone on bone grind on left.  I also seem to have an impingement which is a nub on the bone that is likely a partial cause to the problem.  I also had an injury in high school which was also a likely contributor.  I think the diagnosis is correct.  I am at the livable stage of pain, but I am amazed in how much I had changed my activities to accommodate or avoid the pain now that I admit it is there and real. 

I need to reprocess your many postings, and look up some of the details mentioned.  There is a little more than I can look at right now, but it is nice to know that I am not the only one going through this at my age.  For Dave and several others that mentioned Dr Ratterman at the FL Clinic, I have an appointment this week to speak with him as a surgeon and discuss timing, etc.  The initial ortho surgeon literally asked me to wait as he grabbed the display model for resurfacing and told me well this is the only solution to your problem.  He wasn't quite that blunt but you get the idea.  I don't mind the bluntness, but wished here are your options part of conversation would have been longer, and more detailed than get a really big bottle of Alieve.  This to be honest does not really seem to help much. 

Looking forward to Dr. Ratterman appointment and some more information.  I will post after I do the appointment.  So much thanks for the great information from folks on the site.

Keith

[Miguelito]

I think you asked a question, so...

I feel confident in saying that there is no current device or anything legitimately on the horizon that guarantees a one-time fix. That being said there are a lot of people hopeful that they take their first HR devices to the grave, but the history of these devices is short (I believe the new generation of devices came out somewhat less than 20 years ago), so projecting lifespans is just that, projecting.

Personally I think it somewhat likely that a relatively younger person such as myself (and yourself) will have to have the device replaced at some future, hopefully very distant point. Once I accepted that possibility, the point of waiting to have the surgery done kind of lost its luster (I am talking about my first hip, which was incredibly painful some of the time).

Best of luck at your appointment.

Mike

[LDG]

I'm also from the Tampa area and Dr. Stephen Raterman has done both of my hips.  Get a doctor that you are comfortable with and for me that was Dr. Raterman.

I concur with what most have written in that you will know when it's time for the surgery.  For me it came after my first cortisone shot wore off and I felt the debilitating effects of the hip again.

After having a pain-free 60 days I was unwilling to live with the pain any longer.  Best decision of my life.