Should I wait til I have severe pain? Or do it now and get back to living.......

[badbone]

I cant thank thank the forum members enough for all of their support and for Pat, for starting this site.  Such a wealth of information for us to feed upon.

Background:

50 yr male
great shape (except for bad hip)
2 scopes
labrum tear/FAI


I have my good days and my bad days.  Some days I am pain free and others require 2 Aleve and rest.  I become very stiff after sitting for extended periods of time (movies, etc) and limp after getting up due to the stiffness and limited ROM until my joint loosens up due to activity (walking) Pain sometimes resides or not.

I know its a personal decision based upon individual pain thresholds and goals, but what ultimately drove you to have surgery.?

I am 50 years old, and still very active.  I cant run (longer than 1 miles) of course or play tennis due to the onset of pain and limited ROM.  But I can walk pretty much pain free unless my hip catches  (I am bone on bone in some areas) within the socket and gives me a twinge.  Then I will go into limp mode and hobble for a bit. Take 2 Aleve and I am back to normal pain wise, but that doesn't address my limited ROM or the inability to participate in active sports  (tennis, run, hoops, snow ski)   Again, some days are better than others.

My point is this.   I am SCARED to death at the alternative.  I know I will need this surgery down the road.  My question is this....DO I wait until I CAN'T tolerate the pain  to get it done? Or get it done now before me pain becomes intolerable?

CONCERNS
-how long will the implant last?
-converting to a THR and really being limited with activity
-complications during surgery  (no gurantees)- I have been told I am an excellent candidate by 2 well known surgeons

Or if I delay the surgery til I absolutely CANT move due to pain and lack of ROM, then I am forced to get it done, and by waiting I have effectively;

-extended my time with a BHR and thus extending its life span by having it implanted later in life


So my biggest fears are...limited life span with a BHR and converting over  to a THR.

Does anyone make a revision for the BHR so you don't have to get a THR?

Help put my fears to rest.

Sorry for ranting....just nervous about surgery.

[chuckm]

Badbone, you should do it now. If you can't do things anymore that you would like to do then find a great surgeon and fix this. The BHR's are coming up on 20 years and they aren't falling apart or wearing out.

If you get this done you can go back to tennis. And I don't mean play a little, you can train for it and go all out.  I pound on my BHR several times a week playing soccer and it NEVER hurts anymore. Last night I was running wind sprints to keep my conditioning for soccer.


Most of the problems that ever crop up with resurfacing invariably go back to using an inexperienced surgeon who didn't line the thing up right from the get go. That's why you MUST pick a real good surgeon who can align the parts perfectly.

The longer you wait the and the more severe your limping becomes will directly affect how long it will take for your body to straighten itself out after the hip is fixed. A lot of the soft tissues will not totally recover unless you work at it and the more your body has changed and adapted to accommodate the bad hip the more work it is to get back to normal.

And the strange thing is you have NO IDEA how crooked your muscles are until after the hip is fixed.

After reading that good surgeons have already said you are a good candidate that you should just do it. Get back to normal.

Chuckm

[JHippy]

An HR cannot be revised to another HR (on the femoral side) because it's impossible to remove the implant (on the femoral side; the head) without removing the bone. Most of the time if you need a revision because a problem on the femoral side, it's the bone anyway. On the acetabular side (the socket) it's technically possible to revise that without also revising the femoral side but that's very controversial. So basically a failed HR leads to a primary THR.

I think most people, in hindsight, will say they wish they had done it sooner (myself included). It's a very personal decision though. Rather than repeat myself, check out this post I wrote here: http://surfacehippy.info/hiptalk/index.php?topic=5628.0

[karlos.bell]

