Introducing myself to the group

[Dennis]

Hello,

I'm located in California and am considering the hip resurfacing procedure as a fix for the worn cartillage in my right hip.  I've had an MRI about 1 1/2 years ago which revealed worn articular cartillage, torn labrum, and paralabral cysts.  Since then, I've been getting follow-up x-rays every 6 months.  I'm trying to put off any surgery as long as possible.  I know that the development of bone cysts, especially in the femoral neck, can be contra-indications for hip resurfacing.  The 6 month x-rays are to keep watch for the development of cysts, while I put off the surgery as long as possible.  The orthos who review the 6 month x-rays tell me that I am bone on bone and marvel how relatively pain free I am despite what the x-ray shows.

Prior to the discovery of the problems in the right hip, I had a severe attack of "sciatica" which left me, temporarily, with foot drop in the right foot.  The foot drop went away in a week or two, but the episode was frightening.  I had (and have) residual pain down the outside of the thigh, the outside of the calf, and ankle stiffness, all of which persist.

I had always been very active.  I had been a runner for nearly 40 years.  I was a mountain hiker, a skier, a water skier, etc.  I've had to give up running.

After the foot drop episode, I had an MRI of the lumbar spine which was followed by a transforaminal cortisone injection at L-4/L-5 area.  This gave me a few months of relief from the sciatica, during which I experienced a miniscal tear in the left knee.  This was repaired arthroscopically.  It is believed the miniscal tear resulted from the gait related to the right leg sciatica.

A month later, I had another extreme episode of sciatica and wound up on crutches for 3 or 4 days.

I believe that I can distinguish the discomfort generated by the two issues that I have described.  However, I wonder if they are related.  I wonder, if I went ahead with the hip resurfacing would the "sciatica" disappear?  I can make the sciatica symptoms go away, temporarily, by sustained stretching of the lower back.  Of course, it returns.  The hip pain comes on from remaining on my feet too long or carrying heavy objects.  Of course, I no longer run.  I now ride a bicycle for cardio training.

Can anyone out there share their experiences?  Have you had lower back issues and/or sciatica leg pain/tightness?  If you went ahead and had the hip resurfacing, did the back issues/sciatica go away?

I read about possible future therapies for hips with failed articular cartillage.  I read about possible injections into the hip joint, much like the injections that are commonly delivered into knee joints.  Does anyone have any information or contacts on this subject?  Does anyone know of clinical trials that are being conducted with this?

Has anyone had experience with Dr. Klapper, in the L.A. area?  Has anyone had him do hip arthroscopy as a means to put off or possibly avoid hip surgery?

Can anyone recommend a well-qualified "sports medicine" type of physician to consider my case and develop a strategy for dealing with the hip and lower back issues?

Can anyone recommend an experienced hip resurfacing surgeon, in California, that has performed your surgery or the surgery of persons that you know personally?

Currently, I am still functioning without any "pain" medication other than a once-daily Alleve.  This is not to say that I am pain free after taking the Alleve, because I am not.  I don't hesitate to bicycle for several miles.  I still will engage in an occasional moderate speed and moderate length day hike (5 or 6 miles).  I still am able to enjoy the snow ski season, although I do not bang the big bumps any longer.  Has anyone out there engaged in the same approach that I am taking?  In other words, so long as I am without heavy duty pain and so long as I don't develop serious bone cysts, I will put off the hip resurfacing surgery.

I would appreciate any comments from anyone out there.  Please respond with whatever information or personal stories you may be willing to share.

Thanks for your interest in reading this message.  I'd appreciate hearing from you.

Thanks,
Dennis

[Pat Walter]

Hi Dennis

Welcome to Hip Talk.

I had very bad attacks of siatica before my hip resurfacing.  One time it was so bad, I was on crutches for 10 days. I could only get out of bed to go to the bathroom. 

When you have a bone on bone hip, you leg length is not quite right and the rest of your body is trying to compensate for the bad hip. It is thrown off balance.  I use to live at the chiropractors prior to hip resurfacing.  I too had two kinds of pain that eventually I could tell the difference between.  The siatica made a certain terrible pain in my hip in addition to the OA.  I could only sit up in a chair at night and could not sleep even with the best of pain meds.