 :)
Bad Bone Hi.
Lots of hips can have bone on bone and still work. But it seems to be when there is gaps and the fluid has to take up the slack then that becomes inflamed is an issue. My hips example were never bone on bone actually I had 3/4 cartilage on the left and half on the right. It depends on a lot of congenital factors as well. We are not all the same. So after having the so called FAI diagnosis and 2 scopes and a rebuild, rebore it made it worse Yep worse...... So after 7 years on crutches I bit the bullet and had them replaced due mainly I had injury to them as well as FAI. Things like the shoulders suffered and the right shoulder  now after seven years I slept on it last night without pain, the rear end muscles wasted away to very little as I could not use my butt well. So you end up with muscle imbalance if you wait too long. I am now just able to squat. Things like after 7 years now I can just lift my leg to brake from the accelerator. Your hips from now may never get any worse.
They may stay the same until you get real old or you could look at getting it sorted. Either way its your decision on surgeon and or type of device.
The resurfacing seems to be new idea in terms of medical stuff even though it has been around along time. Have to trust a surgeon I suppose, mine said it could last the rest of my life with that option I am now walking without crutches- limp and getting to enjoy life. I can't wait to see what the next year is like to get some more Mo Jo back will be awesome.
Would I like to go back to my old hip joints at this point, Nope not at all.
Good luck with your choice and maybe time will make your decision for you.
Cheers K

[karlos.bell]

;) Hi again bad bone.
Yep just read Chuckm reply.
Hes pretty right just your choice at the end of the day.
Surgery has to be your choice but he well onto it about it all.
Good luck...K

[blinky]

My sports med guy, never one to push you into a decision, said "you have enough OA that any insurance company would cover THR" and "you are in the best shape right now that you will be in to have surgery." He finished by asking me "can you do the things you want to do? Is your everyday life affected by your OA? When you feel like your life is shrinking in an unacceptable way, it is time to act."


When he asked me that, I believed I was in pretty good shape, more good days than bad, not able to run anymore, but I could do anything else I wanted to do.


But I started paying attention to my everyday life. I realized that I wasn't going upstairs in my house every day. The bedroom is on the first floor, so I didn't have to. I could yell at kids and pets to come down if I needed them. I wasn't picking up the mail, located about a block away at a central mailbox. I was waiting until I was driving that way to check the mail. The OA was limiting me. I began to think  about surgery.


When I sent my X-rays out for review by surgeons, I learned I had a lot of cysts, and my days for choosing resurfacing were numbered. My pain wasn't that great, I could take some Advil and pace myself through the day, but time was running out.


So I made the choice.


I understand your concern about the device wearing out. I am worried about that, too. Some people have had outstanding results and kept theirs for more than a decade, others not so long. But I see the same pattern with THR. The new ones are lasting longer and people are keeping them more years, but some people need a revision sooner. Stuck in my head is the conventional wisdom that a hip replacement lasts about ten-fifteen years, less in a young, active person. Because of that, I am assuming I will need a revision sometime in my life, assuming I live another thirty years.  I decided to go with HR because 1) I will have more bone left for the revision and 2) I can have a more active, unrestricted life for the next ten-fifteen years. I am hoping I will die decades from now with the HR still in me, but I am prepared for it not to happen. It is the best choice for me; I am comfortable with it.


Other factors besides your pain and activity levels to consider would be family, work, insurance, finances, and time delay in scheduling the surgery (the three month wait to get in).


In summary:


If I waited until the pain was unbearable, I would have waited too long. My pain tolerance is too high. You may be in the same situation; monitor your condition. Meanwhile, my world is shrinking.


If this HR lasts ten-fifteen years, I will be older and slower and more ready to swim/bike for fitness if I end up with a revision.


I guess the other complications, the really life threatening ones, don't scare me. I am in good shape, as are you. I picked a great surgeon with very very few serious complications. If I wait and do this when I'm older and less fit, I am just gong to be more vulnerable to those complications. (Ironically, I just visited a coworker who had THR. She is a decade older,  not in great shape and has suffered both blood loss and pneumonia. I am sure she will bounce back and find a new normal, but she will have a much harder time.)


Good luck whatever you choose.

[blinky]

Read Jhippy's post.


The only thing I would add would be the mental side of it, and he covers that.

[Slinkycarrot]

I think it is better to go for it rather than wait on the basis of 1) quality of life, 2) if you wait you will be deconditioned and all your muscles will go out of whack making it a much harder and longer rehab. 


Ive had problems for a few years and my knees are having a lot of problems now. I dont have bad OA but like you have had failed scopes and am still in pain (but more severe than you).  Im due for the op in 2 months and can't wait. 


good luck!