Dr. De Smet, my hip surgeon, feels that many back and knee problems will solve themselves after surgery.  Dr. De Smet of Belgium has done over 3000 hip resurfacings and over 3000 thrs. He is one of the best hip resurfacing surgeons in the whole world.

I had my hip resurfaced March 2006 when I was 61.  I had been very active during my early life ice skating 4 times a week, tennis, biking, etc.  Since I was 50 and had OA in my hip, my activities stopped one at a time until I sat in a chair and could not sleep at night.  I refused to have a THR, so did nothing until I learned about Hip Resurfacing.

I still have some siatica attacks, but less intense and fewer.  It takes your body a long time to try to get back to normal since it took years to get out of balance with the bad hip.

If you pain only requires an Allieve, it sounds as if you are still function well.  The real problem is all of us feel pain differently.  Some can have terrible hips and not hurt much, while others have less problem and hurt really bad.

You can miss your window of opportunity to have a hip resurfacing.  I would suggest the best approach would be to send Dr. De Smet of Belgium, Dr. Bose of India and Dr. Gross of SC an email with your x-rays attached digitally.  In a .jpg format.  If you only have real x-rays, you can take photos with a digital camera holding them up to a window or light. That's what I did. Both De Smet and Bose will give you a free consultation and let you know where you stand. 

A few other orths will too like Dr. Rubinstein in Illinois.  You need to find out from a really experienced hip resurfacing surgeon - one that has done many hundreds or thousands - whether you are a candidate.   A less experienced surgeon or one not doing hip resurfacing will not give you a good consultation.  Dr. Klapper has written a very old fashioned book with very outdated info.

The expreinces surgeons that have done thousands, will always give you a Hip resurfacing before a THR. 

If you are going to talk to Dr. Klapper you would be wise to read some of this info first - because he will give you statistics that are wrong.  You have to get written info from real medical studies about the current hip resurfacing since 1998 and he uses old info from hemi-resurfacing.  This is a good page http://www.surfacehippy.info/vmbhrhistoryinfo.php   Current statistics for the BHR just published at the Florida Ortho Conference Vicky Marlow went to.

Vicky is in CA and is having a get together for possible hippies in January.  If you are interested in meeting real people that have had hip resurfacing, I will give her your information.  Her friend, Cory Foulk, ran a marathon at 3 months and finished an Ironman at 6 months post op http://www.surfacehippy.info/coryfoulk.php   So did Michael finish an Ironman at 6 months post op  http://www.surfacehippy.info/michaelmontgomery.php

Here are all the athletes stories http://www.surfacehippy.info/athletes.php  and a hundred personal stories http://www.surfacehippy.info/hipstories.php

If you want to remain an athlete and stay active, make sure you learn all you can about hip resurfacing.  Don't let old fashioned doctors and untrained hip resurfacing doctors be your only source of information.

Please keep in touch.

Pat Webmaster/Owner Surface Hippy

[Dennis]

Pat,

Thanks for your message.

Yes, I would like you to give Vicky my information.  I would be interested in the January get together.

I have a consultation scheduled with Dr. Amstutz, in January.  I chose him because of your recommendation of surgeons with the most experience.  According to your stats, in California, he seems to have the most experience.  I did notice that you did not mention him in your message.  Reason being he prefers Conserve to BHR?

I have seen Dr. Michael Ries, at UCSF.  He says he has been to the UK for training on the BHR.  I don't know how many BHR's he has done.  He says that, although I have small cysts in the femoral head, since my pain level and activity level are still fairly normal, my personal preference to delay the surgery don't present a problem.  Your emphasis on choosing the most experienced surgeon has caused me to schedule the consult with Dr. Amstutz.

Your experience with sciatica was of great interest to me.  I would like to speak further with you about this.  Was it sciatica symptoms that caused you to see a physician first? 

Thanks,
Dennis

[Pat Walter]

Hi Dennis

I notifyed Vicky for you.  She has been to Dr. Bose in India for her hip resurfacing and most recently to the Florida Orthopedic Conference where she gathered info from Mr. McMinn, Treacy, Bose, Su, etc, etc.