[Crazylegs]

badbone - one year ago i was EXACTLY in your shoes.  I was told i had bad arthritis in both hips when i was 42 (3 years ago).    i was still very active (played men's ice hockey once a week, ran a few miles a week, skied, played sports with my kids, etc).  No debilitating pain, but ability to have fun playing sports was starting to be impacted.


I had the exact same worries and concerns as you: is it bad enough to warrant surgery? should i wait until it get's worse? will it last long enough? am i underestimating the downsides?  On top of that, i'm what you would call a p-ssy when it comes to anything medical related. i can barely give a vial of blood without getting lightheaded.  i was almost paralyzed by the fact that while my surgeon said i should get it done, i was basically still able to do all the sports and activities i liked to do, including ice hockey (albeit limited to once a month) and skiing (in fact i went away on a 3 day ski trip a few days before my surgery date). how could i justify surgery if i could still be that active relatively pain free?  my worst fear was, if the surgery was unsuccessful, i would be worse off than i was before the surgery.

many people on this site say "you'll know when it's time".  i can tell you that i literally had doubts until the moment i was rolled into the operating room.  but here's why i ultimately decided to get it when i did: i was going to have to get it done within a few years anyway - why live 2-3 years with a lower quality of life than i had to?  i wanted to get back to doing all the things i liked to do without discomfort.

i'm 7 months post surgery.  i played ice hockey for the first time in 8 months last week.  i just got back from playing soccer with my 10-year old. for me, i can say, "so far, so good".  but honestly, i won't know if it was the right decision for at least a few more years.

the reason why i'm writing this post is to give you an example of someone who had severe doubts and worries up until the moment i was put under. not sure if that's helpful to you or not, but i figured i'd share my story in case it was.

[karlos.bell]

Crazy legs cool name... so is Bad Bone... george thorogood?  yep I had same thoughts I was crazy too. Hunting a week before I went off to Belgium. But I was all strapped up. The strapping and braces changed my life from a cripple to some one that could walk like a fish. I wish I could take back those years to the age of 41 when it all happened but I cannot. I am now 49 So if I had my choice again I would do it sooner. Hell man if these things last like they should 20 years...etc... of fun is a long time and a lot can happen in 20 years.... Cheers K

[MattJersey]

I was in a similar place, probably a little worse. Was getting fed up with golf and finding sports limited. Couldn't run, rowing was starting to cause pain in my calves and back. Find cycling a little boring.


I wa also getting up several times a night. I thought it was to pee, but when I started taking painkillers after a round of golf, I noticed that I slept much better. Then I connected the dots and realised it was the hip discomfort affecting my sleep, and when I woke I would go for pee (not the other way around).


And finally, my sister was diagnosed with cervical cancer (2b), scan in Oct to hopefully show all clear, and another friend, only a couple of years older, and absolutely set in life (great kids, family, career, friends etc) had a turn at work, and 8 months later was dead from a brain tumour.


So I concluded amid that backdrop: the next 10-15 years are my most important ones, and if I only get 10 years out of my hip, then it will have been worth it.


It sounds to me like you're ready, but only you can decide. There are risks. I found myself, eventually, content that if I woke up and had THR instead, I wouldn't be upset.  There are other risks, but I was happy with statistics on those.

[badbone]

Thank you for everyone's feedback. I very much appreciate the time and effort to those who responded both publicly and privately. Your personal insight has opened my eyes to new perspectives and I thank you!


Has anyone been quoted best case scenario for the life expectancy of the BHR?


Thanks

[karlos.bell]

Yep Bad Bone.
Best case scenario from Dr De Smet as I have said is the rest of my life. I am 49 at 20 years of age if installed correctly these things at 20 years are looking like the day the are installed. So they really do not know how long they will last. Could be real long. Cheers K

[chuckm]

Badbone, the biggest reason a hip prosthesis has late-term failure is osteolysis. That is when the bones around the device begin to dissolve or be resorbed by the body due to a reaction. That reaction is usually because the body no longer tolerates the wear debris piled up from the device then it loosens from the bone. This is typical of devices that use polyethylene. The body cannot deal with those wear particles so they accumulate around the device. Naturally the less active you are with those devices the longer they last. New polyethylene is showing far less wear and so those are expected to last much longer.