She helps a lot of other people learn about hip resurfacing and holds a surface hippy meeting each year.

I did not mean to leave Dr. Amstutz out. He is by means one of the most experieneced hip resurfacing surgeons in the US.  I just normally give out De Smet, Bose and Gross in the begining because I know they do free consultations.  Then I normally just have a person look at my doctors list.

Many of the newer doctors are starting to get more experieneced which is good. In another year or so, we will have many experienced surgeons to choose from.

You have to really determine yourself what you want in a surgeon and who you feel comfortable with.  I am old fashioned and want experience. There are many people, however, quite willing to be the first, 10th or 50th hip resurfacing for a doctor.  If you look at the statistics, there is about a 6% revision rate.  So 6 out of 100 will have problems.  I guess that's not a bad statistic to gamble on.  I however, wanted to make sure I was not a statistic and went with experience.

I know Vicky will get back to you shortly.

My hip pain was the reason I went to an orthopedic about 10 years ago.  Then when they suggested a THR, I decided to try everything I could to keep from having one when I was 50 years old.  I went to the chiropractor and started treatments with corrections and light traction.  That helped me a great deal and made my pain much less in my hip - at least for sleeping at night. If I kept my back in good shape, my hip did not hurt as much in the begining. 

I had one cortisone shot in the hip capsule under x-ray. That helped for about 6 months or so.  Then I did not want to get another because steroids tend to destroy the joint.  So I went to Celebrex, etc.  that also long term destroys the joint.  I used Glucosimine and other herbs, added the copper bracelet and magnets. Did everything that was legal.  Eventually, nothing helped since my hip was bone on bone.

The doctor and ER call my back attacks siatica.  I have spasms that will drop me to my knees, put me in a cold sweat and get nauseated - right now.  It is terrible.  It happens when I tend to lean over to the right and reach.  I feel it immediately.  If I don't just go lay down for a day or two - it gets worse.

Several years ago I had it happen from brushing one of our dogs.  Went to bed and several days later started to get better - then had a sneezing spell.  That meant another several days in bed.  Then one of our dogs seemed to have an injured foot - I bent over and went down to the ground. It took 10 days of bed rest before I could stand and walk.  I was on 2 Vicodene, muscle relaxers and 4 ibupropen and still had terrible pain.  Worst thing I ever went thru in my life.  I used crutches to walk because my back could not hold my body up.

After my hip surgery, things have gotten better.   I had 2 bad attacks and my doctor friend gave me steroid shots in the L5 area.  That has helped.  I have degenerated discs, but don't know how bad at this point.  No insurance means no MRI just to take a look.  I am careful.

Massage, Chiropractor, water therapy and steroid shots all help. Not too happy with many more steroid shots, however.

I guess I have told you my whole back story now.

Pat





Keep in touch.

Pat

[Dennis]

Pat,

Thanks for your follow-up message. 

Have you heard or read anything about the efficacy of hip injections similar to the knee injections that are helpful with arthritic knee joints?  I have read something which suggested that  this will be the future treatment of choice for problem hips and it will eliminate the need even for resurfacing.  Do you know of any clinical trials being conducted on this approach?

Dennis

[Pat Walter]

I have heard about people trying the injections for the hip that are similar to the knee ones ( I am not talking about steroid shots).  From the posts I have read, most people said they did not help or did not help very long.

From what I understand, the hip joint is quite different than the knee joint. 

Again, this is not based on medical studies, only what I have read on the Yahoo Surface Hippy Discussion Group.

Trust me - if there were something less invasive than a BHR that would heal or cure OA or a bone on bone hip - we would know about it.  I have read about studies to regrow cartilage - but again, they are in their very early stages and I have not heard about any great results. I thought someone or two on the Yahoo Group were trying to be part of a study, but again, I have a difficult time remembering everything I read if there is not some printed material for reference.

Regrowing cartilage sounds like a great approach to me - but since it took over 10 years just to get the BHR approved in the US, I can imagine such new methods will take years and years to perfect and then get FDA approved.

Pat

[Vicky]

Hi Dennis,

You might want to try Dr. Gilbert in SF or Dr. Ure in Mt. Shasta for local surgeons.  I just sent you an evite to the hippy gathering.

Vicky