A BHR does not use polyethylene, just metal against metal. The BHR has a run-in period for a few years where it self polishes its own surfaces. They are already incredibly polished but after millions of cycles they smooth out even more. Once it reaches that point, the wear particles are so small they are removed from the body through the blood and excreted so there is no accumulation around the device. Long term failure due to osteolysis caused by wear debris theoretically will not happen - and hasn't been happening so far.

Another potential reason for late term failures was the cemented femoral component might come loose because that was a big reason for failures in other resurfacing devices in the past. But the BHR used a different method to cement the component than earlier devices. The fact is they were not coming loose and the oldest implanted BHR's are still not coming loose.

Both in theory and statistically (nearly 20 years of stats) the BHR is quite durable. 

Chuckm

[blinky]

That is the million dollar question, Badbone.


As chuckm noted, you could keep your HR device your entire life with no revision. I think HR doctors are cautious about overpromising, however, after almost two decades of experience and seeing what really happens (bad placements by inexperienced surgeons, recalled devices, MoM scare, etc).


FWIW there are THR surgeons and manufacturers who will promise you a a lifetime of wear. There is a lot of confidence in the latest generation of THR devices. I had one OS tell me I could run, do yoga, anything I wanted, and my THR would last me years, maybe forever. There is a new device called the "Forever Hip." Chat on some joint replacement forums is quite optimistic about the durability of new THR devices, too.


But do I believe the hype? No.


I think there is the potential for the new THR devices to last a person's lifetime. I think there is the potential for my soon to be placed HR to last the rest of my life! But I also think there may be some as yet undiscovered problem with the new THR devices, and, more importantly, I think that as dynamic, unique biological creatures, unpredictable events can happen that can shorten the life of an implant.


Two examples: first, a few years ago, there was a popular THR device that had three pieces (I am oversimplifying). The cup, the spike, and the head. It sounded like a brilliant idea. The separate spike and head would move more like a real hip, and the head could be changed out. However, turned out there was corrosion between the spike and the head, so the device was a dud.


Second, not hip related. My mom had a bladder sling put in almost thirty years ago. She loved it. That thing did exactly what it was supposed to do and she felt great for almost 25 years.Then a piece of bowel got pinched by the sling, a completely freakish and unanticipated  occurrence 25 years ago. She could have died. But she didn't; the problem was found and quickly corrected. In her case no one made a mistake, she was just  a dynamic, biological creature, and the situation changed.  To make it hip related, I suppose I could get my HR (or THR) and then fifteen years from now be diagnosed with cancer and receive some sort of cancer treatment that will cause my implant to loosen.


Bottom line for me: HR has been around long enough to be well understood. There are risks. There may be long term risks (20 years plus) that have not yet surfaced. Unusual events may happen to me that at this point are unforeseen that will cause my implant to fail. I look at all the information I have available to me now, and make the best decision I can.

[Debcoco]

Blinky,
Where are you going for the HR?
debcoco

[blinky]

Dr Gross.


I guess I am a good example of quieting the doubts because I can't wait. I am ready to be done and in recovery mode.

[livendive]

46 year old male here, pretty active, and had both hips resurfaced this year.  I put it off for a long time...too long really, the last year was totally miserable and things didn't happen in a hurry just because I finally decided it was time. With 7/9 months on my new hips, my only regret is not having done them a year or two earlier.  These things are awesome! :-D

[Coquí]

Badbone, I can identify myself with your feelings. I am 36 year old male, with Avn on left hip. I am schedule to have my left hip resurface by Dr. Gross next Nov 18. Because of my age, I am always asking if my decision to do this procedure now is the correct one. In preparation for the resurface I have been training the last three months a minimun of three days a week with a personal trainer. The exercises had really help me feel a lot better, including not having any pain at all on my hip the last month and a half. Prior to working out with the trainer, I havent done any exercises  for the last 6 years, trying to protect my hip and extend the need for a surgery. Sometimes I wonder if the exercises is helping me with the AVN and if I should cancel my resurface for later on....then I remember the days that I havent been able to put my socks bacause of pain, or play freely with my kids....these thoughts are the ones that help me continue going forward with resurface,with the hope that after recovering from it, I will be able to gain back a pain free life for more than a month and a half....